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Answering Questions About The Affordable Care Act

(via Flickr/Jennifer Boriss)

Sign-up for major provisions of the Affordable Care Act, also known as ObamaCare, begins October 1st.

With less than three months before marketplace exchanges for health insurance go online, many questions remain about who is eligible, what the requirements are and what kind of penalties people and businesses may face if they or their employees continue to be uninsured come January 2014.

NPR's Julie Rovner put togethera piece answering some of those questions.

But we wanted to know how the exchanges will specifically affect people in Missouri and Illinois. Guests Sidney Watson, J.D. and Professor with the Saint Louis University Health Law Policy Center, Lance Weiss, CPA with SFW Partners, LLC and Cynthia McCafferty, Senior Vice President and Partner with FleishmanHillard joined us today to help provide some clarity on the issue.

The biggest differences between Missouri and Illinois, said Watson, are who will be running the marketplace exchanges in each state and whether or not the state will have expanded Medicaid coverage. Missouri's exchange will be run by the federal government while Illinois will implement its own exchange. Illinois has also chosen to expand Medicaid while Missouri so far has not.

"Come January 1st we should have close to a million uninsured people here in Missouri eligible for new coverage," Watson said. "A little more than half of them will be able to purchase plans on the exchange, about 80 percent with new premium tax credits to help with affordability. But about half of the uninsured here in Missouri are eligible for that Medicaid expansion. So we are leaving a lot of people behind."

“Moving into setting up the exchanges, we know that about 78 percent of the uninsured who are eligible for this new coverage don’t know about it yet. So the biggest challenge right now is getting the word out,” Watson added.

The state of Illinois has a $35 million contract with FleishmanHillard to market and promote its health insurance exchange.

CPA Lance Weiss of SFW Partners, LLC explained the delayed penalty for employers with 50 or more employees.

“An employer could have been charged a penalty under two different situations," Weiss said. "Either they should have been providing insurance and weren’t, or they are providing insurance but it’s not good enough or it’s not cheap enough.”

Once the penalties go into effect in January 2015, employers with 50 or more employees will be charged a $2,000 penalty per employee that should have been provided insurance but wasn't and $3,00o per employee that was provided insurance but it cost more than 9.5 percent of the individual's income or was inadequate in its coverage.

Weiss and Watson agreed that pushing the penalties back a year were a "win for everyone" to allow time for further clarity on definitions of employees and employers. They noted that there is particular concern among the service industry, which typically does not offer healthcare.

For further understanding of your eligibility and possible penalties, Weiss and Watson recommended several websites. Weiss suggested www.sba.gov for businesses, especially to find a tool that estimates premiums in your area, and theKaiser Family Foundation website. Watson recommended monitoring the healthcare.gov website periodically, both to see where you stand now and to be aware of any changes that might occur. 

Missourians can also go to www.healthcare.gov to sign up for health insurance coverage. Since Illinois is running their own marketplace exchange, they will have a different website. Currently, information about the exchange in Illinois can be found at www.insurance.illinois.gov.

St. Louis on the Air provides discussion about issues and concerns facing the St. Louis area. The show is produced by Mary Edwards and Alex Heuer and hosted by veteran journalist Don Marsh.

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