Key de­ci­sions loom on health care; many choices con­fus­ing

The Covington News - - OPINION -

We are about to ex­pe­ri­ence the big­gest change in the health care his­tory of our na­tion.

Time is quickly ap­proach­ing for the open­ing en­roll­ment day of the new Pa­tient Pro­tec­tion and Af­ford­able Care Act, also called “Oba­macare,” that may very well mark the most im­por­tant day in your health cov­er­age his­tory.

Iron­i­cally, it is es­ti­mated that less than half of Amer­i­cans have any de­gree of sig­nif­i­cant un­der­stand­ing of how the PPAAC Act is go­ing to work and how it will af­fect them. This bill now en­com­passes more than 22,000 pages with more changes hap­pen­ing ev­ery day. No won­der it is baf­fling for so many.

The PPAAC was a con­gres­sional bill that was signed into ef­fect March 2010 amid heavy op­po­si­tion and de­bate, which still con­tin­ues to some de­gree to­day.

This bill was in­tended to broaden the reach of health care to pri­mar­ily those who were pre­vi­ously deemed “unin­sur­able” be­cause of health af­flic­tions.

It was also to help pro­vide health care cov­er­age to some 41 mil­lion in­di­vid­u­als to­day (1.8 mil­lion in Ge­or­gia) who could not af­ford costly pre­mi­ums.

This would be achieved by broad­en­ing Med­i­caid and by of­fer­ing Fed­eral govern­ment sub­si­dies to help on pre­mium costs to those at or be­low four times the poverty level.

Ge­or­gia is one of the 14 states that has de­cided not to broaden its Med­i­caid base.

Cer­tain key “es­sen­tial ele­ments” of cov­er­age would be in plans of­fered through the ex­change. There will be four ba­sic “metal­lic plans” avail­able with vary­ing pre­mi­ums and cov­er­age.

Th­ese man­dated ele­ments would also be re- quired for em­ployer’s cov­er­age as well and will come un­der Fed­eral scru­tiny for proper im­ple­men­ta­tion.

Those busi­nesses em­ploy­ing more than 50 em­ploy­ees will be re­quired to of­fer this cov­er­age or face a $2,000 penalty for each em­ployee (less the first 30).

Most in­di­vid­u­als’ cur­rent ma­jor med­i­cal plans do not meet all the Fed­eral re­quired qual­i­fi­ca­tions for cov­er­age. Be­cause of this, many will re­ceive let­ters in the mail this fall stat­ing that their cov­er­age will be ter­mi­nated at the end of the year.

Only those plans in force prior to the sign­ing of the bill, March 2010 will be grand­fa­thered.

The Fed­eral cov­er­age ex­change plans are be­ing out­sourced to var­i­ous in­sur­ance com­pa­nies that have sub­mit­ted bids for plans in the states they wish to par­tic­i­pate as an of­fered car­rier.

Ge­o­graphic dis­trict ar­eas will be set up through­out the states in or­der to ad­just pre­mium charges for the more ex­pen­sive health care ar­eas — for ex­am­ple, ru­ral or in­ner city.

Fund­ing for this health in­cen­tive will come from sev­eral sources of var­i­ous taxes and fore­casted Medi­care cuts over the next 10 years. It will be in­ter­est­ing to see all the ram­i­fi­ca­tions of this health care re­form im­ple­men­ta­tion. Sheri­dan & As­so­ciates will be hold­ing free ed­u­ca­tional sem­i­nar meet­ings to help you un­der­stand how PPACA works and how it will im­pact your life.


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