A S P E C I A L S E C T I O N F R O M T H E A R K A N S A S I N S U R A N C E D E P A R T M E N T

I N T H E A R K A N S A S T I M E S

G E T I N F O R M E DConnecting You to the

H E A LT H I N S U R A N C E M A R K E T P L A C E

Patient Protectionpg. 3

how the aca affects youpg. 4

affordable care act uniquely suited to benefit arkansas

pg. 5

the history of healthcare reform in the u.s.

pg. 5

health insurance marketPlace

pg. 6

financial assistancepg. 6

datapg. 7

Check out these reliable sources on the Internet for information about the Patient Protection and Affordable Care Act, including help in calculating the approximate amount of financial assistance you might receive to purchase insurance:

HealthCare.govachi.net

EnrollAmerica.org

ARHealthConnector.org

Table of ConTenTs

Where to Go For More

Patient Protection - 3 how the affordable care act affects you - 4

affordable care act uniquely suited to

benefit arkansas - 5

health insurance marketPlace - 6

2 Get informed ConneCting You to the health insuranCe MarketplaCe

How the Affordable Care Act Will Help Consumers in the Future

• Coveragecan’tbedeniedtoanyonewhohasapre-existingcondition,suchascancer,diabetesorhearttrouble.

• NoinsurancepolicyforanyoneinAmericacanlimitannualorlifetimebenefits.

• Premiumscannotbeincreasedduetogender,healthconditionsorpersonalhealthhistory.

• Premiumscanonlybeincreasedduetoage,geography,andtobaccouse.

• Eliminationof“donuthole”chargesby2020.

• Eligibilitydeterminationsare“realtime.”

• Primarycarephysicianswillbepaidatleast100%ofMedicarepaymentratesforprimarycareservices.

Patientprotectionearnedtop

billingwhenCongresstitled

thehealthcarereformlaw.The

provisionssafeguardingpatients

applytoeveryoneinthecountry,

notjustthosewhoareuninsured.

How the Affordable Care Act is Already Helping

• Childrencanstayontheirparents’insurancepolicyuntilage26.

• Insurancecompaniescannolongerdenycoverageofachildunderage19duetohealthconditions.

• Lifetimebenefitlimitsareeliminated,andannualbenefitlimitsoninsurancecoverageareregulateduntil2014.

• Rescindingcoveragebyinsurancecompaniesisprohibitedunlessduetofraud.

• Preventiveservices(suchasmammograms,colonoscopies,wellnessvisits,etc.)arecoveredatnocosttotheconsumer.

• Rebatesonmonthlypremiumsarepaidtoconsumersiftheinsurancecompanydoesnotpayenoughonhealthinsuranceclaims($11millionpaidtoArkansasconsumersinthefirst2years).

• Coverageisavailableforearlyretirees(age55-64).

• 446,000ArkansansnotenrolledinMedicareAdvantagewillseedecreasedpremiums.

• Morethanahalf-millionArkansansbenefitfromdiscountsonMedicarePartDdrugspurchasedinso-called

“donuthole.”

Patient

Protection

3 Get informed ConneCting You to the health insuranCe MarketplaCe

My family is already insured through my employer. Will I be affected?

Many insurance policies now cap a person’s lifetime benefits, but the Affordable Care Act (ACA) says they can no longer be capped. The law also removes the annual limits on benefits that your insurance may now im-pose. Your insurance provider will no longer be able to stop your coverage or raise your premium because of a pre-existing condition. Sons and daughters now can be kept on your insurance until they are 26 years old.

Also, your insurance company must give re-bates if it fails to spend a certain percentage (80%–85%) of the premiums on healthcare each year.

My family is insured through an individual policy, which is expensive. Can I switch plans?

Your insurance will not be affected, but you may be helped because more insurance plans will be available in Arkansas through the Health Insurance Marketplace created by the ACA. In Arkansas, you can access the Marketplace through the Arkansas Health Connector. The competition among more companies and more plans tends to drive down premiums and out-of-pocket costs. If you see a plan in the Marketplace that is bet-ter or cheaper, you may switch to the plan. You will not be eligible for financial assis-tance unless your family income is no more than 400% of the federal poverty level.

I have Medicare. Will my benefits cost more or less?

Less. The ACA, starting last year, closes the so-called “donut hole” year by year until it disappears in 2020, saving some seniors more than $1,000 each per year

I do not have insurance through my work, and I cannot afford to buy an individual policy for my family or myself. How will the Marketplace help me?

This fall, the new Health Insurance Mar-ketplace will give you a choice among an ar-ray of insurance plans that fit your family’s needs and your pocketbook—with financial assistance if you meet income eligibility.

Starting Oct. 1, you will be able to shop for an insurance plan online, by telephone, by mail or in person by contacting a qualified insurance agent or visiting one of the many organizations around the state serving as In-Person Assisters, or “guides,” to help you through the enrollment process.

I have no health insurance, but my family and I are in good health. I don’t want to buy insurance. Do I have to?

You can choose not to buy insurance. Instead, you will pay a penalty to the federal govern-ment each year that you and your family are not insured.

I run a small business. Must I provide insurance to my employees or else pay a penalty?

If you have fewer than 50 full-time employ-ees or the equivalent of that (100 half-time employees, for example), the law does not require you to provide insurance, nor does it levy a penalty for failing to provide it. If you have 50 or more full-time employees, or the equivalent in part-time workers, you must provide quality, affordable insurance for your full-time employees or else you must pay an additional income tax of $2,000 per full-time employee. The first 30 employees are excluded in calculating the tax.

Is absolutely everyone required to have insurance or pay the penalty?

No. There are a few exemptions, such as if you are in the country illegally or are in pris-on, or you are a member of a federally rec-ognized Indian tribe or a religious sect that is recognized as conscientiously opposed to health insurance benefits.

I have military insurance (either VA or active military), so will the ACA affect me?

No. Your insurance provides the required coverage. The same is true of nearly all gov-ernment employee insurance programs.

How tHe

AffordAble cAre Act

Affects you

4 Get Informed ConneCting You to the health insuranCe MarketplaCe

No other state will have as large a share of its population that will be helped by the ACA, no other state will receive quite the economic boost, and few, if any, states will bear as light a load of taxes that pay for the reforms as will Arkansas. Rather than the spending burden many feared, the ACA will produce large sav-ings for the state.

The Arkansas legislature in April voted to expand Medicaid as called for in the ACA. This was accom-plished with an approach tailored for the Natural State by covering the poorest Arkansans through private health insurance plans. The bill, called the Arkansas Health Care Independence Act, overwhelmingly passed and was signed into law by Gov. Mike Beebe.

With the Arkansas Health Care In-dependence Act, our state has posi-tioned itself as a national leader in healthcare reform. No other state is attempting such a unique ap-proach in implementing the ACA.

The ACA also establishes a Mar-ketplace in each state, including Arkansas, in which insurance companies, starting this fall, will offer a range of insurance plans. Uninsured people can shop for a plan that suits their needs and

budgets. The government will provide financial assistance on the premiums for families meet-ing income eligibility. The plans will take effect in January, 2014.

Every year, Arkansas ranks among the unhealthiest five states in the union, based on a variety of measurements such as the number of people with blood-pressure ailments, obesity, diabe-tes, smoking, etc.

Since more people in Arkansas need insurance and medical care, Arkansas will experience a large infusion of federal dollars start-ing in January. With 75 percent of Arkansans earning less than 400 percent of the poverty level, Ar-kansas has the highest percentage of its citizens in the nation who are eligible for federal assistance in paying insurance premiums.

The impact will go far beyond that. A major purpose and effect of the ACA and the Arkansas law is to end unreimbursed care at hospitals, clinics and doctors’ offices. More patients being cov-ered will infuse much-needed resources into those hospitals. Arkansas’s rural hospitals have been struggling with uncompen-sated care and they will receive welcome relief.

History of

HealtHcare reform

in tHe U.s. & arkansas

affordable care act

UniqUely sUited to

benefit arkansas

President Truman endorses universal health insurance but fails to pass it.

President Roosevelt ponders including national health insurance in a sweeping social insurance bill that became Social Security, but omits it because of

opposition.19351948

Workplace health insurance grows, primarily in large industries under union agreements.

1950s

Under Gov. Dale Bumpers, Arkansas greatly expands health and social services by matching federal funds under Medicaid.

1971

President Nixon outlines a universal health insurance bill to Congress, calling for all employers to buy insurance for their employees. The plan goes nowhere.

1973

The Massachusetts Legislature adopts a universal health-care plan proposed by Gov. Mitt Romney and backed by Sen. Edward Kennedy that requires people

to buy health insurance and covers adults under 150 percent of the poverty line

through Medicaid.

2006

President Clinton puts first lady Hillary Clinton in charge of developing a bill to provide health insurance to all. The bill fails.

1993

Arkansas Gov. Mike Huckabee signs a bill to create ARKids First, which expands Medicaid to cover more children.

1997

The Patient Protection and Affordable Care Act, based on the Massachusetts model, is signed into law by President Obama.

2010

Gov. Mike Beebe, joined by Democrats and Republicans in the Legislature, signs the Arkansas Health Care

Independence Act.

2013

Congress passes and President Johnson signs a bill masterminded by Rep. Wilbur Mills of Arkansas that establishes Medicare and the joint state-federal Medicaid program.

1965

5 Get informed ConneCting You to the health insuranCe MarketplaCe

The “affordable care” half of the Patient Pro-tection and Affordable Care Act is least un-derstood in the lengthy law.

The Affordable Care Act builds on the U.S. system by making private insurance more af-fordable for low- and middle-income families and by giving strong incentives to buy it.

The incentives are that (1) the government will help you pay the premiums with ad-vance tax credits if your family income is no more than four times the poverty level (about $94,000 for a family of four), and (2) most people who decline to buy insurance will have to pay a penalty when they file their in-come tax returns.

Fifty million or so Americans—more than 500,000 of them in Arkansas—can start shopping on Oct. 1, 2013, in a new Health In-surance Marketplace for an insurance policy that will fit their families’ needs and budgets. Coverage begins Jan. 1, 2014.

Consumers can access the Marketplace on-line through the Arkansas Health Connec-tor or by contacting insurance agents or In-Person Assisters (guides) by telephone, mail, or in face-to-face visits. The Marketplace, which will allow people to compare the costs and benefits of a number of plans, will offer

open enrollment from Oct. 1 through March 31. There will be a new enrollment period ev-ery year.

Insurance premiums in Arkansas doubled between 2000 and 2010, the year Congress enacted the law, while the number of unin-sured people rose, according to Arkansas Surgeon General Joe Thompson.

This meant that a smaller and smaller part of the population bought insurance but paid for more and more of the medical costs of people who were uninsured and got charity care from clinics, hospitals and doctors.

“The idea of the Affordable Care Act is that you bring everybody in, the good risks and the bad risks, the well and the sick, and spread the risk over a larger number of peo-ple,” Thompson said. “That is the only way to make the health insurance system work.”

The goal of the Marketplace is to have a num-ber of insurance companies offering compet-ing plans, which will hold premiums down and stretch benefits. Five insurance compa-nies indicated to the state Insurance Depart-ment in early June that they would each offer medical plans. Four companies plan to offer pediatric dental plans. Other companies have expressed an interest and may enter the mar-ket later. There will be competing plans of-fered in all 75 counties.

Each company must accept every person who applies, regardless of their health or age, and can never stop a person’s coverage if he or she becomes ill.

If a person goes online starting Oct. 1, there will be simple descriptions of the benefits and costs of each plan and how the insur-ance company will spend the money. There will be easy comparisons of plans and sim-

ple calculations of how much of the pre-mium will be borne by the customer and how much the federal government will pay in the form of tax credits. The Arkansas Insurance Department’s Arkansas Health Connector will help Arkansans enroll in a plan that best meets their needs.

Every plan must provide at least these 10 essential benefits: outpatient care; emer-gency treatment; hospitalization; prescrip-tion drugs; maternity and newborn care; mental health and substance-abuse treat-ment; rehabilitative and habilitative care; laboratory services; preventive and well-ness services; and pediatric services in-cluding vision and dental care. Plans may also cover other services.

95%2017

100%Through 2016

100%

90%

80%

70%

60%

50%

100%

90%

80%

70%

60%

50%

100%

90%

80%

70%

60%

50%

100%

90%

80%

70%

60%

50%

100%

90%

80%

70%

60%

50%

94%2018

93%2019

90%

2020 and thereafter

THE U NINSU RE D IN ARK ANSA S &

NATIONALLY

HE ALTHCARE REFORM BY THE

NUMBERS

THE IMPACT OF THE AFFORDAB LE

CARE ACT

Up to $67 million annually will be saved in Arkansas because of a reduction of costs for uncompensated care.

Uninsured Americans who have been without coverage for 2 or more years.

Uninsured Americans who don’t know about the new Health Insurance Marketplace.

Estimated amount of uncompensated care costs to Arkansas hospitals in 2010.

of Arkansas residents report they could not see a doctor due to cost.

16.5%

Over $338 million

67%26% of working-age Arkansans are uninsured.

The Affordable Care Act and the Arkansas Health Care Independence Act will help Arkansans get the treatment they need and help hospitals stay in business. This data demonstrates the need and the assistance on the way.Sources: The Rand Corporation, Arkansas Center for Health Improvement, Demos.org, Act 1497 of 2013, and EnrollAmerica.org

Adults are more likely to be diagnosed with later-staged cancer due to delays in seeking care.

For those without insurance:

Adults are more likely to die from trauma or other acute conditions like heart attacks and strokes.

Cost for Medicaid coverage expansion paid by the federal government, not Arkansas taxpayers. Begins at 100% and will gradually reduce to no less than 90%.

THE IMPACT OF INSU FFICIE NT

HE ALTH INSU R ANCE

78%

Annual increase to Arkansas gross domestic product (GDP)

$550 MillionAt least

Lives saved each year2,300

New jobs created6,200

A 2013 study by the Rand Health Corporationon the economic impact of the ACA in Arkansas

predicted that by 2016:

26%

Percent of bankruptcies in the U.S. which are due to medical debt.

62%

Nationally, 47 percent of all indebted households indicated out-of-pocket medical expenses contributed to their credit card debt.

47%

Individual plans with total annual premium cost of $5,600FPL % 133 150 200 250 300 400

Annual Income ($) 15,281 17,235 22,980 28,725 34,470 45,960

Income % for premium 3 4 6.3 8.05 9.5 9.5

Consumer payment ($) 458 689 1,448 2,312 3,275 4,366

Subsidy ($) 5,142 4,911 4,152 3,288 2,325 1,234

Family of four with total annual premium cost of $15,700FPL % 133 150 200 250 300 400

Annual Income ($) 31,322 35,325 47,100 58,875 70,650 94,200

Income % for premium 3 4 6.3 8.05 9.5 9.5

Consumer payment ($) 940 1,413 2,967 4,739 6,711 8,949

Subsidy ($) 14,760 14,287 12,733 10,961 8,989 6,751

Advance tax credits paid directly to insurance carriers subsidize premiums on plans purchased through the Marketplace.

The amount you pay depends on where your income falls relative to the 2013 Federal Poverty Level (FPL).

Financial assistance

Tax credits vary and are based on your income.

the health insurance

marketplace

6 Get inFormed ConneCting You to the health insuranCe MarketplaCe

95%2017

100%Through 2016

100%

90%

80%

70%

60%

50%

100%

90%

80%

70%

60%

50%

100%

90%

80%

70%

60%

50%

100%

90%

80%

70%

60%

50%

100%

90%

80%

70%

60%

50%

94%2018

93%2019

90%

2020 and thereafter

THE U NINSU RE D IN ARK ANSA S &

NATIONALLY

HE ALTHCARE REFORM BY THE

NUMBERS

THE IMPACT OF THE AFFORDAB LE

CARE ACT

Up to $67 million annually will be saved in Arkansas because of a reduction of costs for uncompensated care.

Uninsured Americans who have been without coverage for 2 or more years.

Uninsured Americans who don’t know about the new Health Insurance Marketplace.

Estimated amount of uncompensated care costs to Arkansas hospitals in 2010.

of Arkansas residents report they could not see a doctor due to cost.

16.5%

Over $338 million

67%26% of working-age Arkansans are uninsured.

The Affordable Care Act and the Arkansas Health Care Independence Act will help Arkansans get the treatment they need and help hospitals stay in business. This data demonstrates the need and the assistance on the way.Sources: The Rand Corporation, Arkansas Center for Health Improvement, Demos.org, Act 1497 of 2013, and EnrollAmerica.org

Adults are more likely to be diagnosed with later-staged cancer due to delays in seeking care.

For those without insurance:

Adults are more likely to die from trauma or other acute conditions like heart attacks and strokes.

Cost for Medicaid coverage expansion paid by the federal government, not Arkansas taxpayers. Begins at 100% and will gradually reduce to no less than 90%.

THE IMPACT OF INSU FFICIE NT

HE ALTH INSU R ANCE

78%

Annual increase to Arkansas gross domestic product (GDP)

$550 MillionAt least

Lives saved each year2,300

New jobs created6,200

A 2013 study by the Rand Health Corporationon the economic impact of the ACA in Arkansas

predicted that by 2016:

26%

Percent of bankruptcies in the U.S. which are due to medical debt.

62%

Nationally, 47 percent of all indebted households indicated out-of-pocket medical expenses contributed to their credit card debt.

47%

Get readyto get

■ Affordable health insurance is coming!

■ Pre-existing conditions can’t keep you out

■ You can fi nally control your family’s healthcare options

■ Learn how at ARHealthConnector.org

Text “GetIn” to 84700 | Call 855-283-3483

Get health surance coverage

AID 0613 013 GenericOriginal_10x12_4C.indd 1 6/25/13 11:13 AM