A standing-room-only crowd gathered on Wednesday at Kalispell Regional Medical Center to listen to a presentation on the new federal health care law and how the new regulations could affect them.
Montana Insurance Commissioner Monica Lindeen presented an overview of the Affordable Care Act, commonly referred to as Obamacare, at a KRMC conference room on Oct. 2, garnering a crowd of a couple hundred attendees.
The Kalispell town hall meeting was the sixth in Lindeen’s tour of the state’s major cities to discuss the health care law.
As the state’s insurance commissioner, Lindeen’s office is responsible for regulating the insurance and securities industries in Montana. She told the crowd that regardless of what she or any other state insurance commissioner might think of the new law, they have the legal responsibility to regulate the health care insurance industry, and the ACA is bringing about major changes.
The ACA was signed into law in 2010, and largely upheld by the U.S. Supreme Court in 2012. Despite the federal government shutdown connected to U.S. House Republicans seeking to defund the new law, the health insurance exchanges opened Oct. 1. The exchanges are marketplaces for uninsured people to buy insurance from private companies.
Those companies are currently Blue Cross and Blue Shield, PacificSource, and the Montana Health Co-op. Other companies are choosing to sit out the first year of implementation, Lindeen said, or are participating in states with larger populations than Montana.
Coverage purchased before Dec. 15 will take effect on Jan. 1, 2014. Federal government subsidies, through up-front tax credits, will be given to people earning less than 400 percent of the federal poverty level.
Lindeen said the state estimates about 195,000 Montanans are uninsured. She went over the basics of how the law has changed requirements for insurance companies, such as private companies no longer being able to deny coverage for preexisting conditions, and focused on how Montana is implementing Obamacare.
Part of the law requires insurance companies to cover the 10 essential health care benefits, Lindeen said. These include doctor’s office visits, hospitalization and surgery, prescription drugs, maternity and newborn services, mental health, lab work and imaging and dental and vision care for children.
“Almost all of the 10 essential health benefits are already mandated in Montana state law,” Lindeen told the crowd.
As a result, Montana didn’t see the “sticker shock” in higher insurance rates that other states did, she said.
When the new online marketplaces opened on Oct. 1, many people reported problems accessing the system. The federal government built Montana’s online marketplace, as per the state Legislature’s directive, Lindeen said. States that relied on the federal sites saw similar site crashes that Montana did.
“When you have a million people trying to go online at once, servers tend to crash,” Lindeen said.
In an interview following her presentation, Lindeen said her main advice to Montanans trying to purchase health insurance through the marketplace is to take their time, because the coverage won’t start until January anyway.
Lindeen warned that the individual mandate – possibly the most controversial piece of the law – requires individuals to have health insurance or face a penalty. That penalty is $95 per adult and $47.50 per child in 2014; $325 per adult and $162.50 per child in 2015; and $695 per adult and $347.50 per child in 2016 and beyond.
There are exemptions to the mandate, including families for whom health insurance would cost more than 8 percent of their income or those whose income is under the threshold for filing income taxes.
Lindeen also warned against fraud and scams growing around the new law. There are websites popping up claiming to be health insurance marketplaces, she said, but any site that doesn’t end in .gov is not real. The real site is www.healthcare.gov.
There are also scammers targeting Medicare consumers, calling and saying they need new Medicare cards and numbers. There are no changes to Medicare, Lindeen said, and these scammers are just mining for personal information.
Montanans covered by Medicare are considered covered by insurance as far as the federal government is concerned, Lindeen said, and there is no need for these residents to purchase new insurance to satisfy the individual mandate.
For information on fraud and scams, visit the insurance commissioner’s website at www.csi.mt.gov or call 1-800-332-6148.
Lindeen touched on the Montana Legislature’s decision not to expand Medicaid in the state, noting that 50,000 people will still be uninsured and won’t qualify for tax credits. These people will likely go to the emergency room and be written off as charity for the hospitals, she said.
“It means you and I are going to pick up the tab for that,” Lindeen said.
The state Legislature’s 2013 law allowing Lindeen’s office to review insurance rates is already paying off, she told the crowd; one national insurance company decreased its rates by 66 percent after her office filed objections, she said, and a state company dropped its rates by 7 percent.
“It’s already working,” Lindeen said.
Lindeen and Christina Goe, general counsel for the commissioner’s office, took questions from the public after the presentation. The questions ranged from confusion about individual situations to requirements for small businesses.
Lindeen said she thought the meeting was productive, and that every one of the town hall gatherings in her tour of the state were standing-room only.
For more information on the Affordable Care Act as it relates to Montanans, including insurance rates from the companies involved in the new marketplace, visit www.montanahealthanswers.com.