New insurance laws loom

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What to expect under Affordable Care Act provisions

By Terri Likens, Editor

In about six months, every man, woman and child in the United States will be required to have health insurance under the Affordable Care Act.

Can you and your family afford it?

What options do you have?

And what are the penalties if you don’t, say, get with the program?

A representative from a new kind of health insurance entity was in Roane County recently to help dispel some of the fog.

Lisa Preiss works with Community Health Alliance, a new company based in Knoxville.

Community Health Alliance is one of a new breed of nonprofit health insurance companies set up under the Affordable Care Act with the intent to give mainstream corporate insurers some healthy competition.

In the new health-care vernacular, Community Health Alliance is a CO-OP, short for Consumer Operated and Oriented Plans.

Tennessee was able to get a federal loan of $73 million to set up its CO-OP. Some states did not get such loans, either failing to apply in protest of the new law or by waiting until congressional sequestration set in and the money was not available.

According to Preiss, only 24 states have CO-OPs, which will operate much like credit unions: They will be member-governed, and profits will be rolled back into the program to offset enrollee premiums or offer wellness incentives to their customers.

“We’re here to transform the health-care delivery system,” Preiss said, speaking before a roomful of representatives from charities, nonprofits and social service agencies at a Roane County United Way interagency meeting.

Preiss, a community relations manager with Community Health Alliance, is part of a team that expects to have a full calendar of speaking engagements to get the word out before the enrollment period begins on Oct. 1 of this year.

“It really is a new era,” she said. “And not just in Tennessee, but for the whole country.”

Community Health Alliance’s target customers aren’t just individuals, but also small businesses, which fall under a whole new set of rules for offering health insurance under the new law.

Customers are expected to enroll through a regulated health insurance marketplace, formerly referred to as exchanges.

The marketplace will offer a standardized set of government-regulated health insurance plans.

One of the benefits of the marketplace is that customers will easily be able to compare the costs and benefits of their options — a feature that even critics of “Obamacare” have embraced.

“When they go online, people should be able to see apples to apples,” Preiss said.

Who will be turning to the marketplace for insurance?

About 1 million Tennesseans who are currently uninsured, Preiss estimated.

Since many of those people don’t have insurance because they don’t believe they can afford it, how will they be able to manage it under the new law?

Preiss noted that health insurance through the marketplace will be subsidized in several tiers for people who are at or near the poverty level.

Tennessee’s current state insurance will cover those who are at or under 100 percent of the poverty level. That’s about 400,000 residents.

People whose incomes are up to four times the poverty level will receive subsidies to help pay for the insurance through the marketplace. Preiss estimates about 475,000 will fall in this group.

Another 50,000 or so Tennesseans whose incomes are more than 400 percent of the poverty level are still expected to turn to the marketplace for health insurance, she added.

What if an individual fails to get the insurance as required under the law?

That person will face fines that are relatively low — less than $100 — the first year, but are expected to soar quickly after that.

The Affordable Care Act is a major social experiment, and there are still a lot of unknowns at this point, Preiss acknowleged.

“We are getting new information each day,” she said.