The complexities of the exchange

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MENDIOLA

 
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It’s been a tall order. The new Idaho Health Insurance Exchange’s 19 board members were given only 4½ months to launch an enrollment period in compliance with the Patient Protection and Affordable Care Act, commonly known as “Obamacare,” which officially takes effect on Jan. 1, 2014.

Idaho is getting late into the game. Most other states have been working out details for more than two years to comply with the mandate by either joining the federal exchange or creating their own exchanges. Insurance companies argued strongly in favor of an Idaho-based exchange.

All Idahoans 18 and older will have six months to enroll (from Oct. 1, 2013, through March 31, 2014) and choose among 79 plans from five insurance carriers to get mandatory health care insurance. If they don’t enroll, they face penalties. The exchange covers all 44 Idaho counties.

How Idaho would comply with Obamacare turned into one of the most bitterly debated issues in the final weeks of this year’s legislative session, pitting Republicans versus Republicans, causing a delay in the enactment of an Idaho-based exchange. The Legislature adjourned on April 4 after agreeing in March to establish the state-based exchange.

Weeg
Stephen Weeg

When he named the Idaho Health Insurance Exchange board members on April 10, Gov. C.L. “Butch” Otter announced that Stephen Weeg — a veteran health care professional from Pocatello who retired in July 2012 after eight years of directing Health West Inc. — would chair the Gem State’s exchange. The members met for the first time on April 21.

In addition to rigid time constraints, also complicating matters for the exchange board is the fact about 190,000 Idahoans find themselves below the poverty level and 222,000 have no health insurance; the state’s median family income is among the lowest in the United States; the average hourly wage in Idaho in 2012 was 46th in the nation, and the state’s minimum wage is $7.25 an hour — making it difficult for people to afford health care insurance. Idaho has the highest number of per capita minimum wage earners.

Although their travel expenses are reimbursed, the exchange board members do not get paid and do not have a staff.

“Other than that, it’s been a piece of cake,” Weeg remarked to Rotary Club of Pocatello members when he explained the Idaho Health Insurance Exchange on Thursday, Aug. 29, noting only 35 days remained before the enrollment period would start. Weeg spent 40 years in health and human services administrative positions.

“I did try to retire a year ago,” Weeg said, noting he got a call at the end of March from the governor’s office urging him to take on the major challenge of chairing Idaho’s health insurance exchange board. “I asked, ‘Can’t anybody in Boise do this?’”

Weeg emphasized that the exchange board consists of Idahoans engaged in small business, health care and health insurance. Three legislators and the directors of the Idaho Departments of Insurance and Health & Welfare also serve.

Gallatin Public Affairs has been contracted to handle public information, and a web site has been set up at www.yourhealthidaho.org to address questions and concerns of Idahoans. Consumers also may call 855.944.3246.

“Consumer connectors,” including agents, brokers and assisters, will be trained to help residents navigate their health insurance options both online and offline throughout the state. “It really is a market place,” Weeg said. In accordance with Idaho law, only insurance agents and brokers can legally advise in regards to insurance matters.

Weeg noted that a 1.5 percent premium will be applied to insurance sold on the Idaho Health Insurance Exchange as opposed to a 3.5 percent assessment imposed on the federal exchange.

Some Idahoans may be eligible for premium assistance depending on their income, employment status or family size. For example, a family of four making $32,500 or $90,000 a year could qualify for an estimated $950 or $350 a month, respectively, in subsidized assistance. Some may qualify for Medicaid or Children’s Health Insurance Program coverage.

Weeg said he expects the Idaho Department of Insurance will soon announce the cost-per-person rates that will be charged by the five participating insurance carriers — Blue Cross of Idaho, Regence Blue Shield’s BridgeSpan, SelectHealth of Utah, PacificSource and Altius. He said he expects the rates will average $250 per month per individual. Dental and vision coverage will not be included.

Those who do not choose to buy a health insurance plan with basic minimum standards could face penalties in 2014 of either $95 a year or 1 percent of taxable income, whichever is greater.

In 2015, it would be the greater of $325 per adult or 2 percent of taxable income. In 2016, it would be the greater of $695 per adult or 2.5 percent of taxable income. After 2016, the tax penalty would increase annually based on a cost-of-living adjustment.

“The truth is for the whole system to work … everybody’s got to play,” Weeg said.

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