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Health

Health Reform Expert Sheldon Weisgrau Discusses Affordable Care Act In Kansas

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Carla Eckels
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KMUW

Carla Eckels sat down with Sheldon Weisgrau, director of the Health Reform Resource Project, to talk about the Affordable Care Act in Kansas.

On the status of the Affordable Care Act in Kansas:

The law is a success so far on almost every measure you can think of. If you look at what it’s done for access to care, for quality of care and for the cost of care, it’s all been very successful.

Access, of course, is the main point of the law: It’s to get health insurance for more people, and we know that more than 17 million people who were previously uninsured now have insurance because of this law. What that’s done is in some states, the [uninsured] rate is below 10 percent and a few states, it’s below 5 percent. 

Uninsurance rates have gone down across the country. They have not gone down a quickly in Kansas, and the reason for that is because we have not expanded our KanCare program. 

And so we still have a lot of people who come to the marketplace and shop for a plan and find out that they make too much money to be eligible for our current KanCare program. They don’t make enough to be eligible for subsidies to help them pay for a private plan, and they’re stuck in the middle. They generally can’t afford to play the full rate on their own, and so they remain uninsured. They fall into the what we call the coverage gap. We have about 150,000 people in Kansas who are in that situation.

On shopping in the marketplace every year:

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Credit Healthcare.gov
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Normally if you’re happy with your plan you don’t have to do anything, it'll just get automatically renewed every year. ...It’s a good idea for everybody to go back every year and shop, because we know that people tend to get complacent. It’s a difficult subject and it’s easier to just sit back and let your plan renew. But we know that when you do that, you may no longer have the plan that’s best for you.

So I think Kansas are being good consumers, they are looking at their options, and if they’re finding plans that better meet their needs--it may be they’re less expensive or provide more the overage that they need--they’re changing to those plans, and that is ideally what should be happening every year in the marketplace.

On penalties for not having insurance:

One of the things the Affordable Care Act did was it mandated that folks have insurance coverage. And if they don’t, they will pay a tax penalty for that. There are a lot of groups of people that are exempt from that, but in general, for people who have to pay the penalty, yes, the penalty is increasing. It is actually becoming a meaningful amount of money. For 2016 if you’re not insured, you'll either pay $695 or 2.5 percent of income, whichever is higher.

And what we’re seeing is there are actually some people out there who will pay less for insurance coverage than they would pay for the penalty if they choose not to get covered. That’s not the case for most people, but for some people it is. And the idea behind the penalty is we can’t have a viable insurance market unless we have a lot of people in that insurance pool. We need healthy people and sick people in the pool.

Healthy people tend to be reluctant to buy insurance because they feel they don’t need it...so the penalty is seen as an incentive. We’re seeing some evidence that maybe it’s working. We’re seeing signups for the insurance marketplace all across the country, and in Kansas as well, going at a little bit of a faster pace than it’s gone in the past. And the penalty may be one of the reasons for that.

Important deadlines:

The big deadline coming up is January 31, which is the last day of the open enrollment period for insurance coverage. And so anybody that doesn’t have an insurance plan yet should go to the marketplace at Healthcare.gov or see a local navigator who can help them navigate through that system by January 31. ...People can go to the website at CoverKS.org and it will give them a list of assisters that are available in their local community who can sit down with them face to face and help walk them through the process and help them understand this. Insurance is a complicated product. It's not an easy decision to make.

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Carla Eckels is Assistant News Director and the host of Soulsations. Follow her on Twitter @Eckels

To contact KMUW News or to send in a news tip, reach us at news@kmuw.org.