Decoding Obamacare: A Guide to New Healthcare Marketplaces Designed to Help 48 Million Uninsured
The following content originally appeared on DemocracyNow!:
As Republicans try again to block the implementation of Obamacare, the major part of the Affordable Care Act is about to take effect. Individuals seeking health insurance under Obamacare will be able to enroll online through new federal marketplaces beginning October 1. The marketplaces are primarily designed to serve the 48 million Americans without health insurance and those who buy insurance on their own. To help navigate the new system, we speak to Elisabeth Benjamin, Vice President of Health Initiatives of Community Service Society of New York. “When you go to the marketplace, you will be able to put in your information and it will give you a very small selection of plans. You will have choices, but the choices will be standardized. You will be able to do a real comparison — you will know exactly how for example Aetna compares with Empire or Blue Cross Blue shield,” Benjamin says. “So for the first time, purchasing health insurance will be on a level playing field, which is remarkable for consumers.”
This is a rush transcript. Copy may not be in its final form.
JUAN GONZÃLEZ: As Republicans try again to block the implementation of Obamacare, the major part of the Affordable Care Act is about to take effect. Individuals seeking health insurance under Obamacare will be able to enroll online through a new federal marketplaces beginning Tuesday, October 1. The marketplaces are primarily designed to serve the 48 million Americans without health insurance and those who buy insurance on their own. Earlier this week, the White House unveiled new figures showing most health care premiums will cost less than previously the projected. The average mid-tier plan will cost $328 a month with most qualifying for government subsidies to lower that price. Meanwhile on Capitol Hill, Republican Senator Ted Cruz of Texas held a quasi-filibuster against what has come to be known as Obamacare.
SEN. TED CRUZ: And anyone who is trying to make this a battle of personalities is trying to change the topic from the topic that should matter. Whether or not Obamacare is helping the American people. Mr. President, if you focus on the substance, the evidence overwhelming, this law is a train wreck.
JUAN GONZÃLEZ: On Thursday, President Obama mocked his Republican opponents and vowed to stop attempts to get the program bogged down in an ongoing budget stalemate.
PRESIDENT OBAMA: Now, of course, the closer we have gotten to this date, the more irresponsible folks who are opposed to this law have become. Some of the same Republicans who warned three years ago that this law would be Armageddon. That is what they said, Armageddon. Now, they’re threatening steps that actually would badly hurt our entire economy, not because of the Affordable Care Act, but, because of what they’re threatening to do. Some have threatened a government shutdown if they can shut down this law. Others have actually threatened in economic shutdown by refusing to pay America’s bills if they can’t delay the law. That is not going to happen as long as I am president.
JUAN GONZÃLEZ: Under the new health care law, everyone must be enrolled in a health insurance plan or pay a penalty by next year. With the opening day for the health insurance — for the health exchanges less than a week away, many people still have questions about how the program will work.
AMY GOODMAN: Here in New York, people looking for health insurance will be able to turn to a network of agencies around the state to help them enrolled. One of the partner organizations is the Community Service Society of New York. To walk us through what will happen here and throughout the country, we’re joined by its Vice President of Health Initiatives, Elisabeth Benjamin. Welcome toDemocracy Now!, Elisabeth. You’re chosen as one of — you’ve been qualified as one of thousands of navigators throughout the country who are officially empowered to help people. So, what happens on Tuesday, October 1?
ELISABETH BENJAMIN: What happens on Tuesday is the state-based exchanges and the federally facilitated exchanges, or what we now call marketplaces, will be open for business. That means there will be these websites, essentially, there’s one giant one for the entire country — it’s at www.healthcare.gov — will be open and people will be able to put in some basic information about themselves and who lives with them and set up a little account, a little username and an ID, then they’ll set an–put in information about themselves, their family. They’ll indicate if they have a Social Security number or not. They will put that in. They’ll put how much their income is roughly, and then they will be processed and determined whether they are eligible for financial aid to buy health insurance. And then they’ll — once they decide they’re eligible for financial aid to buy health insurance, then they can select between the different plan options that are out there. So, basically, people will be able to start shopping for health insurance in a way that does apples to apples comparison.
JUAN GONZÃLEZ: Now, you mentioned in the state exchanges and the federal exchanges. Could you explain the difference? Where the states are running them as opposed to the federal government and why?
ELISABETH BENJAMIN: Sure. There’s 17 states that have decided to move forward with the implementation of the Affordable Care Act. There’s seven states that are sort of half-way implementing it, and another 17 — I’m sorry, another 27 that are just saying, we don’t want anything to do with this. We’re going to let the federal government come in and run the marketplace for our state. No matter where you are, you will be able to get a wide selection of insurance carriers and you will be qualified for financial aid. In New York, three quarters of the people who go to the marketplace will be eligible for some kind of financial aid to purchase commercial health insurance.
AMY GOODMAN: So, here you are, you go on this website, and you just said, once you put in all of your information, you then choose the insurance you want. I mean, that sounds, to say the least, extremely daunting. How on earth — I mean, first of all, how many choices to people have in New York and all over the country? How on earth can you figure out what you want?
ELISABETH BENJAMIN: The amazing thing is, it won’t be daunting anymore. It’s exactly the opposite. Right now, if you are a small business and you wanted to shop for health insurance on the open market in New York State, you would have a choice of 15,600 products. That is overwhelming. That is complicated. When you go to the marketplace, you will be able to put in your information, it will give you a very small — it will give you a selection of plans, you will have choices, but the choices will be standardized. You will be a able to do a real comparison. You will know exactly how, for example, Aetna compares with Empire or Blue Cross/Blue Shield. For the first time, purchasing insurance will be on a level playing field, which is remarkable for consumers. So, it’s almost the opposite. It’ simpler now.
JUAN GONZÃLEZ: Elisabeth, now, you mention small businesses. There have been some, obviously, kinks in the rollout of the program and some information, that for instance, Spanish-language information will not be available yet for several weeks? And also, information on small businesses, has that been delayed as well?
ELISABETH BENJAMIN: No. What is really great for small businesses, there was never a mandate. There was never a stick or requirement for a small business — and a small business is actually quite large, it’s less than 50 employees, and that’s common-law employees. So, you could have 80 employees, half of them are halftime or whatever. You still qualify as a small business. There is no mandate. There is no stick or requirement for them to offer coverage to their employees. What there is, however, is this incredible opportunity of 50% tax credit. That means, for example, say we have Bob who owns a body shop. He has seven employees that make $24,000 a year. He lives in Queens. He is not paying very much money, but his workers are low-wage. He can have the federal government pay 50% of the $16,000 insurance tab for that small business. So, 50%, $8,000 just the federal government will write. That’s a big carrot. And the rest of it, the other $8,000, he can deduct from any income taxes he has or profit taxes that his business has. So, it is an extraordinary incentive for small business. If you are someone that has two or more employees, I really encourage you to go what they’re called small business or marketplaces or shop exchanges is sometimes the other words we use for them. There will be one of the federal level but there’s also one in a lot of the states that are moving forward, and shop through there. What has been delayed was the mandate on large employers to either offer coverage or pay a penalty. Now, that is not so important for the simple reason that 95% of all large employers already are offering coverage. And most large employers offer coverage, why? Because that is how you maintain good employees. So, we don’t really think the delay of the mandate is that significant of an issue. What’s really exciting is that there’s incredible incentives for small businesses.
JUAN GONZÃLEZ: Also, the issue of, you mentioning large businesses that already supply insurance. Are there provisions for tax credits for employees who are receiving health insurance but maybe their premiums that they’re being offered are too high? Not just the 48 million who are uninsured, but actually people who are currently insured?
ELISABETH BENJAMIN: Some employers do offer coverage, but it’s extremely — the employee portion, what comes out of your check every two weeks, is extremely expensive. If that insurance is over 9.5% of your gross income, your gross wages, you can then say, forget it, I’m not taking my employers offer of coverage, my job based insurance, I’m going to go into this marketplace and get a big old tax credit or financial aid and get insurance through the marketplace. So, that is super good.
AMY GOODMAN: And this issue of the Associated Press reporting that the Spanish language version of the healthcare.gov site will not be ready for several weeks?
ELISABETH BENJAMIN: I believe it will be up shortly. It takes a lot. It is a big project. They are working as hard as they can. The best IT minds in the country are working both on the federal exchange and here in New York. I think it will be bilingual shortly.
AMY GOODMAN: And if you don’t have access to a computer, what do you do?
ELISABETH BENJAMIN: Well, that’s where people like me come in. So, what we are called — certify —- we’re navigators. And we are certified in New York State. We have been through a very comprehensive three-day training. We are the place you can go for absolutely neutral, independent assistance enrolling into this marketplace. So, you can come to me. I can sit with you with a laptop. I can go to your home. I can sit down with you and walk you through the process. Explain -—
AMY GOODMAN: You personally or your organization?
ELISABETH BENJAMIN: I am certified. But, my organization, we have, I think 10 of us already certified. And we have a network of 40 other groups, 17 of which are Chambers of Commerce around the state of New York, who are certified help either small employers or individuals go through this process. What is great about these navigators, and we’re all over the country, every single state has them, is that we are absolutely neutral. We are not on commission from an insurance company. We have no opinions about whether one insurance company is better than another. We’re just going to help you through the enrollment process. We’re going to figure out which insurance companies offer your hospitals, your doctors, how they — we can tell you how they rate on the quality ratings, like how they do on outcomes for various things like do they vaccinate their kids by 100% of the kids that are enrolled in that company by age whatever it is — two, five — they keep having more [unintelligible] vaccines on my kids. But, anyway, that’s what we can do. But we aren’t — we are paid by grants from the government, we are not on a commission from an insurance company, and that’s very important.
JUAN GONZÃLEZ: You mention that there are navigators all around the country. Some states have made the certification and the availability of these navigators extremely difficult. Georgia, for example, of Florida. Could you talk about the difference and how states are dealing with question of —
AMY GOODMAN: How do people find these navigators?
JUAN GONZÃLEZ: Ether finding them them or licensing them.
ELISABETH BENJAMIN: Well, we’re all licensed either by a federal government through that training or in New York we do it through a state-based training. We all go through rigorous training, at least three days here in New York. There’s in-service training that will be going on all along. And people find them by going to healthcare.gov. You just type in I want in person assistance and this is my state. If you go and type in New York, it will flip you over to the New York State of Health marketplace . And then every county has a pop up. My organization is in, I believe and 61 out of 62 counties in New York State. There is one county we couldn’t find a partner in, but they have great navigators in that county. So, we’re everywhere in New York and there’s a lot of them all over the country.
AMY GOODMAN: What’s the number of Community Service Society? And also, are navigators taking calls now or is it October 1st that the phone — ?
ELISABETH BENJAMIN: Oh, we are booking appointments now. I’m trying to — I want 25 people in to CSS on Tuesday. So, our number is 888-614-5400 or you can just email us at firstname.lastname@example.org .
AMY GOODMAN: We’re going to take a break and then we’re going to come back to this discussion. We want to ask you about some of the people who have come forward now to ask for health care — for insurance and how you’re going about dealing with them. Elisabeth Benjamin, Vice President of Health Initiatives at the Community Service Society here in New York, and she is one of the thousands of navigators who have been trained all over the country to help people navigate the system that begins on October 1 in states around the country.
JUAN GONZÃLEZ: I want to turn to President Obama. On Wednesday he spoke with Bill Clinton at the Clinton Global Initiative Conference.
PRESIDENT OBAMA: Essentially, what we have done is we have created what we’re calling marketplaces, in every state across the country where consumers are now able to be part of a big pool. Insurers have to bid, essentially compete for the business of that pool. And what we now have set up are these marketplaces that provide high-quality health care at affordable prices, giving people choices so that they can get the health insurance that they need and that they want, and the premiums are significantly lower than what they were able to previously get. I’ll take the example of New York State. The insurers put in their bids to participate in these marketplaces. It turns out that their rates are up to 50% lower than what was available previously if you just went on the open market and tried to get health insurance. 50% lower in this state. California, it’s about 33% lower. In my home state, Illinois, they just announced about 25% lower.
JUAN GONZÃLEZ: That was President Obama at the Clinton Global Initiative’s Conference. We are here with Elisabeth Benjamin, Vice President of Health Initiatives at the Community Service Society of New York. What about these lowered premiums here in New York State? How was it accomplished? And also, could you talk about the different levels of coverage that people have access to because of, depending on the level, the premiums rise substantially.
ELISABETH BENJAMIN: That’s true. So, the reason why costs are lower, and I think the best way to think about it is kind of like a Costco. What you have here is you have the ability, because of the mandate, more people are coming into the market. Insurance works on a solidarity principle, or like a Costco. The more people that go, you have bulk purchasing. If things are bulk purchased, it’s highly discounted. And so, that’s what happened in New York. Right now if you go on the open market in New York, you’re paying over $1000 a month for one person to get health insurance. The lowest prices on exchange is like $200 before financial aid. So, it is really an extraordinary thing that we’ve been able to pull prices down so much. Going to your second question, which is there’s these different tiers, right?. First of all, there’s two different things that are happening at once that affect prices. The first thing that is happening is you get financial aid based on your income level. So, the people that are poorest, like 15,000 for a family of one, those folks will go in the Medicaid. But, as you go up the income band for one person up to 45,000, there’s really good financial aid. Now, obviously, the most financial aid goes to the most needy, the people at, say, 200% of poverty and the least amount goes to people at 400% of poverty. So, 45,000 for a family of one or 94,200 for a family of four. So, it depends on how many people are in your household. So, we — so, they will figure out what your financial aid amount is based on how many people in your household and how much income you have. And then you take your voucher, if you will, your financial aid and you can apply it to the cost of premiums every month. Now, what premiums do —- but, there’s different premiums, right?. Because, some plans are -—
JUAN GONZÃLEZ: But, how does that voucher work? It comes directly off the premium that you have to pay? Or you have to pay it first and then get it rebated?
ELISABETH BENJAMIN: No, there’s two ways you can have it. First of all, you can just say apply it to the cost of my coverage and your coverage will be discounted automatically. And so, then you just pay whatever is remaining to the carrier every month. Or you can say, I want — I think I might be getting a big raise. My income is too unstable. I’m just going to do it at tax time and I’m going to true up a year and a half later, or a year and a quarter later on April 15. So, it really depends if you want to take it now or take it later. So, going to your second question from before, there are different value levels for the insurance companies and they are ranked. Each insurance company will have a bronze offering, a silver offering a gold offering offering or a platinum offering. So, obviously, bronze is not as good as platinum, just in the medal tiers. So, for bronze, you will be expected to pay about 40% of your costs altogether. It is not every time you go to the doctor. And the insurance company pays around 60%. At platinum, you pay less than 10%, or, for example, $200 ever, in the whole year. In New York, that is our platinum product. And the insurance companies paying the other 90%. So that’s really — the fancier the plan you get, the less you pay when you go to the doctor but, you pay more on that monthly bill, right? Because it’s fancier it costs more. The other thing to remember, is that even if you go for a bronze plan, there’s this incredible thing in the Affordable Care Act that you will never have to spend more, altogether, deductibles and cost-sharing, than say $8,000 a year if you’re at 400% of poverty or maybe $400 if you’re much lower income. People don’t go bankrupt for $4000 or $8,000. Under the Affordable Care Act, we will see medical bankruptcies go away. Which is sort of an amazing thing.
JUAN GONZÃLEZ: One thing I wanted to ask you, because in existing insurance, those of us who have it, we are bewildered constantly by the co-pays and the deductibles and the doughnuts and you can never figure out exactly what your payment is supposed to be. How will this function under the Affordable Care Act?
ELISABETH BENJAMIN: So, you will have two different forms of payments. Number one, you’ll have your premium payment on a monthly level and then you have what we call cost-sharing when you go to the doctors. If you have a very inexpensive plan, you might also have a deductible. A deductible means you have to pay a certain amount, usually in the platinum product, for example, it’s $200. In a silver product it may be $1,000 — as much as $1,000. Although, there is special cost-sharing protection for very low income people in the silver product. So, you have to pay that before your insurance kicks in. The good news is, is those deductibles don’t apply to things like primary care — preventive care. In New York it won’t apply to drug costs — drugs. So, there’s some real protections for people on the deductibles side. So, there’s a monthly bill and then what you pay when you go to the doctor.
AMY GOODMAN: Give us some example of people who are going to go to the system.
ELISABETH BENJAMIN: So, we like this example of Angie. She just graduated from college, she lives in Queens, she’s making $28,000 a year as a graphic designer. She decides to go — she is at 250% of poverty at 28,000. So, she is not really eligible for any special cost-sharing protection, but she is eligible for a significant monthly coupon. Her monthly coupon or discount, financial aid, whatever you want to call it, is around $176. If she goes for the bronze plan, which is around $300 in Queens, she will get $176 discount off of that. So, the most she’ll spend a month is $162.
AMY GOODMAN: And someone else?
ELISABETH BENJAMIN: So, we have a family of four in Brooklyn. They make around $47,000. The wife is a independent freelance photographer, husband just got laid off. They used to have job-based coverage. Let’s say it happened midyear. If you get — we should talk about the enrollment periods, but, if you get laid off midyear, you can go into the exchange during the year. If there’s good reasons you can go into the exchange. Otherwise you have a strict period.
AMY GOODMAN: So, let’s talk about that. October 1, if you sign up, you get your health insurance October 1?
AMY GOODMAN: No, you get your insurance starting January 1. The coverage starts January 1, and this is the only year where you have that gap. You start shopping in October. It’s called the open enrollment period. You have until March 31 to voluntarily get into a plan. If, for some reason, you don’t do that — maybe you had job-based coverage and you lose job-based coverage in July, then you can get into the exchange and get financial.
AMY GOODMAN: What if you get hurt in April so you decide, oh my gosh, I need insurance?
ELISABETH BENJAMIN: Then you really might be out of luck. You won’t get the financial aid.
AMY GOODMAN: But, talking about pre-existing conditions now, that is OK?
ELISABETH BENJAMIN: Yeah, there will be no pre-existing condition exclusion anymore.
JUAN GONZÃLEZ: And of the 48 million, roughly, Americans that don’t have insurance, how many are expected to be covered by the Affordable Care Act?
ELISABETH BENJAMIN: Well, it is a little confusing because of the Medicaid wrinkle that the Supreme Court did. But, originally they thought it would be 15,000 people on Medicaid and around 15,000 people getting financial aid. What I do know is that three quarters of the people that go to the exchanges, at least in New York, will be eligible for some kind of financial aid or Medicaid.
JUAN GONZÃLEZ: Three quarters of about, what in New York it’s about 2.3 million or so?
ELISABETH BENJAMIN: No, there’s 19 million people in the state, 2.3 million are uninsured, and so they’re expecting about 1.1 million people to go into the marketplace.
AMY GOODMAN: Now Elisabeth, I want to turn to a new ad on the Affordable Care Act that’s produced by Generation Opportunity, an activist group with funding ties to the conservative Koch brothers. The video shows a nurse escorting a young woman into an exam room for gynecological exam. For our radio listeners, I will do some narration for the parts you can’t hear.
NURSE: Oh, I see you chose to sign up for Obamacare.
PATIENT: Yeah, it’s actually my first time here.
NURSE: Well, here we are, then, change into a gown and the doctor will see you soon.
DOCTOR: Great, well, your vitals look good. Any change in your diet or exercise?
DOCTOR: Alright, can you swing on over, scoot on down and try to make yourself comfortable. OK, let’s have a look.
AMY GOODMAN: The doctor walks out of the room, the woman’s alone with her legs up in stirrups. And all of a sudden, Uncle Sam pops up between her legs. She screams. The note says "Don’t let the government play doctor. Opt out of Obamacare." And he is holding up a speculum. And it says "Opt out" again. So, Elisabeth, the debate that is going on in Washington and what it means to say opt out, is it possible this won’t happen, that the Republicans will succeed in preventing the October 1 opening of the marketplaces from happening?
ELISABETH BENJAMIN: Absolutely not. The marketplaces are up and running. The beta tests have been done. You can go in already and start playing with your income amount. And October 1, there will be plans up and you will be able to start doing comparison shopping and qualifying for financial aid.
AMY GOODMAN: And reproductive health care for women, how women choose what is covered, if they can go to the clinics of their choices.
ELISABETH BENJAMIN: Well, one of the things that is really nice about the Affordable Care Act is that most plans will offer reproductive health care and you will be able to have contraception and no co-pays and it’s really and extraordinary thing.
AMY GOODMAN: That’s new under the ACA?
ELISABETH BENJAMIN: The Affordable Care Act. Correct. It’s considered preventative care.
AMY GOODMAN: And it happens no matter what, with the debt ceiling, it happens no matter what?
ELISABETH BENJAMIN: October 1 — the marketplaces are paid for, the insurance plans have made their — they basically laid their bids, they dropped their prices. They think people are coming in. The insurance industry, I think in this case, really understands what is going on. And for the insurance industry to drop their prices by over 50% in New York State means it’s going full steam ahead.
AMY GOODMAN: And in California?
ELISABETH BENJAMIN: California they say over 30%.
AMY GOODMAN: Oregon?
ELISABETH BENJAMIN: I thought it was over 20%.
JUAN GONZÃLEZ: And Elisabeth, those Americans who choose not to participate in the Affordable Care Act, what are going to be the penalties and how will they be — how will they be assessed since this is now a requirement for individuals?
ELISABETH BENJAMIN: I think they start — The Affordable Care Act now gets that people — not everybody may be able to do it at once, right? And they really expect sort of a phasing in of participation. So, the first year the penalty is relatively small. It’s $95 or one percent of your income. So, that’s not a lot of money. And how that would be levied, if you will, would be not this coming April 15 in 2014, but in 2015. So, it’s a year and a quarter away. So, you have to show that you got some kind of coverage next year and then you can avoid paying that penalty.
JUAN GONZÃLEZ: And in subsequent years it’s expected to rise?
ELISABETH BENJAMIN: Yes, it goes up to, for example, a maximum of 2% of gross family income and then 3%.
AMY GOODMAN: Elisabeth, I want to thank you very much for being with us. The Community Service Society is her organization and she’s Vice President of Health Initiatives there. And again, if people want to get in touch with Community Service Society, can they call call from other states?
ELISABETH BENJAMIN: They can. We would probably send you to healthcare.gov . I think it’s better, if you live in another state, to go to www.healthcare.gov . They also have a toll-free number with live answer operators. You know, it’s right there on the website.
AMY GOODMAN: So, you can be directed to a person who will help you navigate through this.
ELISABETH BENJAMIN: Absolutely, yes.
AMY GOODMAN: And the Community Service Society number?
ELISABETH BENJAMIN: For people in New York, it’s 888-614-5400.
AMY GOODMAN: Elisabeth Benjamin, thanks so much for being with us. This is Democracy Now! , democracynow.org , The War and Peace Report. When we come back, we’ll be joined by Anabel HernÃ¡ndez. Her book, "Narcoland: The Mexican Drug Lords and Their Godfathers."