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Health Care Reform

Sep 27, 2013|

A discussion with Sheila Jameson, the Cover Oregon Account Manager for Providence Health Plan, and Dena Dooney, the Owner of DDI Benefits, about the imminent changes coming as the Affordable Care Act is put into place and what they’ll mean to Oregonians. www.coveroregon.com www.providencehealthplan.com/reform

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Automatically Generated Transcript (may not be 100% accurate)

You're listening about -- -- a series of interviews with people of interest in northwest Oregon and southwest Washington I'm your host content Douglas. Now if you're like you -- years someone with a job you got some health insurance or maybe don't have a job your -- on health insurance and anytime you would need to contact. -- health insurance you are lost you don't know who to contact you know what questions to ask and now you you throw in all the health care changes in reform is going on and it is just kind of like the rules are constantly changing you don't know how to handle it well today I have to guess with -- gonna help us. Sort some of that out I have Sheila Jamieson she is the cover organ account manager for Providence health plan. And -- do any who's the owner of dvi benefits a local employee benefits consulting and insurance brokerage firm thank you both for joining me today -- So before we get things kicked off let's get grocers a little bit -- and on yourselves and how you came to be in this business. She -- with you. Well -- I have over twenty years experience in the health care industry with a focus on state like government accounts and association and currently I am as you -- the account manager for Providence health plan and my job -- Q overheated successful implementation. Of the cover -- exchange. At Providence. Very -- and had Dina you -- Well I'd like she I had been in the business burned over twenty years 22 years and it actually worked. On the carriers tied for ten years as an account executive for -- -- -- health -- and then the last twelve years as -- benefits consultants and and helping small businesses individuals families and Medicare age folks with their health insurance. So as everyone knows -- is this seems to be is that the Affordable Care Act seems to be -- them. This ball keeps Joseph and collected juggling around one side to the other we never know if it's gonna absolutely go through it's always been threatened to be defund it -- -- but there's there's. They laundry specifics to organ and that is about to take effect -- what does that. Well if you're referring to do February -- -- and health insurance exchange that all the states are required to implement an effective January 1 and 2014 that's the biggest. Keep -- -- that we're facing up. At the moment and that is an exchange where a marketplace where individuals and small businesses under fifty employees. We'll be able to -- purchase plan. And get. Help financially harmed by tax subsidies to pay for their health insurance that's the primary school. They cover going to be exchange he -- right and I met. So yeah well you know Health Care Reform for the Affordable Care -- get used to date has been in effect for years now and we have seen a lot of the changes already like more preventive care coverage. And children being able to stay on their parents' health plan until they reach age 26. But as being ahead starting October and connect did OK everyone will be able to shock for a brand new health insurance plan and some people even qualify for financial assistance to help pay for their premiums and. While so it in that -- BA gigantic. Change and that is not just the people are gonna be able to. Jobs for new class but the the plans themselves are new and a how're they different from what we have today. Well the biggest change that is that knowing can be denied coverage based Don hat you know pass health problems or preexisting conditions preventive care is going to be the folk can't trust and these new plan -- that carriers. Are required to offer effective January -- and are going to cover a much wider range of benefits. And even include the the vision and dental coverage for kids. Under eighteen. And then if you do you get sick and need to -- your health plan is going to be a lower limit on how much she will have to pay out of your own pocket but I like to putting out because he -- -- so different. And cover a lot more. Premiums may be different as well you play well that Affordable Care Act. Required -- planned to offer what we call potential health benefit and I'm making more preventive care services breast -- fall. And I know. Premiums depending on your level of coverage for daylight your buying baby me either go up or are they may go days. Can you tell me -- -- depending on what you're doing better but overall it sounds like the service the -- is going to improve dramatically -- the coverage at least. The coverage will be expanded most definitely because of the requirement. Potential health benefits and some of these plans. That we have today -- to cover. All of the ten potential health benefit from. Right right I think a lot of people are prone like me or I -- through the -- my health insurance even though I've covered through work and then it's amazing what isn't covered. And it's amazing what the deductibles are when used when you think about all the money your pain and -- for just for the premiums it's incredible so anyway helping get sounds pretty good domain. So it. Who in -- where what the demo I guess or who's going to be most impacted by this. Well I can try to answer that killed because I'm ridiculous how many different businesses and individuals. And different insurance carriers. Right really I think that the benefits true cover -- again and the exchange is certainly wish -- -- said that you cannot be denied coverage and that's tickets will be going through the exchange order continue like your private policy interact with an insurance company that. The benefit is really going to help those that make the low 400%. To. Of the poverty level because as an individual that's where you start to. Paula -- -- said that -- -- tax -- in order to help pay for your premiums if you don't qualify for help in paying for your premium. Then like you as saying that cost of entrenched product -- an -- they're really going to be cheaper so I think those that. It can qualify for help financially are definitely going to benefit. Sure that's you know move those of -- that do you have insurance Emmy night but you pay a lot for about -- I can afford it but there's so many who cannot so that that's wonderful. So when we talk about pre existing conditions. I we have always been kind of confused at that I know -- you know when you think about someone who has let's -- has diabetes and has had a three years and had they are looking for insurance. And may be interest companies are so big on that because it's a much bigger risk. But what do people who were like who wait until they get sick to get insurance for the first time. I I can answer that day you know Health Care Reform requires every wanna purchase health insurance in 2014. Or else they may have to pay a -- And for individuals there's going to be an open enrollment period from October land through the end of march. And if you don't in ruled during that time you'll need to wait in town next year's open enrollment period. So if you cannot week and tell you get sick if you elect not to enroll during the open enrollment period and then you may have to pay a penalty. And how does that penalty work and a does that come around tax time how does that work. Yes they'll come around tax time finish here and individuals the penalties for the first year can be about 95 dollars or 1%. Of your income whichever is black. But in years killing three. It it goes up. Tyson Tyson says a little bit of like okay if you are paying attention and you missed it. We feel the only way this time attendance came on. Correct perhaps and and also the open enrollment period it is special at this special time period just this year only -- being. Extended and now march 31 -- Sheila. Yeah I've been -- that's for the first year only and then next year will be October through December -- Match he had Medicare open drama that's right. I say so wouldn't. What we're talking about this open enrollment is people who don't currently have health insurance if you are like reunion do currently have health insurance what is this gonna do for me. Well if you have insurance on the job like hey I'm champions are you won't see any changes but if you buy insurance on your own or you know currently don't have insurance. You'll definitely want to check out your options. Okay I'm so when you say that it doesn't change hadn't been stiff premiums things like that but it will the coverage change with the way -- all the other coverages change and. Yet -- plan that we know today as an employee he have a small bit of that before as an individual they're all going away. Because the Affordable Care Act required have you you know. Add more benefits than change you weigh the benefits are administered. With lower deductibles and out of pocket expenses no plans will be different starting January 12014. Then. We know them. Today. And that's just very small business and individual or 2014 and it -- had a small business plan. Your plan would change upon -- -- Few renews your company renewed their plan and you have open enrollment every year in March for an April 1 effective date and your plan doesn't act. Actually change until April 1. -- asked in the individual that's different small businesses it's a little bit different and then if you're over fifty employees. The employer mandate laugh we'll have ever -- radio interview next year. Kelly can talk about 1115. When -- over fifty employer groups have to deal would be pat employer mandate lot. And -- your plan could season. Some changes I -- I say yes is I work within our comments are owned giant national companies -- that they'll do a little bit from me. That piece of a lot of people are getting this competed I get this after -- in my eyes. I intend employer -- friends at five employee groups you do have to offer health insurance now because helped carry firemen putting fourteen minutes. No -- employer mandate applies to only groups that have over fifty employees. And that law would be played recently right at -- time to go. Again another year is difficult amino blame anyone for being confused file this there is. The basic information itself is confusing enough for the there's so much misinformation that's put out there by you know Lyndon B politic in one way or another. Yeah it's it's crazy time for that Dan really think you thanks for coming hunter showed today to help clear some of this up. Can you just joining us you're listening to met your scope a series of interviews with people of interest in northwest Oregon and southwest Washington I'm your host Ted Douglas. My guess they are Sheila Jamieson she is the cover organ account manager for Providence health plans. Passive Dina -- who's the owner of -- benefits which is a local employee benefits consulting and insurance brokerage firm they were speaking about some of these mass changes that are going on in health care both with the Affordable Care Act. And -- with cover organ. Which I wanna get into a little bit now the what is cover organ and how does that and and I just cover organ market place how does that work. Oregon is a a marketplace where people can go to shop for health insurance and in Oregon and our marketplaces called cadaver organ and it's open for business and October 1. If it's an online marketplace where people can shop floor and rule. In health plans and actions -- financial assistance to help pay for coverage. Most of all of the major insurance companies including Providence health plan will offer health plans to recover -- Fantastic and looking out your website military is very easily laid out. You know so many times you go to it's it's like trying to track down the IRS if you have a question and good luck getting a hold of them you know and most through most -- insurance companies. It is to be quite difficult suit to kind of -- through the shield the -- cook but this looks very very easy to navigate and then get the information they need. Instead we like -- tell folks they can go to Q Providence health plan dot com slash reformed for a lot of information on this very complicated subject. Yeah and you have that broken down very nicely in there as well those kind of navigating through both the sites earlier today and that cover organ is cover organ dot com and like you say DM the Providence page is. Providence health plan dot com slash reform. I help you make sense of all this stuff as if you're you know I'm some time that I hear stuff and it doesn't quite stick and you see in black and white there and as. And very easy to you -- your hands around it if you -- in France. So they we have the marketplace which helps you who helps you determine what kind of insurance you need him where you can get it from. But what sort of incentive for discovery and offer for a small businesses. Well I can probably address this business tax credits. Though if says small business qualifies they would be able to cake at 250%. Tax credit on net premiums for employer paid for any employee eat but that you have to qualify and the factors are you can't have more than 25 full time employees. And on average you can't paid your employees more then 50000 dollars. Annually in order to qualify for that tax credit that some employers might be thinking gosh I only have five employees and I ain't nobody makes more than. Forty grand I that I would qualify and then -- -- fiercely take a look at. The -- exchange which is what. The cover organ small business. Marketplace is called the shop. And let's say then you've got. Forty employees and you know right away he wouldn't qualify but if you're under 25. Employees. And do you think that they are paid on average below 50000. Can be able to take a pretty nice tax credit. I guess I think he's that a big incentive for or against small business it's going to be. The broad choice and option which. Is an option exclusive and that cover organ Mark Clayton and what I mean by that did an employer will be able to contribute a -- dollar amount toward their employees health insurance coverage and then let him. Employees shop on cover organ. For the insurance company for that plane and and according to be frightened that that would benefit their need. You know. I know it can be a challenge for a small business owner can pick one plan that meat -- -- all employees if it's very stressful so. Under the spotlight and employees have a choice the plan to -- -- from that will work best for them now this option to a degree is also available out -- died as a cover organ marketplace but I know many of the insurance companies including. Are working to allow employers -- multiple choices of plans. While that's wonderful and then that -- is that the firm understanding correctly and correct me if I'm wrong. But the business owner contribute says that as well rather than then picky in one group planned for everyone to be under instead. They put a little bit of money towards your plan. They -- the cover organ portal of the aid going and the employers picks have a reference plan. They're required to contribute at least 50% of the employee -- spring and that's the requirement for shopping on cover organ. And though they going to pick a reference plan and let me that references -- planted -- silver metal plant. That cost 300 dollars. They're gonna and it. Fund 50% of that I was. A 150 and in the employee can accused above that reference plan belittle that reference plan and if they -- above. And anything above that is out of their own pocket and below that might be they need to -- -- the person who works great. Right it is the biggest thing is people have options now. Yeah I would absolutely they have not been -- and made it is important to put them understand kill that. If let's they've come Bergen doesn't make sense to them for whatever reason or maybe they did to employees that the race. For the plan within cover -- again. Are going to be that same directly with the carriers and that led. A rule that or one plan can't be cheaper inside the exchange as -- as opposed outside the exchange the same plans and rates are available in exchange. As they are outside the exchange direct from the -- Under the standard metal plant. Right and and it's -- important do you play out keypad that the you know I can't say it enough -- of the subcommittee that. It could happen to help pay for your premiums or tax credit was given at the end of the year. Are only available through the exchange -- marketplace and are only available -- people. As being mentioned earlier that fall between zero and 400%. Of the federal poverty level. But today in organic handling of all are earning 92000. Dollars a year. -- that 400%. A federal poverty level and may be eligible for some help. Well that's great and that on a street that's that's me. But I -- that fantastic. Now that it's not all immediate good news -- some businesses so we'll see their rates actually go up a little bit rather than. Down as a practice -- we're hearing we. The -- to do so why would that be. Well because like Sheila mentioned there are added benefit can -- plans although I would say it just. That in order again our plans -- -- then. Pretty thin ahead of the curve and turn to. Legislation to improve our health insurance over the years. You know we're we have we have we don't quit pretty solid health plan options in our state and really solid health care delivery and health care. Treatment. Providers rather. Right right yeah I talked to so many of them on the show I lose this seems like her lucky in this area. We are lucky and I think we've been ahead where a lot of these things are already built into our plans for other states are having to make dramatic changes that are. Having big effect on their cost. And but there's also the taxes and fees that are built concur premium to help pay for Health Care Reform is the reality and that is -- Do our plans. Just to kind of pay for. The reform that's happening in the long term I think it you know. Personally believe they'll work out -- right and in the short term because there's so many unknowns and underwriters don't understand how -- necessarily going to affect the planned financially -- gonna keep an increase in the rate. But I do all -- content alleging that you know. And and just reiterate that in -- and we have we have already seen a very competitive marketplace and because of the Affordable Care Act. We're seeing even more competition among carriers had little everyone's yeah and then. You know for those folks see income comic is a 138%. Or below. The federal poverty level. That Oregon health plan is an option. And with Oregon health plan there will be no waiting let us know open enrollment period and no one will be turned away. Fantastic that stranded and frustrated so when we're talking about also that you know the Health Care Reform in all of the messaging that's been out there one way or another. The one thing that no one seems real to mathematically disprove is that it costs overall are gonna go down in the long run if this all. Gets to take effect if we if we keep on the way we're going. Yeah well I I mean that the focus on -- of Health Care Reform is on. Actually I think I hear that the goal is to get more people covered with the expansion of Medicaid that we just talked about. And the premium and tax credit subsidies for the exchanges. And also more afternoon -- Q primary and preventive care which will you know keep people healthier right. And then the introduction Q and new model of care delivery like the primary care medical home. Well you know help patients get it right here at the right time. All of these changes won't decrease -- content immediately. Because they're gonna take some time -- and they're they're requiring new investments and like -- said be paid for. By a host of new taxes but over how the name. Content trend should moderate. Right closer -- anytime your starting up even a new just a basic new business and there's the immediate costs and and that kind of he gets you know divided up over time and things give less and less expensive as you go because you already have everything in place -- -- gray and -- put everything in place right. Now marine and you're redefining the game here for him right now and I am and so we are coming up here closed the end of our time but I wanted to wanted to ask you -- outside of -- stuff that there is there and then the cover organ market place. And the sort of talked about what other options will there be for purchasing health insurance. So besides going to recover or can't well then did the same -- and purchasing health insurance today to India and that might be. Direct with your insurance care or carrier insurance broker or agent. Or through your employer. So those avenues. Will continue. -- for the first month for most of October while there's open enrollment for shopping for plans. You will be. He will need to work with either community partner that has been designated by the cover or again or with health insurance broker. Can help you navigate this system and that first month. And then after that and you can shop online to recover -- again work with your broker. Called you know Providence health plan nor any of the other carriers direct and so those -- the recession that you wanna use. Yeah they're definitely definitely it's it's like hiring a contractor to put an adoring your house it's -- -- could probably doing yourself but it's never going to be quite right you wanna get somebody who's going to be there on your -- to help guide to journalists. And then I'd like to do like add -- that pat you know is because the sentiment -- That cover organ portal is new. Who. We can't cover organ is asking for people -- -- the community partners and the -- -- agents and then. In the next couple three for a week -- certainly before November 1 of people who like to shop on -- maybe so but they're just huge being good the first three weeks. The grand opening -- -- You know work out they can't because it's. It's a very complex IT infrastructure and and tell you go live you never know what is going to work -- six -- I -- health. He'll be able to work went. Agent and can need partners who are licensed and ready to go to help them and want us. Well ahead here also that I wanted to ask you what if congress who votes to defund obamacare but we are run and real tight on time is there loser quick answer to that. Well I think that the grant. That have funded cover organ in all of our data exchanges that they are in place they're not going away if a lot -- congress and the president signed it. It would not impact the grant funding that might be deputy are the tax credits but. Cover or again it will push on regardless of. So we've been that we even had this direction before all that's. For thirteen years yeah had a vision of the health insurance exchange so we didn't want to adopt. So this all this is really distressed country catching up Dorgan. And yeah that that's fantastic -- I knew we are over achievers. -- will think you both so much for coming on the show today. And ended did you just joining us -- been speaking with Sheila Jamison from the Providence health plan indeed it do any from DN benefits is is a local. Employee benefits consulting insurance broker -- brokerage firm. And I we -- speaking about the Affordable Care Act and cover organ and how this is all gonna come and play and -- ye -- go back and -- the show again online or you can visit their web sites at Providence health plan dot com slash reform. Or cover organ dot com and get all this information. And did you wanna do it you'll look this up because everyone's gonna is gonna have to know what's what's what's for real soon so hard to get on it. We'll think union both so -- your dream be today. All right already -- -- -- it for this edition of -- -- scope and Entercom communications public affairs program I've been your host had Douglas if given nonprofit or public affairs organization that you would like to let others know about please email me at -- to -- editor conduct comment -- starts is any. At least put metro scope in the subject line so it doesn't get snagged -- my spam filter or -- directly to the station's website click on the community link it to -- your information there. Also be like to hear this program again you can visit our podcast page of metro scope PDX dot com where you'll find this in the last couple months -- so -- And please feel free to post it to your FaceBook -- MySpace your blog Twitter you Google+ what every got the strength of this important information out to as many people as possible. Thank you again Sheila thank you -- I think you all so much for listening this is thin -- so.