National health care reform rolled out Oct. 1, leaving some confused about if and how things will change, and others lost in the details of premiums and health insurance exchanges.
On the Vineyard, the staff at Vineyard Health Care Access is at the front lines, fielding calls from residents, receiving training on the new law, and answering questions about how things will change with the Affordable Care Act. The answer, executive director Sarah Kuh said this week, is not too much.
“A lot of people think it’s going to change everything for everyone and that’s not true,” Ms. Kuh said at her office on Wednesday. She added that while the impacts vary by circumstance, “most people are not impacted by the Affordable Care Act.”
President Obama signed the Affordable Care Act into law in 2010. The program is similar in many ways to Massachusetts’s health care reform: it mandates insurance coverage for individuals, provides subsidies for individuals falling below certain income levels, and creates health insurance exchanges or marketplaces where people can purchase insurance plans.
Health insurance is a perennial issue on the Vineyard, which has a largely seasonal economy and small business employers, Ms. Kuh said. State and federal agencies do not have offices here, and it is costly and time-consuming for people to go off-Island to get help.
So a staff of five, working out of an office on New York avenue in Oak Bluffs, is a one-stop shop in a lot of ways, Ms. Kuh said. They help people get access to insurance, answering questions and helping to cut through confusing or complicated requirements and paperwork. They also help with disability claims, Medicare, dental care and other types of assistance.
The program does not have state or federal funding. It is run by Dukes County, and receives financial support from all the Island towns.
“We’re fielding a lot of calls from people who are calling to ask if things change or if they qualify for something,” Ms. Kuh said. “It’s been busy, but all of us expect the pace to really pick up in November, December.” That’s when the websites where people can check for coverage options will begin working better, she said, and people will come in with more questions about their options.
Most people who receive health insurance through their employers will not be affected, she said, nor will most seniors on Medicare.
“To some degree, there are more calls about people who already have insurance wondering if they need to do anything,” she said. “Usually the answer is no.”
In Massachusetts, changes are in store for those enrolled in Commonwealth Care, a state-subsidized insurance program for those with low or moderate incomes. This program will end Dec. 31, requiring people on those plans to transition to new, similar programs via the Massachusetts Health Connector. People on those plans will receive reminders that they need to reapply by mid-December, Ms. Kuh said, and should see little change in their coverage.
“Sometimes people panic when they hear their current plan is ending,” she said, but she emphasized that it will be a one-time switch and the benefits and premiums will be similar.
A big group who may see a benefit of the Affordable Care Act, Ms. Kuh said, includes those who make too much to qualify for health care assistance but do not make enough to easily afford payments. The threshold to qualify for assistance is increasing from 300 per cent of the federal poverty level to 400 per cent. Those within that limit may qualify for discounts on insurance if purchased through the Massachusetts Health Connector, Ms. Kuh said. The assistance comes in the form of tax credits.
“People who did not get help but find it hard to pay will now be able to get different kinds of help paying for premiums,” she said. There are likely a few hundred people on the Island in this category.
Some college students may also be able to switch to a less expensive plan through the health care exchange, she added. Dental care will also be affected, she said, as people can now shop for pediatric and adult dental insurance.
Changes go into effect Jan. 1, and open enrollment for the Massachusetts Health Connector runs through March 31. Ms. Kuh said there have been some noted glitches with the website for the state exchanges.
“It’s a pain in the neck but let’s not lose sight of the fact that people have until the middle of December to apply for changes that don’t take effect until January,” she said.
In fact, she encouraged people who think they might fit the criteria to wait until November to visit the website when the bugs will be out of the system.
Ms. Kuh said she wasn’t sure if some would see higher health insurance costs. “I think it’s unlikely,” she said, noting that Massachusetts has mechanisms in place to cap how much premiums can increase.
As a requirement for the Affordable Health Care Act, the staff at Vineyard Health Care Access was trained as certified application counselors, so they are authorized to help people apply through the exchange program. Training includes weekly updates from people at the state level.
“We always encourage people to try to go on the website and try on their own,” she said, but the staff is available for those people who need assistance. A state connector customer service line is also available for people who have questions or want to find out if they qualify.
Massachusetts’s earlier health care reform has been helpful, she said, because the insurance marketplace already exists in Massachusetts.
“I do think it was helpful that we had the experience and programs in place because it isn’t like we were starting from scratch.”
“We kind of had our excitement in 2007” when the state health reform went into effect, she said. “My recollection, when we did this in 2006 and 2007, it was hugely exciting and unbelievably gratifying to be able to help people who didn’t have health care because they couldn’t afford it before,” she said.
She said there is extra satisfaction in helping people get insured who really need coverage.
“It really validates the work that we do, seeing what we’re doing here happen at a national level,” she said.
“Our little community, five people working here to navigate the bureaucracy for our little community, it’s great to see that there’s acknowledgement that people need this, and are finally getting to do something about it in other states as well.”