By Stephen J. Kotz
It’s pretty much all over but the shoutin’. After more than three and a half years of fiercely partisan political warfare, the federal Affordable Care Act, more commonly known as Obamacare, will be completely phased in this year.
Insurance brokers and state run exchanges, or marketplaces where the uninsured can shop for health care policies, will likely see a continuing brisk business for the next month or so, as the final open enrollment period ends on March 15, with mandatory coverage required to begin by April 1.
“It ruined my hunting season,” said Karl Washwick, drolly, of the rush to buy new policies meeting the requirements of the law this year. The owner of the Washwick Agency, an insurance brokerage in Riverhead, Mr. Washwick said the final push to implement the health care legislation had proved to be a logistical nightmare for everyone from consumers to insurance companies themselves.
“If anyone had asked me I would have said this is a recipe for disaster. It’s insanity to ask everyone in New York State to switch policies on the same day. It’s the same as telling everyone to renew their driver’s license the same day. Can you imagine the lines if they did that?” He said a phased-in implementation would have saved lots of headaches.
Susan Morrissey of Morrissey Advisory Services, a Sag Harbor health insurance brokerage, agreed that there was still a lot of confusion among consumers.
“At times I’ve felt like I’m a social worker,” she said of all the counseling and hand-holding she has had to do with her clients in sorting out their options from among dozens of plans with various prices that are available.
Although plans that went into effect last year and expire later this year remain valid, any new plan that goes into effect this year has to include pediatric dental and vision care as well as mental health benefits, Ms. Morrissey said.
On top of that, Mr. Washwick said, if they were not already, consumers have to be prepared for a new age, in which just about all plans have high deductibles. “Generalizing across companies and policies, it means about a $6,300 out-of-pocket at most for an individual and double that for a family,” he said.
Both Ms. Morrissey and Mr. Washwick said the vast majority of companies they represent, which are typically in the small business market, have continued to offer insurance for their employees.
But if a company does not provide insurance or a consumer is self-employed, they have two basic options: buy an individual plan from a broker or visit the New York State insurance exchange site, nystateofhealth.ny.gov .
“There are two stores to buy insurance from; you can buy from the state store or the Washwick store,” said Mr. Washwick. The first difference is that someone who buys through the state exchange might qualify for a price subsidy if their income falls below $45,000 for an individual or $95,000 for a family.
Although the prospect of a subsidy sounds inviting, Ms. Morrissey said it’s still a case of buyer beware. “A lot of people might not know that although the same insurers are on the exchanges as you can get from a broker, the networks aren’t necessarily as good,” she said. “People buy policies and then have trouble when they find out that they can’t go to their regular doctors.”
She pointed out, for instance, that Stony Brook University Hospital, recently announced that is not accepting any plans sold on the state’s exchange.
“The only reason you’d use the exchange,” she added, “is if you think you are going to get a subsidy.”
Americans who do not buy insurance face a fine of $95 or 1 percent of their income, whichever is greater, an amount many healthy young Americans may be willing to pay to avoid paying monthly premiums, Ms. Morrissey said.
The Affordable Care Act had good intentions, she said of the effort to make sure all Americans have health insurance. But she said, so far, it’s had mixed results and will likely need some serious tweaking. While an individual policy would have cost about $1,000 last year and policies are now available for as low as $590, people will still end up going to the emergency room when they need health care if they have a limited network of doctors to choose from.
“From the eagle view in Washington, D.C., it’s fabulous,” Mr Washwick said of the $6,300 out-of-pocket limit for an individual. “You get cancer and your total cost is one-third the price of buying a Toyota,” he said. But to the average Joe, it’s ‘Why do I have insurance?’”
The dilemma still vexing this country, according to Mr. Washwick, is that Obamacare “is not health care reform, it’s health insurance reform.”
The question “is how do you get people healthier?,” he said. “The overwhelming number of health care claims are lifestyle claims. Supersize me. Marlboro Lights, please. Yeah, I’ll have one for the road.”