By Sean Engeldrum
The launch of federal health care reform, known as the Affordable Care Act (ACA), hasn’t gone to plan. Popularly, and often derisively, known as Obamacare, the law has been beleaguered by problems ranging from technical bugs, to some citizens losing their existing coverage. With everyone pointing out the negatives, can Bronxites find a way to benefit from the new law?
I wondered about the potential positives when I found out I would need a new health insurance plan. I am currently enrolled Healthy NY, a program subsidizing individuals earning below a certain amount. However, due to reforms, Healthy NY will no longer provide coverage for individuals or sole proprietors by the end of this year, so I had to use the new system to find a plan or face a tax penalty.
The central component of the new law is the marketplace where individuals can compare different plans. Being able to see premiums, deductibles and coverage levels is meant to lower the cost through competition. This is where my initial apprehension came in. Everything I had heard about the health marketplace was bad. Even late night comedians were making jokes about how the website was slow, confusing and unreliable.
States weren’t required to set up their own health marketplaces. Most states use the default, which is the federal site, HealthCare.gov. The federal site has had an embarrassing amount of difficulties. The interface was buggy, the layout was confusing, and the hardware infrastructure wasn’t up to the initial rush of people looking for insurance options when it first went live in October, causing frequent outages.
Since then, there has been a concerted effort to fix the federal site. These efforts are starting to bear fruit, but people in states like California, Nevada, Washington, Connecticut and New York have had their own systems in place. Most of these have had far less problems.
NY Health Care Site
Creating an account with New York’s site, www.healthbenifitexchange.ny.gov, was a simple process. The first step was entering my information. Name, address, social security number, email address, phone number and other pertinent information. Eventually, the website confirmed my identity through questions about school history, registered vehicles, and other governmental records.
At this point in the process, there is the option to apply for financial aid by providing income and dependent information. The Affordable Care Act lacked a public insurance option, but includes varying subsides for families and individuals within 400 percent of the poverty line. The law also gives states the option of expanding the scope of Medicaid.
Individuals in states expanding Medicaid, including New York, can now utilize the program if they are within 133 percent of the poverty line. As the poverty line for a single person in 2013 is $11,490, the threshold for Medicaid is $15,282. This will allow many more people to join the program, especially in the Bronx where over 28 percent of people live below the poverty line, but still more live at, or just above the line.
Federal Poverty Guidelines 2013
If you meet the requirements for Medicaid, the site will list several providers to choose from. These include some name brands, like Fidelis Care and HealthPlus. Each is listed with ratings and some description of what they provide to help with the decision.
If the requirements for Medicaid are not met, you now have access to the Health Care Exchange. The exchange lists all of the plans available to you. You can filter results by cost, deductible, and quality. You can also check if your current healthcare providers accept a plan you’re thinking of getting.
The plans also follow a tier system: Bronze, Silver, Gold, Platinum and Catastrophic. Bronze through Platinum fulfills your legal obligation to have health insurance. They vary in quality, Bronze being the least expensive, but having the least coverage and higher deductible, whereas Platinum is the most expensive, but has little or no deductible and the best coverage.
Catastrophic is separate. Cheaper than Bronze, it provides little coverage and has a huge deductible, often exceeding $6,000. These plans only exist to limit debt in cases of serious injury and sickness, which require extended medical attention. These plans do not fulfill the legal obligation to have insurance, and you will still face tax fines if you procure this type.
After looking through the options, I backtracked through the site and filed for aid. I had to use the telephone service during this process to ask about some details involving my current enrollment with Healthy NY and if it changed my eligibility for financial aid. The operator answered my question quickly and pleasantly. It turned out that I was eligible for Medicaid, as I make below the annual threshold due to working part time while in school.
This is not a unique experience. Though acquisition of private insurance policies through the various marketplaces have been slow, new enrollment in Medicaid has surged forward. The Obama administration recently announced 1.46 million more people had joined Medicaid or the equivalent Children’s Health Insurance Program.
This is a great benefit to the people of the Bronx. With over 250,000 individuals in the borough currently living without insurance, having a chance to get coverage in any form is a necessity. Caridad Moreno, a 26-year-old resident of the Bronx who lost her insurance in August of this year, went through this process. She was surprised by how simple it was.
“I was expecting something far harder,” said Moreno. “Everything you hear about it scares you away. When I finally sat down and did it, it took less than an hour. I was surprised I was eligible for Medicaid too. I don’t remember hearing about it being a possibility.”
“I’m definitely recommending other people try it now that I know how easy it is,” Ms. Moreno said, when asked if she thought others should try. “It doesn’t cost you anything to look.”
White House: Eight Ways Obamacare Helps You
Not everyone in the Bronx is benefiting. David Goldsmith, a 25-year-old member of the Construction and General Building Laborers’ Local 79, lost his coverage when the new laws made it too expensive for the union to continue their health plan.
“I found a new plan with the help of a union rep,” said Goldsmith. “It is basically the same coverage, but now I need to take care of the bill myself. Even after the union reimburses us, now that we aren’t covered, I’m going to end up paying more per month,” Goldsmith said. “Screw Obamacare.”
Though the law is far from perfect, it can improve the lives of many people in the Bronx. As the deadline looms, take some time to check your options, especially if you’re heading into the new year with no insurance.
There are resources to help you find coverage before the December 23 deadline:
New York’s site. Straight forward to use and has links to assistance and information. If you need extra help, the phone number is: 855-355-5777
A site which gives detailed information about every aspect of the process. A great first stop if you want to educate yourself before trying the government site.
A quick overview of the poverty line which can help you determine how much assistance you can expect before applying.
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