LIHU‘E — A federal health official recently visited Kaua‘i to explain the Affordable Care Act to the public. But nearly six months after President Barack Obama signed the controversial health care reform package into law, questions still remain. “We wanted
LIHU‘E — A federal health official recently visited Kaua‘i to explain the Affordable Care Act to the public.
But nearly six months after President Barack Obama signed the controversial health care reform package into law, questions still remain.
“We wanted to come out and do some extensive outreach in education,” said Herb Schultz, U.S. Department of Health and Human Services director for Region IX. The Obama appointee oversees Hawai‘i, California, Arizona, Nevada, Guam, Saipan, American Samoa, Marshall Islands, Palau and Micronesia.
The main priority of HHS, he said, is the implementation of the law. He has been traveling extensively with HHS regional outreach specialist Eric Alborg, reaching out to local governments and communities to explain how the new law works.
“(The health care reform package) is a historic law that was passed to provide more than 30 million people access to insurance coverage in the United States, to provide quality care much more cost-effectively,” Schultz said.
Employers and employees will benefit from the bill, he said. As the cost of coverage reduces, employers will be able to grow and hire more workers. Employees will have access to cheaper coverage with better quality, Schultz said.
Starting Sept. 23, the half-year anniversary of the bill, covered individuals will have no copayment for preventive care, he said.
Also beginning that date, citizens 19 years old and younger cannot be denied health-insurance coverage because of pre-existing health conditions, a common practice in the industry, Schultz said.
In 2014, this anti-discriminatory measure will extend to every individual regardless of age. It will benefit those who have diabetes, asthma, HIV and many other chronic conditions, he said.
Covering the ‘donut hole’
Currently in the Medicare prescription-drug program, when senior citizens reach a point where they have spent over $2,800 but below $5,600 in medicine, they pay 100 percent of the costs. This gap, which was created by a law passed during the previous administration, is called the “donut hole,” Schultz said.
This year those seniors will receive a $250 rebate check. Schultz said the government has already disbursed 1 million checks and is forecasting to send another 3 million checks before the year’s end.
Next year, seniors in the “donut hole” will pay only 50 percent of the copayment for most prescription medicines, according to Schultz. In a period of 10 years, the “donut hole” will gradually disappear, he said.
Preventive medicine
Schultz said because the system is so expensive, the Affordable Care Act shifts a lot of the focus on preventing issues such as diabetes from childhood obesity and cancer from smoking tobacco.
First Lady Michelle Obama has made fighting childhood obesity one of her key causes, said Schultz, noting the goal is to eliminate childhood obesity within one generation.
One of the ways the department is implementing this preventive measure is working with local governments and communities. Schultz said Kaua‘i Mayor Bernard Carvalho Jr. is a leader who is doing active work in schools to ensure healthy eating, including promoting community gardens.
System kinks
The law, however, is not yet fully understood even by the experts explaining it to the population.
The pre-paid health act in Hawai‘i requires that business owners provide health insurance to employees who work more than 20 hours a week during four consecutive weeks.
Schultz said the department is still working on sorting out the interaction between the federal law and the Hawai‘i law.
“I can’t say at this point ‘this applies and this doesn’t apply,’” Schultz said. “There are a lot of questions.”
Neither Schultz nor Alborg was able to come up with a timeline for when an answer would be forthcoming.
“It’s a little bit difficult to give you a date,” Alborg said. “There are a lot of regulations that we need to work through; there are a lot of parts of the bill that we need to look at.”
Schultz said he understands the importance of the issue, and that the department is “clearly working” through the issues.
He said it’s important to realize that the country up until now had a “broken health system.”
“People have paid far too much money for not enough benefits, and the system itself is not working,” Schultz said.
Businesses
Many employers have dropped retirement-insurance benefits, Schultz said. The health care reform act will compensate those businesses, providing funding so the employees can receive their payments.
“It’s incredible relief,” said Schultz, adding that 2,000 businesses across the country have qualified and “there are many more to come.”
Businesses with 25 or fewer employees will also receive tax credits. The idea is to incentivize small businesses, he said.
If a business grows and adds more staff, it may lose those tax credits, but Schultz said there are significant benefits other than tax credits.
“This law is really designed to be able to reduce cost and provide access to quality coverage,” Schultz said.
Low income
Under this law, families of four who earn up to 400 percent of the federal poverty level, or $80,000, will have access to subsidized coverage, according to Schultz.
Those who don’t file taxes for not hitting this limit are not in the category of people who comply with the law, Schultz said. Those who are receiving a salary and paying taxes will receive, based on that 0 to 400 percent criteria, premium credit subsidies that help make coverage affordable.
“It’s an expansion of the private sector, and an expansion of the public sector in a very modern way that everybody gets coverage,” he said.
Those who do not make enough money to file taxes are not required to get insurance in 2014, Schultz said.
Alborg said the reason is because their income level is under the individual mandate. But they still have other options to get health care, he said.
Medicaid is going to expand, Schultz said, and for those at the lowest end, 94 percent of their premiums will be paid.
“When you’re in that very low income group, there’s very little you’ll be required to pay for insurance,” Schultz said.
Those whose income level ranges from zero to 133 percent of the federal poverty level will automatically qualify for Medicaid. “Most of the cost of this is paid for through the system,” Schultz said.
Visit www.hhs.gov for more information.
