BOISE -- The biggest change to health care in decades is coming in just a few months. The Affordable Care Act will affect almost every Idahoan, and almost every health insurance plan.
KTVB took an in-depth look at how the insurance exchange will impact you, your family, and the local businesses you shop at.
IDAHO'S INSURANCE EXCHANGE
On March 23, 2013, Idaho passed legislation to create its own, state-run insurance exchange, instead of choosing the federally run option.
After much debate, senators approved the plan by a vote of 23 to 12.
The bill includes competitive bidding requirements for contractors seeking to run the exchange, gun rights protections for participants, and a 19-member board that must meet publicly.
WHO WILL USE THE EXCHANGE?
The exchange will be targeted at individuals needing more affordable health insurance options.
We talked with Daniel Hickman. He's one of the many who are confused and concerned about how the exchange will work and how it could affect his family.
I can't afford it right now, plain and simple, bottom line, said Hickman, describing the cost of health insurance.
Hickman is a single father of two teenage girls, and turns 40 this year. He tells KTVB he's been uninsured for decades.
He's just one of nearly 300,000 Idahoans living without medical coverage. However, that could change.
We showed Hickman the estimates for insurance plans in the exchange for a family like his.
Yeah, that's quite attractive for a lot of people. As a matter of fact I think I could swing that, said Hickman in response.
While Hickman was impressed by estimates of the premiums prices, he was upset about the requirement that every individual have insurance, or else pay a penalty.
I don't like the penalty, that's unfair to everybody, to make people pay for something they are not even using, said Hickman.
WHY THE EXCHANGE IS NEEDED
Dr. Ted Epperly works at the Family Medicine Residency of Idaho. He treats around 20,000 uninsured patients every year.
I think most people really do want some sort of insurance, said Epperly. It's a matter of cost and a matter of affordability.
Dr. Epperly supports the exchange and thinks it's exactly what's needed for a healthier Idaho.
I think we are headed in the right direction. That's the key piece. I think the nation has done quite a bit to make sure people get covered, and that's important, said Epperly.
He says the law will help many low income workers living without options.
Dr. Epperly says many of his patients are holding down two jobs trying to make ends meet, choosing food for their families over medical coverage.
You're just living sicker. You're taking chances. You're risking medical bankruptcy. You're dying younger, said Epperly.
HOW THE EXCHANGE WILL WORK
While the Affordable Care Act requires that everyone have medical coverage, there is no requirement to use the exchange.
Insurance companies will still offer plans outside the exchange, along with the option to offer four levels of plans inside the exchange.
The plans on the exchange will include platinum, gold, silver, and bronze options.
It's an online marketplace so you as a consumer have the information at your fingertips to compare plans, says Corey Surber.
Surber is the Director of Community Health Initiatives for Saint Alphonsus Health System.
She says the best example of what the exchange will look like is a travel website where different companies offer different choices at different prices, showing an easy comparison for consumers.
The federal government will also offer discounts on a sliding scale, depending on your family's income.
Families making between 133 percent and 400 percent of the federal income poverty line are eligible. That equals an income of nearly $30,000 for a family of four, to nearly $90,000.
The less your family makes, the bigger your discount will be.
If you are at the poverty level, at that very bottom eligibility for premium discount, then it's very significant, says Surber.
We're told those who already have health insurance through their employer won't be affected by the exchange.
IMPACT ON YOUR PREMIUM'S PRICE
There is another significant piece of the Affordable Care Act that will impact everyone's health care, the new essential health benefits will be required in each and every plan, including:
- Ambulatory patient services
- Emergency services
- 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 management
- Pediatric services
However, bigger plans mean bigger premiums for almost everyone.
You can't offer a more generous package of benefits without having additional costs, said Shad Priest.
Priest is with Regence Blue Shield of Idaho. He says prices will jump different amounts depending on your age and condition, but most people will see a significant increase.
They are estimating between 27 percent and 55 percent increases in health plans, said Priest.
Priest says in Idaho, prices will rise even higher, since rates throughout the state are typically lower than average.
He says premiums will stay pricier, unless health care expenses drop.
Priest said, It didn't do hardly anything to address the cost of health care that drives insurance rates.
We wanted to know how the insurance companies' plans will be regulated in Idaho, and went to the state's department of insurance.
Director Bill Deal says they will oversee all coverage options.
Be sure that the rates in particular meet Idaho code and statute as well as the requirements through the affordable care act, says Deal.
EFFECTS ON LOCAL BUSINESSES
The health care reform will also affect many small businesses throughout our state.
Companies with 50 or more full time employees will be required, under federal law, to offer health insurance to all full-time employees.
Sylvia Hampel started Clearview Cleaning 17 years ago, and is worried about her company's future under the new rules.
We employ a lot of people here, and I don't want to have any of them lose their jobs because of some government regulation, said Hampel.
Hampel employees exactly 50 full-timers, along with 200 part-time workers.
For her, it's going to be a big burden to the company's bottom line. That's because right now, she only offers benefits to about 10 workers, all at the management level.
If you just think about 50 employees at $200 a pop, that's $10,000 a month. That's an enormous hit for a commercial cleaning company, says Hampel.
If a business doesn't offer the required coverage, it will be penalized.
If that large employer provides coverage, that coverage has to be affordable to the employee which means it can't be more than 9.5 percent of their household income, their share that they pay for that plan, said Priest.
Priest says there will also be new reporting requirements for all employers. He says the process will involve exact calculations regarding the hours that employees work.
This is a big deal. If you are an employer out there and you've got 50 or more employees, you need to be looking really hard at this right now, says Priest.
Yet, Hampel says many business owners like herself are still confused about exactly what the affordable requirements will mean for their company.
She says while she supports offering medical benefits, it simply doesn't make sense for all employees and all businesses.
However, Dr. Epperly says requiring employers to offer insurance is what low income employees need.
This is exactly the sort of thing we need to start doing to have a healthier Idaho, Epperly said.
Hampel says the law will effect more than just the thousands of employers in Idaho but stretch to those buying the products or services as well.
Obviously if I'm having to pay more to run this company, I'm going to have to charge more for my services, so it just kind of all trickles to everybody, says Hampel.
For more information on the Affordable Care Act and the health insurance exchange, you can visit the following sites: