Kansas State University


Issues in Health Reform

Month: October 2013

Time for ACA Open Enrollment: State vs Federal Exchanges

In the past week a new distinction in implementation success between states that had chosen to facilitate their own new insurance marketplaces (also called Exchanges) and those that did not has become apparent.  Previously much was written about how much it really did NOT matter if the Exchange was going to be run by a state or run by the feds.  After all, there were going to be marketplaces with a collection of new insurance policies for consumers to choose regardless of who was doing the facilitating.  Negotiating with the different insurance companies happened.  States have lots of policies being offered in these Exchanges.  But getting access to them online has been quite a different experience for those trying to access a state facilitated Exchange vs those accessing healthcare.gov to get to their states’ federally facilitated Exchanges.

Early on it was apparent that the burden of having the feds do it for over half of the states was going to take its toll on the administrators.  But beside that, things were going to be fairly equal.

Well, not so.  The federal website is experiencing all sorts of glitches and delays.  It is unfortunate since those who have been able to create and account and see what their states’ insurance offerings are have been satisfied. We now see evidence that running such a massive online site, with apparently outdated government type computer services, is more problematic than having states put together smaller Exchanges. Check out this article explaining the differences: http://www.nytimes.com/2013/10/09/us/politics/uninsured-find-more-success-via-health-exchanges-run-by-states.html?_r=0

Kansas families who have not been able to register or submit an application to consider a policy being offered in the Kansas Exchange can at least get a glimpse of what the premiums and tax credits might be for them in Kansas by going to insureks.org

There one enters county, household size, income, and ages of family members to be covered and a cost estimator gives expected monthly costs based on premiums and tax credits that are true to the cost of premiums in their region of Kansas.


Resources for the Kansas Exchange: Health insurance premiums and other options

There are several excellent resources available for consumers trying to make sense of what the Marketplace/Exchange in Kansas looks like.

The Kansas Insurance Department has a consumer friendly site that helps individuals and families understand the new Marketplace and offers some resources for support in making decisions.

Our colleagues at the Kansas Health Institute have a very informative map on their home page that shows what the ranges of prices for health insurance premiums through the Exchange are in Kansas.  HHS reports that the average monthly premium for a middle of the road plan in Kansas is $260/month, less than the US average of $328/month, the fifth lowest rates in the nation.

The Kansas Health Institute also has an issue brief on the Marketplace.  The brief includes

  • a summary of the 65 types of plans being offered to individuals and
  • tables showing examples of costs depending on region of state, age, and income level including the range of monthly savings for those receiving tax credits (between $100 and $1000/month depending on age and income level).


The role of Critical Access Hospitals for rural communities

With so much attention on The Affordable Care Act and the opening of the Exchanges some other issues important for the continued functioning of our health care delivery system, particularly in rural and frontier communities, is being overlooked.

A recent blog by Josh Freeman covers the role of Critical Access Hospitals for rural communities fairly completely.  Most of the blog covers the factual…how CAHs were created nationally in 1997, that Kansas has more than any other state (83), what role they play in providing health care to high risk populations (those with more occupational injuries…farmers, ranchers, loggers…and older Americans), and how a recent designation change will decrease how much money these hospitals recover from Medicare putting their existence at risk.  Freeman ends his argument with an opinion on the continued worthiness of CAHs.

These CAHs are all connected to a “supporting” hospital where their patients will be transferred to if care is not completed in 3 days.  Click here for a map of those Kansas networks.