Come New Year’s Day 2014, health insurance coverage as we know it in Kentucky—and across the nation—will change.
Or exchange, in the case of Kentucky and at least 14 other states plus the District of Columbia.
It is on that day that the state-run, but federally funded, affordable health insurance Kentucky Health Benefit Exchange that Gov. Steve Beshear created by executive order in July to comply with new federal health care requirements under the 2010 Affordable Care Act (aka “Obamacare”) becomes fully operational. The exchange is supposed to help Kentucky make essential health care benefits (like hospital, maternity, pediatric and prescription drug coverage) available to over 221,000 uninsured or non-Medicaid eligible individual Kentuckians and uninsured small business employees as required by the ACA. Premium assistance, in the form of tax credits, for those with a household income of between 133 percent and 400 percent of the federal poverty level will be available to those who qualify.
Kentucky hopes to use the Anthem PPO plan as its benchmark plan for the exchange, as well as for plans offered outside the exchange, which will be used to set minimum benefits to be offered in the individual and small group markets starting Jan. 1, 2014. Anthem PPO is the “largest small group plan currently offered in Kentucky, and includes coverage for all state mandates and the 10 essential health benefits, or categories of care, specified by the federal government under the Affordable Care Act,” according to the state Department of Insurance.
As far as Medicaid is concerned, the exchange will help an estimated 261,000 lower income families who are currently uninsured sign up for the Medicaid program as they qualify.
The federal web site HealthCare.gov says exchanges like Kentucky’s will allow individuals and small businesses to “compare health plans, get answers to questions, find out if they are eligible for tax credits for private insurance or health programs like the Children’s Health Insurance Program, and enroll in a health plan that meets their needs. “ Kentucky officials organizing the exchange say it will be an online “marketplace” where people and small group employers can buy health coverage, compare plans, view claim denials made by insurers, and more.
The Kentucky Health Benefit Exchange will hold open enrollment between Oct. 1, 2013 and March 31, 2014.
While the exchange has already received over $60 million in federal grant money, state officials are still in the process of getting the federal government’s approval. This is just one of those hoops that Kentucky, and each state creating its own exchange, must go through so that our program isn’t run by the feds—something that we don’t want to happen for a few good reasons.
First, Kentucky doesn’t want to be part of a one-size-fits-all plan configured by Washington that overlooks our state’s specific needs and instead pegs us in the same hole as, say, South Dakota. Second, Kentucky wants to be able to determine how its benefits are provided itself. Third, the state wants to control determination of our citizens’ Medicaid eligibility, and fourth: Kentucky doesn’t want dual regulation by both the federal and state government (which can create an unlevel playing field).
Our next step in the exchange process is to complete a blueprint of the Kentucky Health Benefit Exchange by submitting an application by Nov. 16, 2012 to the U.S. Department of Health and Human Services that includes all information about Kentucky’s plans to operate a fully state-based exchange.
Some lawmakers are looking past 2014 at those years that, should the exchange still be in place, federal funding would run out. Ideas have been floated for what the state would do to cover costs but I believe that is much too premature. I will keep you posted on the exchange as it is finalized, and implemented, over the next year
You can get more information now about Kentucky’s exchange planning at http://chfs.ky.gov/ohp/con/ .
Have a great week ahead.