As part of a continuing series, Bayoubuzz presents Part 2 of a recently-recorded interview with Katie Vlietstra, Director of Government Affairs for the National Association of Self-Employed, a leading organization representing the millions of self-employed and small businesses.
In today’s edition, Vlietstra discuss some of the changes of the act regarding pre-existing conditions and lifetime caps. Also, Vlitstra talks about how the enrollment process has begun and the organization’s tool to help Americans to understand the changes being made with the new healthcare law.
Here is part one. Impact of Affordable Care Act on small, self-employed businesses, NASE interview I
SABLUDOWSKY As I understand, one of the major changes is the question of health coverage denial or non-denial of coverage and that is called the insurance market reform. Am I correct?
VLIETSTRA: Yes. Those are actually immediate reforms that were put into the marketplace. An individual cannot be denied coverage due to a pre-existing condition so those individuals and, again, self-employed has experienced that quite a bit. Our population trends to be 40 and above and even some retirees who are starting their business for the first time have really run into this pre-existing condition clause and, so up until now those individuals could actually purchase health insurance through the Federal government and have kind of a bridge plan. Coming October 1they, like millions of Americans, will go into the individual exchange marketplace and purchase health insurance. Besides the pre-existing condition that cannot be denied there is also lifetime cap. There is no lifetime limits on insurance and it caps out of pocket expenses and an individual and family will pay annually based on their health plan that they choose in the exchange. So there is some great individual market reforms that really address a problem that we know has been around for some time as to relates to whom is able to access affordable comprehensive healthcare coverage.
SABLUDOWSKY Now you talked about some people who might be retired and say, just starting a business or around retirement time and, I am just wondering, there is also the interface of Medicare.
SABLUDOWSKY So how does that come into play. As I understand that is totally separate.
VLIETSTRA:So from what we have told and, unfortunately, I have not seen the platform downloaded fully, but from our friends at HHS and the Small Business Administration when you go to healthcare.govonOctober 1to start shopping for health insurance there is going to be a few immediate screening questions. Number 1 they are going to ask where you live because depending on where you live you are either under the federally facilitated umbrella or your state. There are fourteen of them who are operating fully on their own. You will be directed to the appropriate portal as they are calling it. So, if you are from California, you will go to the coverage California site. If you are in Texas, you are going to go to the Federal exchange. So that is the first screening question you will be asked. The second basic question will be what is your age, what is your household income, are you a veteran? And those questions will look to screen if you are eligible for any other federal programs; if it's Medicaid, if it's Medicare, if it's any VA benefits, so that as you work through the application and process for insuring you meet the individual mandate it will actually put it altogether in a package. So, you are over 65, I believe is the Medicaid age, so you are eligible for Medicaid, this is how it will impact how much you are spending or the coverage that you receive so, knock on wood, in theory that's how it is supposed to work. In some cases, there are some people with families who have children that are probably eligible for CHIP, which is Children's Health Plan that helps subsidize for low income wage earners so this is going to be an interesting tool to see and people may realize that they may have been eligible a lot sooner for some of these additional benefits.
SABLUDOWSKYI just received an email, I think it was from HHS that said you could actually begin to sign up now or at least put your information up now but certainly not look for different exchanges but you could at least put your information up now.
VLIETSTRA: Yes. They are really trying to push and to their credit and there is some politics with this HHS has a huge burden of many states twenty-six have declined to set up their own state facility of exchanges. HHS has been hit with continued efforts to cut their budget while they are trying to roll out what is now a federal law and so yesterday's email is really trying to encourage people to go ahead and become educated minus the pricing and to start the application process it's more so that they can fill out their numbers and figure out what states are going to be it's all data; like are they not getting enough stuff from Indiana or they so it's just really a hope to get more people educated and in the system beforeOctober 1when they officially can start enrolling and looking at those costs. So to their credit they are trying to reach as many people as possible and try to get them in the door kind of already.
SABLUDOWSKY In terms of chance for the self-employed as I understand and I am reading here that this is actually from your organization, the National Association for the Self-Employed, this is a, I guess a PDF that they sent out and what is the name of this brief?
VLIETSTRA:This is our Affordable Care Act in brief so it is a quick two age summary of some of the questions that the self-employed have been asking us and some more information about, you know, where we kind of fall in this, the issues, you know, the good, the bad, the ugly. We want to be as transparent as everyone; you know this. Laws are made, they are not necessarily perfect so we wanted to highlight these are your new kind of rights under the affordable care act. This is what you should be preparing for comeOctober 1and this is what you need to do to make the law better as of right now we take the stand that this is law and there is always opportunity to improve upon it. The other big thing we point out in the brief document is talking about is premium assistance and how that is going to play in purchasing health insurance so the second page of that document has a scale or has a visual that shows that if you are a family of one how much based upon your household income how much assistance you would be able to receive to purchase your healthcare product come October 1.