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Health Law Professor Answers Questions About Affordable Care Act

Adrian Clark | Flickr

Less than a month into the Affordable Care Act’s open enrollment period, there are some questions, but nowhere near the problems that were seen a year ago at this time.

“Compared to last year, it is going much smoother. The first day, about 500,000 people logged on and 100,000 people actually signed up for coverage, compared to last year when it took us over a month to get the website working,” said Sidney Watson, a Saint Louis University Health Law Policy Center professor.

Open enrollment ends on Feb. 15. Those who sign up for coverage before Dec. 15 will have coverage on Jan. 1. Those who sign up after Dec. 15 may have to wait up to 6 weeks for coverage to begin. Health insurance seekers can “window shop” for plans at healthcare.gov

“All you have to enter is your ZIP code, some questions about your age, your income,” Watson told “St. Louis on the Air” host Don Marsh on Thursday. “You can see all the plans — get an idea of what’s out there. Then, if you want to go back and shop seriously, you can go in and get a password and a personal account.”

Overall, people who signed up last year are satisfied with their insurance plans, Watson said. A November Gallup poll found that 74 percent of those who signed up last year through the government exchange were satisfied with their plans. Saint Louis University students interviewing people who bought plans last year, Watson said,  have heard “glowing reviews.”

Also in November, Gallup revealed that only 37 percent of Americans say they approve of the health care law; 56 percent disapprove.

A case before the U.S. Supreme Court, King v. Burwell, could change the health care marketplace in Missouri.

“It challenges the ability of the marketplace here in Missouri and other states that use a federal marketplace to be be able to supply people with discounts,” Watson said. “These are federal premium tax credits that bring down the cost of health insurance in the marketplace for people who earn between 100 and 400 percent of poverty — that’s families earning up to about $95,000 a year for a family of four.

“It keys into about five words in the Affordable Care Act, which say that these premium tax credits will be paid by state exchanges. The argument is that Congress did not mean to include the federal exchange. Some of the congressional staffers who worked on drafting the Affordable Care Act have said no, the intent was that the federal marketplace be able to pay these premium tax credits. Some of the congresspeople who were involved in drafting the law have said the same thing.”

At fault: Sloppy grammar, Watson said.

“Every bill goes to a conference committee and part of the conference committee process is doing that line editing, the polishing on the grammar, and that just didn’t happen on the Affordable Care Act,” Watson said. “A lot of these grammar issues have been worked out through administrative rules, and actually the Internal Revenue Service has issued a rule saying that when you look at the entirety of the Affordable Care Act, the intent was to allow the federal exchanges to pay premium tax credits.”

If the high court rules that the law does not include the federal exchanges, Congress can amend the act to add clarification.

“That is going to be the real test, because the rest of the Affordable Care Act does stay in place — the new rules of how premiums are priced, rules that insurance companies can’t turn people away, the marketplace continues,” Watson said. “The question of taking these discounts away from over 100,000 Missourians, from millions of Americans nationally, I think we will put Congress to the test.”

Navigators, Rising Costs And Taxes

One of the complaints this year: Cost. Many plan prices have increased.

“But they’ve not gone up the way we saw them going up in the past,” Watson said. “Nationally, the plans have gone up a little more than 3 percent. That’s good news because before the Affordable Care Act we saw plans going up over 10 percent a year.”

Most people who signed up for a plan last year will not have to re-sign this year; most will be automatically re-enrolled. But there may be better choices this year, Watson said.

“Last year we had two insurance companies selling in Missouri; now we have four,” she said. “Last year in St. Louis, we had 22 (to) 25 plans on the marketplace; this year we have over 40.”

There’s also a difference in plan types this year.

“Here in Missouri, last year all the plans offered in the market are what we call PPOs, preferred provider organizations,” Watson said. “If you go to a doctor or hospital that in your network, you get better coverage but you can go to any doctor or hospital and the insurance will pay a little bit.

“This year we’ve got about seven plans that are closed networks. So if you choose one of those plans, if you want your insurance company to help you out, you’ve got to stay in network. That kind of detail shopping is going to become more important.”

Certified health care navigators are available to help with those details, which Watson endorsed.

“They are people who have lots of experience looking at these plans,” she said. “They can help you quickly find out if your doctor is in a particular network, if your prescription drugs are covered by a particular plan. They’re the experts. They are all employees of not-for-profit organizations. They are not being paid by a particular insurance company to steer business in a certain direction. They are there as public servants to help us out.”

To contact a navigator, call 800-318-2596 or visit  localhelp.healthcare.gov or, in Missouri, covermissouri.org.

Those who did not have health insurance for 2014 face tax penalties.

“I think we’ll be hearing a lot from people when we get to tax-filing season — when they realize there are questions on the 2014 tax returns about ‘Did you have health insurance in 2014?’ and if not, what kind of penalty,” Watson said.

For 2014, the penalty is 1 percent of the reported income or $95, whichever is greater.

“There are a number of exemptions: If you have a hardship; you have a religious objection to having health insurance. But we’re going to be thinking about this at tax time,” Watson said.

“St. Louis on the Air” discusses 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. Follow us on Twitter: @STLonAir.

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