When talking about the nation's new health care law, the Affordable Care Act (a.k.a. Obamacare), it's helpful to remember the words of ancient Greek philosopher Heraclitus of Ephesus, who said "nothing is permanent except change."
Or, to paraphrase what Mark Twain said about the weather in New England, "If you don't like Obamacare, wait five minutes."
Also, said another way, here is a direct quote from former U.S. Secretary of Defense Donald Rumsfeld, from a February 2002 press conference, that could easily be said about the new health insurance programs: "...there are known knowns; there are things we know that we know. There are known unknowns; that is to say, there are things that we now know we don't know. But there are also unknown unknowns there are things we do not know we don't know."
Let's take a look at what we know about Obamacare in February 2014, and what we know that we don't know, too. We will leave the things that we don't yet know we don't know for a future column.
What we know: After a difficult first two months, the healthcare.gov web site is working well, allowing previously uninsured adults age 19-64 who don't have affordable employer-sponsored health insurance, and whose household income is above 133 percent of the federal poverty line (about $16,000 for a household size of one person, $32,000 for a family of four) to select from private insurance plans with different premiums and co-pays, called Marketplace plans.
Most people will qualify for some type of tax credit to help purchase these insurance policies, and may choose to have the government subsidy go straight to the private insurer, thus reducing the amount they pay per month. What we don't know is whether their new insurance will be more or less expensive than the policy they used to have, or whether their old doctor will be a provider in their new insurance plan. The answers vary from one person to the next.
We also know that Michigan is developing a new insurance program for low-income adults under age 65 who were not previously eligible for Medicaid. This program, called the Healthy Michigan Plan, is supposed to take effect April 1. We know that approximately 400,000 to 500,000 Michigan adults may qualify for Healthy Michigan coverage, with eligibility based solely on income with no asset tests. We think that enrollees with household incomes between 100 and 133 percent of the poverty line will owe premiums or co-pays of about 2 percent of their income, or about $24 a month for someone making $15,000. People making less than the poverty line may have no fees at all.
What we don't know is when Healthy Michigan enrollment will start, but we are hopeful that county health department offices and Department of Human Services offices will be able to enroll people sometime before April 1. We also don't know whether people who enrolled last fall through the federal web site but were found to be below the income line for a Marketplace plan and referred over to the state of Michigan will be automatically enrolled in Healthy Michigan, or whether they will have to re-apply before April 1. The health department has maintained a list of those people we helped enroll in late 2013 who are eligible for the Healthy Michigan Plan, and we will contact them as soon as we get further information.
Meanwhile, we do know that if you qualify for a Marketplace plan and want coverage to begin on April 1, you need to purchase that plan by March 15. For uninsured people who make too much money to qualify for Healthy Michigan, that is their deadline to purchase insurance and be in compliance with the new law. That is, unless they change the deadline.
For more information, please call your health provider or the Western U.P. Health Department in Hancock at 482-7382.
Editor's Note: Ray Sharp is Manager of Community Planning and Preparedness at Western U.P. Health Department in Hancock.