Officials work to clear confusion on new health care law

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Jim Leute
Thursday, September 5, 2013

JANESVILLE—Just weeks before enrollment begins in the centerpiece of the nation's Affordable Care Act, Wisconsin officials are canvassing the state to try and clear confusion among insurers, employers and individuals who face significant health care decisions.

Town hall meetings kicked off statewide this week, and top state officials are meeting with newspaper editorial boards. Their message: Now is the time to successfully implement—not debate—the legislation known to some as Obamacare.

Most consumers in the individual market will have one opportunity a year to buy coverage. The initial open enrollment period runs from Oct. 1 through March 31, but for insurance coverage to start Jan. 1, it must be signed up for and the first premium paid by Dec. 15.

“The ACA is just like any other piece of legislation, whether state or federal, and it's our job to regulate it,” Wisconsin Insurance Commissioner Ted Nickel said Thursday in a meeting with The Gazette's editorial board. “Our job is to make sure the carriers know the lay of the land, and, second and perhaps more important, make sure consumers know what they will be facing.”

Nickel was joined in Janesville by Kitty Rhoades, secretary of the Wisconsin Department of Health Services; Kevin Moore, her department's deputy secretary; and Dan Schwartzer, deputy insurance commissioner.

All four agreed slick advertising campaigns and meetings with newspaper editorial boards are not the best way to reach many of the people most affected by the new law—those near the federal poverty level who typically don't subscribe to newspapers or attend town hall meetings.

“Getting the word out is certainly a challenge,” said Rhodes, a former lawmaker from Hudson who knows the value of door-to-door campaigning. “The feds spent hundreds of millions of dollars advertising (Medicare) Part D changes, but most people got their information from their pharmacists.

“People go to people they trust.”

That's why one part of the state's outreach strategy is patterned after an effort underway in Milwaukee. It's a regional enrollment network that provides application and enrollment assistance through an extensive network of grassroots organizations.

The plan is for 12 regional enrollment networks. In one, Rock County will join Jefferson, Green, Lafayette, Iowa, Grant and Crawford counties.

The idea, Moore said, is that each community knows itself best. The goal is to infiltrate local advocacy groups, food pantries, free clinics, homeless centers and the like with trained and licensed counselors who can guide people through the enrollment process.

“We need to go to the individual where they touch the system rather than through a global network,” Rhoades said.

Beginning Jan. 1, federal law will require most individuals to have health insurance, either through an employer, from an insurer on the open market or through a health insurance exchange in each state.

The exchanges will offer small businesses, individuals and families a choice of private health plans, similar to what workers at major companies get, with tax credits and subsidies for low-income consumers. 

About 500,000 people in Wisconsin are expected to shop for coverage through the exchange, including about 92,000 currently on Medicaid who will be losing their coverage in January and 400,000 who have no insurance. Those who don't buy insurance will pay a penalty on their federal income tax return

In Wisconsin, 13 companies—including MercyCare and Dean Health Plan—plan to sell insurance through the exchange.

Individuals can retain insurance coverage through employers if the employer continues to offer it as a benefit. If an employer offers coverage to full-time employees, it must offer coverage to people working at least 30 hours per week or face a penalty of $100 per day per member.

Employers with fewer than 50 full-time equivalent employees are not required to offer health insurance.

The law also creates employer requirements that have been delayed until 2015, Schwartzer said, noting the delay is not statutory and could change without notice.

The mandate requires employers with 50 or more employees who work the equivalent of 30 or more hours a week to offer affordable health insurance. Not doing so will result in a penalty of $2,000 per employee, although the law allows the company to exempt the first 30 workers.

Another portion of the mandate requires that larger employers offer “affordable coverage,” which translates into an employee premium of no more than 9.5 percent of his or her income. If the premium charge to an employee is deemed unaffordable and the employee accesses subsidized coverage through the exchange, the employer will be penalized $3,000.

Specifics details and rates associated with exchange plans will be made public nearer the Oct. 1 open enrollment, Schwartzer said.

Consumers, he said, should use the exchange website as one tool.

“There will be more plans available outside of the exchange than inside the exchange,” he said. “People need to shop everything and then add the exchange as an alternative resource.”

Certified and licensed navigators and application counselors also will be available to help individuals navigate the site and understand options.

They will not, however, be allowed to give buying advice, he said, noting that advice can come only from licensed insurance agents.

Schwartzer also cautions people about door-to-door solicitations and offers of help with insurance decisions. State officials, he said, are concerned that those connections often will end in identity theft.

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