Lansing— The historic launch of health insurance exchanges in Michigan and across the country on Tuesday will set in motion sweeping health care reforms, even as tensions over Obamacare escalate in Washington.
Beginning that day, Michiganians will be able to log onto www.healthcare.gov to price-shop for low-cost health insurance plans. The Internet-based marketplace is a key component of the Affordable Care Act, which requires virtually all Americans to carry health insurance by Jan. 1.
Insurance purchased on the exchanges — as well as employer-paid health plans — will include free preventive care and must provide certain “essential health benefits,” including mental health care, substance abuse treatment, hospitalization and prescription drugs, as well as dental care for children.
An estimated 90 percent of uninsured Americans will qualify for federal subsidies to buy insurance on the exchange, according to the Congressional Budget Office. Those with incomes from 100 percent to 400 percent of the poverty level — $11,490 to $45,960 for an individual, or $23,550 to $94,200 for a family of four — are eligible for premium subsidies.
“Passage of the Affordable Care Act represented the biggest change to health coverage since the Medicare Act nearly 50 years ago ... and the opening of the marketplace signals that,” said Daniel J. Loepp, president and CEO of Blue Cross Blue Shield of Michigan. “The way health care is defined, delivered, purchased and paid for is being revolutionized.”
The beginning of open enrollment Tuesday coincides with a deadline for Congress to approve a budget bill or risk a government shutdown. A faction of House Republicans is pushing a spending plan that cuts funding for the Affordable Care Act. There’s little chance the measure will succeed, but the showdown has added another layer of uncertainty to the law.
“They would have to repeal the law, that’s how a democracy works,” said Peter Hammer, a Wayne State University law professor and an expert on health law and health policy. “They would have to have two houses of Congress and get the president to sign it, and they just can’t do that.
“This is all just kabuki theater and bad politics, and has absolutely no substantive impact on the health care law. (But) misperception is dangerous because it undermines the integrity of the law and creates artificial barriers for people getting access to health care who are currently uninsured.”
'Marketplace will be open'
David Simas, special assistant to President Barack Obama, said Wednesday the health care law will go into effect Tuesday regardless of whether Congress passes or fails to pass a budget in the coming days.
“The marketplace will be open if there is a government shutdown or not,” Simas told reporters during a White House briefing. Consumers will be able to sign up for health care, and call centers will be staffed if consumers have questions, he said.
Debate over the law has raged in Michigan, where many Republicans in the GOP-controlled Legislature opposed Medicaid expansion. The state this month became the 25th to expand Medicaid coverage, after eight Republican senators broke with their party to push the bill through. The expansion will add 320,000 Michiganians to the government health insurance program in 2014 and upwards of 470,000 by 2021.
Republican lawmakers, who control the Michigan’s Legislature, were divided on whether the state should run its own federally mandated health insurance exchange or leave that to the U.S. government. Gov. Rick Snyder supported a state-run exchange, but the Legislature voted that down. As a result, Michigan’s health insurance exchange is run by the federal government.
States that decided to run their own exchanges received billions of federal dollars to explain them to the public, and some have developed highly creative mass-media campaigns involving billboards, TV and radio advertising. The Oregon exchange, for example, has its own folksy-sounding song, and Minnesota’s campaign has a Paul Bunyan and Babe the Blue Ox theme. Michigan turned down about $21 million that could have been used to promote the exchange.
“People aren’t well-informed,” said Don Hazaert, executive director of Michigan Consumers for Healthcare. “Most people have no clue that they’re eligible for additional coverage.”
Hazaert’s organization, Michigan Consumers for Health Care, is among four groups chosen by the U.S. Department of Health and Human Services to help Michiganians navigate the new health care system.
The others are Community Bridges Management, the Arab Community Center for Economic & Social Services and American Indian Health and Family Services of Southeastern Michigan.
Navigation help offered
These “navigator” organizations are charged with answering citizens’ questions about the health exchanges, and helping them to select a plan or apply for a subsidy. They are required to be free of conflicts of interest, such as special relationships with insurance companies. Michigan Consumers for Healthcare is the only statewide organization among the four, and will run a network of 250 health care counselors throughout Michigan to provide one-on-one assistance to consumers. A list of navigators will be available online Tuesday at enrollmichigan.com.
In addition to “navigators,” there will also be “certified application counselors.” These are people from nonprofits, churches, hospitals and other organizations who participated in a five-hour training course. Unlike the navigators, they are allowed to work on behalf of a hospital, insurance company or other vested interest, as long as they inform consumers.
“If a hospital is having their employees trained,” Hazaert said, “very often they have special relationships with insurance companies, and they are required by law to reveal they have a conflict of interest.”
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