What Texans need to know about the health insurance marketplace

Texas Press Reports —

With the launch of new health insurance exchanges just about two
weeks away, many of the questions in this month's mailbag focused less
on the big picture and more on exactly how the law will operate for

We can't answer every question we get. But here is a sampling of
questions that were really popular, or that would apply to a lot of

One of those questions came from Melanie Wilson of Kittery, Maine.
“I'm self-employed and my yearly income varies widely from year to
year,” she writes. She wants to know if the subsidies available for
health insurance premiums will be based on gross or net income. “Since
I'm self-employed I have a lot of deductions, so my gross looks good but
at the end of the year the net can be pretty minimal.”

The subsidies, which are available to those earning between 100
percent and 400 percent of the federal poverty level, are based on your
modified adjusted gross income, or MAGI. That includes things like wages
and interest, less deductions like tuition and alimony, and additional
payroll taxes paid by the self-employed.

You'll be asked to estimate what your income will be for next year;
if you're wrong, you'll have to reconcile with the IRS come tax time the
following April.

Francis Sheridan of Anchorage, Alaska, is curious about young people
who opt to pay the tax penalty rather than purchase health insurance,
which is an option under the law. “My question to them is when some of
you, which will happen, are seriously injured or incur other health
care, who's going to pay your health care bills?”

If you don't have insurance, you'll get a bill, just like now. If
you can't pay, the hospital or other health care provider will still try
to collect from you, although there are some provisions of the law
aimed at discouraging some of the most aggressive collection tactics
that have been used in the past.

If they don't collect, the health care provider would have to eat the
cost. That's why hospitals were so anxious to have most people covered
by insurance, so they could stop having to provide so much free care to
people who couldn't pay.

The Texas Medical Association also is answering questions about the
health care law as the insurance marketplaces are set to open Oct. 1.

What exactly is this Marketplace, and why should I care?The
Affordable Care Act requires most individuals to have health insurance
in 2014. So the law requires that so-called health insurance exchanges —
now referred to as marketplaces — be established in every state as
another avenue for individuals to purchase private health insurance on
their own.

Most people get insurance through their jobs. But if you don't have
that option, you can shop in the marketplace instead of buying directly
from insurance companies. Or maybe you have a certain condition that in
the past prevented you from getting health insurance because it was too
expensive or simply hard to get. Now, you will have options in the

Changes under the ACA also require all private health plans to
provide a minimum package of “essential health benefits,” which include a
basic set of services like physician visits, hospital and emergency
care, preventive services like vaccines and screenings, and prescription

So any health plan you purchase on the exchange must cover these
services, and they cannot deny you coverage because of a preexisting

Instead of having to search out health plans on your own, the
marketplace is designed to be a one-stop shop where you can go online to
check out your coverage options in one place, get easy-to-understand
information, and compare plans before you make a decision. Kind of like
Orbitz or Travelocity, but for health insurance instead of travel.

You can also find out right then and there if you qualify for a tax
break on your private insurance premiums — another feature of the health
reform law — or for state programs like Medicaid or the Children's
Health Insurance Program.

The time to sign up for plans offered in the marketplace is approaching:

Open enrollment is slated to begin Oct. 1 for coverage beginning Jan.
1, 2014. Unless you qualify for an exemption under the federal law, you
must get insurance starting Jan. 1 or you could have to pay a fine.

Where can I get more questions answered?Because Texas
chose not to launch its own marketplace, the federal government will run
the exchange here and serve as the main resource for information and

Right now, you can visit Healthcare.gov and CuidadoDeSalud.gov. to
find checklists, videos and other resources to get ready for open
enrollment, although actual plans and price comparisons won't be
available until Oct. 1.

That's when you'll actually apply, too, but you can get ready now. A
toll-free call center is available to help answer questions 24/7 at
800-318-2596. There also will be people in your community known as
navigators to help with the enrollment process beginning in October.

Blue Cross and Blue Shield of Texas also launched a campaign called
Be Covered Texas to help Texans understand the federal health reform law
and navigate the new insurance marketplace in Texas. Call 866-427-7492
Monday through Friday 8 a.m. to 5 p.m. or go to BeCoveredTexas.org.

If you have questions about insurance you already bought in Texas or
receive through your employer, contact the Texas Department of
Insurance at 800-578-4677 or tdi.texas.gov/index.html.

If you think you are eligible for Medicaid or CHIP, contact the
Texas Medicaid Program at 800-252-8263 or hhsc.state.tx.us/medicaid/.

Where can I find out more about the Marketplace?There
is a lot of information out there that can be difficult to sort through.
Here are a few resources we have found helpful on the insurance
marketplace, what to expect, and how to sign up:

• Healthcare.gov is the federal government's official website for
consumer information on the marketplace and the health care law overall.

• Another federal resource with explanations; checklists; and
official forms, applications, and language materials, for instance, is http://marketplace.cms.gov/.

• BeCoveredTexas.org is an English-Spanish website that BCBSTX set up
to help Texans understand how the marketplace will work in this state
and to get signed up. The site offers materials like printable fact
sheets on the marketplace and the health reform law and checklists.

Gov. Perry directs HHSC to pursue Medicaid block
grantGov. Rick Perry is preparing for yet another battle in his war
against Obamacare.

In a letter to the state's health agency on Monday, the governor
laid out his plan to request a federal waiver to reform Medicaid as
Texas sees fit — without expanding eligibility.

“Seemingly, the president and his administration are content to
simply throw money at a problem and hope that any problems will resolve
themselves,” Perry wrote in a Monday letter to Kyle Janek, the executive
commissioner of Texas' Health and Human Services Commission.

response, and the response of the Texas Legislature, has been crystal
clear: Texas will not expand Medicaid under Obamacare.”

Instead, Perry has asked that the agency request flexibility in the
form of a block grant — a fixed amount of money, rather than matching
dollars for Medicaid services — from the federal government to
fundamentally reform Medicaid.

Specifically, Perry requested that the agency seek a waiver that
allows the state to make changes to the program without receiving
federal approval, continue asset and resource testing to determine
eligibility, and initiate cost-sharing initiatives, such as co-payments,
premiums and deductibles, among other reforms.

The waiver “should give Texas the flexibility to transform our
program into one that encourages personal responsibility, reduces
dependence on the government, reins in program cost growth and
efficiently improves coordination of care,” Perry wrote.

The conservative Texas Public Policy Foundation laid out a similar
plan to reform Medicaid with a block grant during the 83rd legislative
session. Some Republican lawmakers also included similar provisions in a
proposal to reform and expand Medicaid eligibility to include
impoverished adults, a measure that failed to receive legislative
approval. Neither Perry nor TPPF endorsed that proposal.

In the current system, Texas receives roughly $60 in federal
matching funds for every $40 the state spends on Medicaid services. If
Texas reached an agreement with the federal government to finance
Medicaid through a block grant, the state would receive a

predetermined amount of federal financing to run the program. By
comparison, if the state expanded Medicaid under the federal Affordable
Care Act, the federal government would cover 100 percent of Medicaid
expansion enrollees' health care services for three years, then slowly
reduce the matching rate to 90 percent.

In a second letter sent to HHSC on Monday, Perry requested that the
agency develop a mechanism to continue collecting and analyzing income,
asset and resource information on Texans who apply for Medicaid
benefits. That's despite a provision in the Affordable Care Act — one
that takes effect on Jan. 1 — that requires the state to stop asset
testing to determine Medicaid eligibility.

Conservatives argue that asset testing is essential to prevent
Medicaid beneficiaries from hiding their assets, such as cars or a large
home, in order to qualify.

But health care and social welfare advocates argue that asset testing
contributes to the cycle of poverty, because the moment people earn
enough money to cover transportation or a home, their health benefits
are knocked out from under them.

The rule change has presented a problem for Texas. Although the
state won't stop asset testing until the rule takes effect on Jan. 1,
the federal government plans to roll out an online marketplace on Oct. 1
to help Texans figure out if they qualify for Medicaid and shop for
health plans.

If an applicant enters their financial information on the federal
website and finds out that they qualify for Medicaid, the applicant
would still need to send additional information on his or her assets to
the state until January.



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