MILLEDGEVILLE — The Baldwin County Democratic Committee held an Affordable Care Act (ACA) forum Thursday evening at Georgia College's Peabody Auditorium.
Democratic Party Chairman Quentin T. Howell said these forums are going on statewide to make sure people understand the true unbiased facts surrounding national healthcare.
State ACA marketplace navigator Harold Weber described the marketplace and current state limits to the system.
Weber is a Health Navigator with Athens Neighborhood Health Center. During a 33-year career with Prudential and Aetna in systems and health plan management, Weber has seen the rise and fall of the HMO and managed care movements.
Weber said the old healthcare system has the United States spending 18 percent of its Gross Domestic Product in that area. Other comparable nations spend half that total.
“We are at a position where we can't afford to do that anymore,” Weber said. “We have 50 million people uninsured, but we have a how lot more folks under insured. The U.S. pays more for services, procedures, medical devices and drugs than the rest of the world. We are wasting a trillion dollars.”
Open enrollment at the healthcare.gov marketplace began Oct. 1 and continues through March 31, 2014. Since the health care marketplace opened, the system has been met with a number of questions and website system setbacks.
The marketplace brings in private healthcare providers to offer services to consumers.
“The Affordable Care Act is trying to address insurance coverage for the uninsured which are generally low income people,” Weber said.
Ninety percent of people currently uninsured will qualify. Twenty percent of Georgia citizens are uninsured.
The marketplace isn't built for those with good job, Medicare or other insurance setups.
In Georgia, those eligible for the marketplace can choose from up to four healthcare plans with varying benefits and premiums.
All plans must cover at least 10 criteria including ambulatory patient services, emergency services, hospitalization (such as surgery), maternity and newborn care, mental health and substance use disorder services, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services and chronic disease executive and pediatric services.
Plans may offer additional coverage.
At present, marketplace insurance carriers available to Georgia residents are Blue Cross Blue Shield, Alliant Health Plans, Ambetter from Peach State Health Plan, Humana Insurance Company and Kaiser Foundation Health Plan of Georgia.
Not all these providers are available in each 159 Georgia counties.
• Georgia is one of 24 states not expanding Medicaid under the ACA
The federal government agreed to pay 100 percent of each state's Medicaid expansion for the first three years under the ACA.
“The thinking by those designing the law was that every state would take the Medicaid expansion,” Weber said. “You can't force a state to spend money on a federal program unless they agree. That meant a state could choose not to take it.”
Georgia argued a $4.5 billion cost over 10 years wasn't worth the expansion.
Weber said over 600,000 would be eligible for Medicaid coverage if Georgia accepted.
“If you provide coverage for that many people, you are going to create 30,000 new healthcare jobs in Georgia,” Weber said. “The multiplier effect would take that job total to 70,000. If you take all the money the state would save with the expansion plus the added tax revenue, you greatly offset the $4.5 billion. Georgia would actually make money.”
State hospital organizations are speaking out in favor of the ACA expansion, according to Weber. The hospitals will miss out on that federal funding otherwise.
• Major life event
If an individual signs up for insurance coverage through the marketplace, but then gets a job with benefits, the person will not experience a lapse in coverage.
“You have to take the coverage with your employer and move out of the marketplace,” Weber said. “You'll have continuous coverage one way or the other.”
The individual must notify their provider of any life-changing event.
The ACA forbids any exclusion based on preexisting conditions. If a person has a life-changing event such as job loss, they can enter the insurance marketplace at any time.
• Everyone must have insurance by 2014
“You have a responsibility to contribute your fair share to the pool,” Weber said Thursday.
People who can afford coverage but choose not to purchase any insurance plan will face fines. Those with yearly income below $10,000 are exempt from the penalty.
In 2014, an individual faces a $95 penalty for every adult in the household and half that for every child. In 2015, the fee goes up to $325 per adult and in 2016 the penalty raises to $695.
“We are trying to get people in the habit of buying insurance,” Weber said.
Visit the Kaiser Family Foundation at www.KFF.org for in depth ACA analysis and important information.
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