Yes, I hear the groaning. While the last several years have been punctuated by the “health care debate,” the rubber begins to hit the road over the next 7 months. Many of the components of the Affordable Care Act are already in place (timeline here) but in 2014 is the 800 pound gorilla – the arrival of the health care (insurance) exchanges for individuals. They will technically begin operation on October 1st of this year, according to www.healthaffairs.org: Starting in October 2013, people without access to coverage through an employer, Medicaid, or the Children’s Health Insurance Program will be able to purchase health plans through health insurance exchanges for coverage taking effect in 2014. These new marketplaces are one of the Affordable Care Act’s key mechanisms for expanding affordable coverage.
This Thursday, June 6th, I will be attending an educational session sponsored by Wisconsin Manufacturers and Commerce, “Preparing for the New Normal Part 2: Implementing the Affordable Care Act in Madison. If anyone would like to attend and carpool, please let me know. There is a $50 fee per attendee (link is the title), the ride will cost you nothing except 5 hours in the car with me!
However, according to an article in USA Today on May 30th, “Seventeen states and the District of Columbia have received HHS approval to create their own exchanges, and 15 states will work with HHS to run a marketplace, while the 19 remaining states will operate exchanges created for them by the federal government. Many states, particularly those with Republican legislatures and governors opposed to President Obama’s health care law, did not create exchanges.” (Wisconsin was one of the states to not create an exchange.) “Beginning in October, individuals will be able to do a side-by-side comparison of plans either through online state or federal exchanges. Insurers will not be able to charge more for or exclude those who have pre-existing conditions.
Insurers have submitted proposed pricing and plans, and, in the states that have released that data, there is a large variety of pricing. California’s premiums came in 50% lower than what had been projected, and in Washington and Oregon, people will pay less for premiums on the individual market than they did before the law, also called the Affordable Care Act.”
While we don’t know what the exchange will look like in Wisconsin, there was an additional option in the legislation: healthcare cooperatives. The new cooperatives are an option that came out of the debate for “a public option” during the national discussion on this topic.
More from Healthaffairs.org: “The provision created what was originally a $6 billion federal fund–reduced by law in 2011 to $3.4 billion, and reduced again in January 2013 as described below–that would enable sponsoring organizations to apply for loans to create new health insurance cooperatives.
These nonprofit, consumer-driven organizations would offer health coverage–and possibly also care networks–through the exchanges under the same regulatory requirements imposed on private insurance companies at the state and federal level. The provision was incorporated into health reform legislation in the Senate, and became law when the Affordable Care Act was signed by President Barack Obama in March 2010. Under Section 1322 of the Affordable Care Act, CO-OPs will offer coverage through the exchanges primarily in the small-group market, which generally serves companies or organizations with fewer than 100 full-time employees, and in the individual market. Like other plans offered through the exchanges, CO-OPs must be ready for open enrollment beginning October 1, 2013. The law required the Department of Health and Human Services (HHS) to distribute funds to at least one CO-OP in each state. But because of the most recent funding cuts, no more new CO-OPs will be established beyond the 24 that have already been created, at least for now (Exhibit 1).”
“Health Policy Brief: The CO-OP Health Insurance Program,” Health Affairs, February 28, 2013.2013.http://www.healthaffairs.org/healthpolicybriefs/
Wisconsin got one of the loans. The Common Ground Healthcare Cooperative, based in Milwaukee, will serve individuals and small employers in Brown, Calumet, Door, Fond du Lac, Kenosha, Kewaunee, Manitowoc, Marinette, Milwaukee, Oconto, Outagamie, Ozaukee, Racine, Shawano, Sheboygan, Walworth, Washington, Waukesha, and Winnebago counties and any individual, non-profit or small business will become a member when they purchase health insurance through Common Ground Healthcare Cooperative.. There are, in fact, health care cooperatives already in Wisconsin, but this is not a purchasing cooperative, but rather an actual insurance company. In answer to the question, “why will this work when similar concepts have failed?” According to their website, “Unlike other initiatives for small employers and individuals, Common Ground Healthcare Cooperative will not be contracting with an existing for-profit health insurance company to buy insurance and create a purchasing pool. Common Ground Healthcare Cooperative will be the insurance carrier and with its non-profit, member governed structure, Common Ground Healthcare Cooperative will provide quality plans that are affordable, coordinated, and responsive. Common Ground Healthcare Cooperative leaders have a strong vision for improving the health of members and for controlling the health care costs of its members which are the key factors to control premiums.” Open enrollment will begin October 1, 2013 and coverage will become effective January 1, 2014. Enrollment will be continuous throughout the year so prospective members can enroll on January 1, 2014 or after. The cooperative has been and will be holding education seminars. The seminars are designed for individuals (under 65) without insurance, self-employed individuals, small business owners and nonprofit leaders. Topics for discussion include the new insurance marketplace (exchange), subsidies for purchasing insurance, the individual mandate and other important issues. Each seminar is identical.
I will be attending the June 12th session in Milwaukee and extend the same carpool offer as above. I can’t find a fee for the session and the ride with me would be no cost (other than 4 hours in the car with me!).
I will report back here on what I learn and my thoughts if you can’t attend yourself (or just can’t bear to!). Whether you plan to attend one of these sessions, or the one we will hold in the fall, I hope you will get yourself educated. This is vital to you individually, your family and your employees. Stay tuned…