Obamacare is here. After years of back-and-forth battles on Capitol Hill, the Affordable Care Act (ACA)—which will require most American citizens to carry insurance by 2014, whether through an employer, the state or a private institution—is set to take effect in a matter of months. Enrollment for ACA coverage, however, began this week.

The date might be set, but the details remain murky, with lingering questions as to how the new legislation will affect the millions of Americans who will now be mandated to have medical coverage. Tensions run high with lawmakers’ stalemate on the nation’s budget and health care, leading to the first US government shutdown in more than 17 years.

Despite the benefits of gaining access to health care and assistance to do so, there are concerns about the potential rise in costs. Then there are the restrictions on age rating, the amount an insurer will charge an individual for health insurance based on their age. Seniors typically accrue higher health costs than younger patients, but in order to keep health care affordable, states can implement age rating to spread out the costs among age groups.

According to America’s Health Insurance Plans, more than 42 states currently have a ratio of 5:1, meaning seniors will be limited from paying more than five times what a younger patient will pay. With new regulations set out by the ACA, however, states will no longer be able to set age rating higher than 3:1, meaning a potentially greater burden on those aged 18 to 30.

Adding to the overwhelming nature of this legislation is the sheer weight of the outlined changes to the ACA. More than 2,400 pages detail the changes broken down into 10 sections. And despite the passage of the Patient Protection and Affordable Care Act three years ago, many remain in the dark about the revisions. According to a poll conducted by the Kaiser Family Foundation, 42 percent of Americans continue to be confused about the pending health care changes.

Claremont residents are taking matters into their own hands. On Sunday, October 13, locals will gather at Claremont’s Taylor Hall to discuss the impact the ACA will have on Claremont constituents—the senior population, student demographic and small businesses among them.

“There is a lot of misinformation out there, and people do not understand how [this legislation] will affect them,” said Sandy Hester, a Claremont resident and member of the American Institute for Progressive Democracy, sponsors of the October 13 health forum. “It’s going to affect different people in different ways. We want to give everyone an opportunity to ask questions about how exactly they will be affected.”

The American Institute for Progressive Democracy has a history of presenting public forums on the health care debate. In 2008, prior to President Barack Obama’s inauguration, the organization held a forum discussing how to pave the path toward health care reform. This month’s discussion, however, will focus primarily on the impacts of the health care reboot, and how to navigate the impending changes. Experts from senior, child and mental health services as well as spokespeople for large and small businesses will be on hand from 2 to 5 p.m.  to answer questions about how the ACA may affect these groups.

Keynote speaker Gerald Kominski, director of the UCLA Center for Health Policy Research and professor of health policy and management at UCLA’s School of Public Health, notes that come time to file 2014 income taxes, all will be required to file their insurance information along with the rest of their information. In this way the government will be able to regulate the new system.

Seniors will be largely unaffected, he claims, unless they are a part of Medicare’s Part D drug coverage or the Medicare Advantage Plan. Over the next decade, Part D participants will see the phase-out of the “donut hole” coverage gap. On the other hand, those with the Medicare Advantage Plan may perceive a drop in some of the items that used to be provided to them under their plan. This is because the ACA eliminates subsidies that are used to provide non-medical benefits, like free eyeglasses. Mr. Kominski maintains that the perceived drop in coverage actually isn’t so.

“What they are losing is something that was not covered by their insurance package anyway,” he asserts, explaining they are just “freebies” HMOs throw in because of extra money provided for them as a result of the 1997 Balanced Budget Act.

The impact the ACA will have on students is not so simple, Mr. Kominski acknowledges. If possible, he suggests students stay on their parents’ plan for as long as possible. The ACA provides an individual may stay on their parents’ insurance plan until age 26. In some cases, like those going to school out of state, he also recommends looking into the insurance their school provides. He cautions students who choose to shop on the exchange to weigh the options carefully. While in some cases it’s worthwhile, students whose parents still claim them as a financial dependent may not qualify to receive a subsidy, and for them it may not be a better option.

“Students are going to have to be smart shoppers and consider their options,” Mr. Kominski said. “There are good affordable options out there.”

Change in health care,

change in costs?

Mr. Kominski does not anticipate a dramatic increase in the cost of health insurance, but not all are so sure. In an article written for The Federalist, John Davidson—a 2013 fellow of the Claremont Institute, a local conservative think tank—points out that the ACA assumes individuals will sign up for insurance through the exchange and pay their share of the premium in order to keep rates affordable. Mr. Davidson is not convinced. He points to a recent US Census Bureau survey that claimed over 4.7 million Americans earning more than 400 percent of the federal poverty level ($46,000 for an individual or $94,200 for a family of four) are uninsured.

“It’s not that they can’t afford some kind of insurance; it’s that they’ve decided they don’t want it,” wrote Mr. Davidson, assuming “a majority of these individuals are probably young and healthy. They might have never been to the doctor in their life and they don’t feel like insurance is worth it.”

Mr. Davidson doesn’t think these people will change, even though the ACA is making it possible. And he doesn’t think the exchange will necessarily be an affordable option. He turns to Trader Joe’s as an example, noting that the grocer, which recently decided to drop coverage for part-time employees, claimed the exchange would be a good choice for some of those employees. While this may be so, he points out that exchange rates change by state and are not necessarily more affordable to these part-timers.

“The company’s claim rests on the price of monthly premiums on the exchange, which will depend on the employee’s age and state of residence, among other things. If we’re talking about a 27-year-old Trader Joe’s employee in Albuquerque, New Mexico, the average monthly premium on the exchange could be as high as $172 a month—a 146 percent increase from the average individual plan in New Mexico right now,” he posed.

Mr. Davidson conceded that subsidies might help, but not everyone qualifies or even cares to apply for them. “Obamacare asks large numbers of people to buy something they don’t think they need while preventing them from keeping ‘bare bones’ catastrophic plans they might currently have.

“The entire exchange scheme comes down to a question of incentives,” Mr. Davidson continued. “What are people more likely to do? Will large numbers of young, healthy Americans agree to shell out hundreds of dollars a month for exchange coverage? Will most people who chose not to buy health insurance prior to Obamacare suddenly change their mind? Don’t count on it.”

For Fred Lynch, associate professor of government at Claremont McKenna College and part of the 5C’s benefits committee, the answer is simple. The ACA will not have a great impact on the Claremont community.

“Really, this whole fuss involves about 7 million people, those who can’t get insurance anywhere else, undocumented workers and young people that don’t want the deduction taken out of their paycheck,” Mr. Lynch said.

And although some fear that, under the ACA, businesses will cut full-time employees in order to avoid paying insurance benefits, Mr. Lynch remains unconvinced.

“There has been a lot of press, but the evidence is spotty,” he said.

Finding a balance

A lot of the hype surrounding health care reform has to do with the way information is presented, Mr. Lynch noted, such as the use of the term “Obamacare” for the Affordable Care Act.

“If you take a poll asking about how people feel about ‘Obamacare’ it gets a slightly negative majority, but if you ask about the Affordable Care Act you get a slightly positive majority,” he said. “It’s part of the politics.”

When it comes down to it, the health care revamp presents a blending of both liberal and conservative points of view, he argues.

“Trust in government is at an all-time low,” Mr. Lynch noted

However, he feels what the government has come up with is a good compromise for both liberal and conservative minds.

“It needs to be said that the Obama healthcare plan really nears Romneycare, and originally the system came from the Heritage Foundation, a conservative think tank,” Mr. Lynch said.

Judgments aside, the health care expert believes the positives outweigh the negatives, and appreciates that the ACA offers coverage of all Americans regardless of preexisting medical conditions. Mr. Lynch, author of One Nation under AARP: The Fight Over Medicare, Social Security and America’s Future, asserts this is crucial for the nation’s aging Baby Boomers.

“There is a built-in age discrimination factor to help those most vulnerable, that is, people over 50 that are not yet eligible for Medicare,” Mr. Lynch said. “Before, if you were in that age range and lost your job, and were diagnosed with diabetes or cancer or any number or chronic diseases that come with age, you either couldn’t get insurance on your own or rates would be sky-high.”

The ACA will also provide the nation’s increasing numbers of underemployed or unemployed the chance to be insured while exacting a relatively small price from those who opt out. Those who decide against health insurance will be fined $95 for the first year, or one percent of their taxable income. In 2015, the fine rises to $325 or 2 percent of taxable income, and in 2016 the penalty will be $695 or 2.5 percent of income. Each year thereafter, that figure will be manipulated based on cost-of-living adjustments.

“What we are talking about is pooling,” Mr. Lynch said. “Everyone is putting their hat in the pool, with the hope that this is a lottery they won’t win.”

Online registration is backlogged and residents may find themselves overwhelmed by the enrollment process. Any Claremont resident who needs assistance with enrollment or information can visit the UFCW Local 1428 office at 705 W. Arrow Highway. The office is a Covered California approved site, offering information that will assist individuals in selecting a plan to maximize health care benefits while avoiding any penalties that might result from non-enrollment. UFCW office hours are Monday, Tuesday, Thursday and Friday from  8 a.m. to 4:30 p.m., and Wednesdays from 9 a.m to 4:30 p.m. The office is closed from noon to 1 p.m. for lunch.

“The Affordable Care Act (Obamacare): How Will it Affect You?” takes place on Sunday, October 13 at Taylor Hall, 1775 N. Indian Hill Blvd. in Claremont. The event runs from 2 to 5 p.m.; doors open at 1:45 p.m. Further information may be found at www.taipd.org or by contacting info@taipd.org.

For more information on the insurance provisions provided in the state of California, visit www.coveredca.com.

—Beth Hartnett

news@claremont-courier.com