Kansas State University


Issues in Health Reform

Category: General ACA information

The ACA’s first five years

Recent testimony to the Senate shows different perspectives on the success and continuing challenges of the Affordable Care Act.

The Commonwealth’s testimony provides a well documented report on the different ways in which the ACA has changed health care delivery in the US. The Commonwealth used Congressional Budget Office figures, usually considered an unbiased source.

Basically, the good news for consumers:

  • more people, of all races and ages, are insured
  • most of those people are satisfied with their insurance
  • less people report being unable to get needed care because of costs…a reflection of lessening financial difficulties due to medical care costs
  • people have found paying for insurance easier in the Marketplace (subsidies have gone a long way…and yes, a pending King v Burwell judgment may change all of that)
  • the markets themselves have proved quite stable
  • states that have not expanded Medicaid (including Kansas) continue to have higher rates of uninsured
  • the rate of growth of health care spending has slowed allowing reduction in projected costs
  • young adults remaining on parents’ plans is significant

Know that other testimony was not as positive. Small businesses find that they are still struggling to provide insurance, sometimes in a volatile market. (See the testimony from the National Federation of Independent Business.) Note though that since the ACA does not mandate small businesses to provide insurance, many of those workers are able to seek insurance in the Marketplaces.  So while it may impact the small businesses in that being able to provide employer sponsored coverage is a currently a marketing and recruitment tool for the best and most skilled workers, those workers still have options.  It will be interesting to watch how this part of the market responds, especially as the SHOP (Small Business Health Options Programs) becomes more popular. The SHOPs offer businesses under 50 employees a marketplace of their own to find plans at better rates. Those under 25 employees are also eligible for subsidies to assist them in paying for premiums for their employees.

And testimony from the Mr. Holtz-Eakin, President of the American Action Forum,was most negative of all:

“The main promise that we heard repeated over and over again was that the ACA would provide universal access to affordable coverage of high-quality health care. In these remarks I will discuss (1) coverage, (2) affordability, (3) quality, and (4) access to care under the ACA.

The ACA has been riddled with wasted money and broken promises. It has proven to be poor growth policy, red-ink budget policy, flawed insurance policy, and poor health care policy. Instead of growth, it has contributed to a mediocre recovery. Instead of fiscal responsibility, it has exacerbated the red ink that plagues the government. Instead of universal coverage for the uninsured, the retention of valued policies and lower premiums, it has produced spotty, uneven coverage expansions, the forcible loss of valued polices and higher premiums for all. And instead of bending the cost curve and raising quality, it has delivered limited access to doctors and the loss of preferred providers.”

This testimony seems focused more on technical glitches and precise wording of promises, rather than an ability to understand the major successes that have accrued to millions of Americans as noted in the CBO figures and Commonwealth report. Mr. Holtz-Eakin speaks to premium increases without regard to the significant impact the tax subsidies are having on the actual out of pocket costs to consumers of those premiums. He complains that Medicaid is not doing as it had intended, yet it was the Supreme Court’s decision that limited significantly the impact Medicaid expansion could have on decreasing the numbers of uninsured, not the ACA itself. Mr. Holtz-Eakin seems concerned with not having access to preferred providers but those decisions are really within the realm of the insurance plans, and they have been changing those, without any laws, for years. Suffice it to say that I find this testimonial to be mostly emotionally charged, focused on specifics of language, rather than seeing the millions who have been helped by ACA consumer protections (including no exclusions for pre-existing conditions, no annual or lifetime maximums of coverage, no non-issuance of plans, and coverage of preventive service, free at time of service).

There are problems with ACA, as noted by the business community, and there is still a long way to go on reforming the system of health care delivery. But as noted by the Commonwealth testimony:

“ At the five-year mark, there is strong evidence that the Affordable Care Act has resulted in gains in coverage, affordability, and access to health care services. It may also have created the foundation for significant changes to the way we deliver and pay for care. Taken together, a promising picture emerges. Five years, however, is a short time in the life of legislation as ambitious and sweeping as the ACA. Additional studies and evaluations will be necessary to paint a fuller picture of the law’s impact on Americans and their health care system.”

How the health care law is making a difference for the people of Kansas

A report issued by the Department of Health and Human Services details how the people of Kansas are faring after the implementation of the Affordable Care Act (ACA/Obamacare).  The full report can be found here:  http://www.hhs.gov/healthcare/facts/bystate/ks.html

It is written by the administration so the tone is favorable.  The report has a section that details who is now insured through the Kansas Health Insurance Marketplace (the Kansas Exchange).  Over 57,000 selected plans in that marketplace.  And, as for the national average, almost 80% of 57,000 are receiving financial assistance paying for the premiums.

States have a choice as to whether or not to expand their Medicaid programs.  Kansas is one of 24 states that have chosen not to expand at this time.  Still, because of heightened interest in health insurance, over 28,000 Kansans have been newly enrolled in the Kansas Medicaid program, KanCare.  If Kansas had expanded there would be another 100,000 eligible.

The report goes on to give additional detail about new coverage benefits and how many Kansans are affected.  It also acknowledges that in Kansas, Medicare beneficiaries have save over $100 million on prescription drugs because of new cost sharing in that program.




How do I get health insurance before the next open enrollment period starting Nov 15, 2014?




Everyone with few exceptions (see https://www.healthcare.gov/exemptions) must have health insurance or may have to pay a penalty. Medicare Tri-Care, VA and Indian Health Service all remain the main insurance for those eligible for those programs. Because these programs qualify as insurance beneficiaries are not subject to penalties for being uninsured.

 Here are health insurance options for you to consider.

Your Job

 •   Your insurance stays the same unless your employer decides to make changes. If this work-based insurance is not affordable (costs more than 9.5% of your household income for a single policy) you may be eligible for financial help if purchasing a policy in the Marketplace.

 The Marketplace at healthcare.gov

 •   The Marketplace refers to a place for specific kinds of insurance policies that have been approved by the federal government to offer policies in Kansas.  Most think of it as the website where those policies can be found but it exists regardless of the website.  People can enroll via phone, mail, in person, or yes at the website.  The website offers an easy way to view and compare plans for providers, services and price. Anyone can shop in the Marketplace however, open enrollment is closed for 2014.

  •   Open enrollment for 2014 ended March 31. Only people with special circumstances can purchase in the Marketplace now   marketplace.cms.gov/help-us/enroll-limited-circumstances.pdf

  On November 15, 2014 the Marketplace will reopen for everyone else. KHN has a good story about those circumstances http://www.kaiserhealthnews.org/Stories/2014/May/09/Andrew-reader-question-on-insurance-between-open-enrollments .aspx?utm_campaign=KHN%3A+Daily+Health+Policy+Report&utm_source=hs_email &utm_medium=email&utm_contnt=12736814&hsenc+p2ANqtz-8xGUxlk04t5iCJ8D7Y8Jwxuv9SS7HSFMuLR4B3eRiCwWSwqRzCZzABM9aYnlvSyRfYLombN4pnWb0OtxE6FVYARW2m7A&_hsmi=12736814

  •   U.S. citizens, nationals and lawfully present immigrants living in the United States and not in prison can enroll in health insurance in the Marketplace.

  •   If you purchase in the Marketplace AND your household income is less than 400% of the federal poverty level (FPL), you may get tax credits to reduce the cost of the premium.  If it is less than 250% of FPL, you may also get help paying for out-of-pocket costs. This is not true for those who have work-based insurance that is considered adequate and affordable. Adequate means that the plan pays on average 60% of all your medical costs in a given year. Affordable is considered less than 9.5% of your annual household income. If work based insurance meets those criteria than you are not eligible for tax credits.

 KanCare at http://www.kancare.ks.gov/

 •   KanCare is the Kansas Medicaid program for U.S. citizens and lawfully present immigrants of low income who are over 65, under 18, or disabled.

 •   Children and pregnant women may be eligible with household incomes less than 225% FPL.

  •      Those over 65 have both income and asset limits, depending on the specific program.

  •   Check eligibility at http://www.kancare.ks.gov/ or the Marketplace healthcare.gov

  Additional options for young adults

  •   Stay on parents’ policies until age 26.

  •   Buy a catastrophic plan (for those under age 30 or with special financial circumstances).

  •   For higher education students, ask about student health insurance.

  Buy a private plan from an agent or broker.

  To get help or learn more to enroll in the Marketplace or KanCare

 •   Call the National Help Center at 1-800-318-2596 available 24/7.


Marketplace Eligibility Monthly Income

Marketplace Eligibility Monthly Income

Group Size

Up to 250% FPL Help with out-of-pocket costs

Up to 400% FPL Income limit for Tax Credits










For each additional person add

For each additional person add




Where are we now that open enrollment has closed?

It’s been a busy few months as we reached the ACA enrollment deadline.  There are lots of reports of how many are actually enrolled (about 8 million with the latest report).  The White House also announced that 35% of those who signed up for coverage were under 35. Twenty-eight percent are between the ages of 18 and 34, falling just shy of the administration’s 40% target. This demographic is needed to keep premium levels down, and to offset the costs of insuring older, and likely sicker, enrollees.
As importantly there have been several recent surveys showing that the rates of the uninsured are dropping.  For a good summary of those reports and explanations of what they mean see http://www.californiahealthline.org/articles/2014/4/17/surveys-highlight-acas-effect-on-us-uninsured-rate
Because some consumers will be eligible for special enrollment periods and KanCare enrollment is year-round, we expect to see the insured rate increase over time. We will be sure to pass along the most recent data on the number of Kansas’s successful enrollments as they are made available – so stay tuned!
There are important questions to be answered and I suspect we will see research trying to answer these in the coming months:
•    Who is still uninsured?
–    What are their options?
–    What will states do re Medicaid expansion?
•    Who is now uninsured who was previously insured?
–    Some very high cost counties, region and age
–    What happened with cancellations? Who was affected? Is new option better?
–    Did mandate work consistently across populations?
•    Is insurance affordable?  In whose terms? And through time (are premiums rising more or less than before?)
•    Has more insurance led to better health outcomes for individuals?  How has it affected community vitality?

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).


What is the impact on the federal budget by allowing businesses to take health insurance as a tax write-off?

This report analyzes the loss to the federal budget by allowing this practice.  This practice was initiated because it encouraged employers to pay for employees’ insurance plans.  Health insurance has, since World War II, been an important recruiting tool.  Businesses with better health benefits could choose from a larger more skilled employee pool.  It’s been a trade off between higher salaries and more extensive benefit packages.  ACA now requires taxing some of the insurance plans offered.  These are now referred to as “Cadillac” plans with the intonation that these plans are perhaps somewhat lavish and therefore not really necessary.  Those who have come to expect that type of complete coverage of their health care needs don’t think the plans are lavish but rather customary and essential.  That’s not the debate here.  This is just showing by how much the general federal deficit could be reduced if the practice of allowing employers to offer such extensive plans and claim tax exemptions for them were eliminated.  Policy analysts have oft referred to these tax exempt plans as money lost to the federal coffers.

Kaiser Health News Develops Consumer Guide to the Health Reform Law

To help answer questions that have been on many people’s minds, “How does health care reform affect me (and my family)?”, Kaiser Health News has compiled Q&As related to the Affordable Care Act and how the law will affect people depending on their different situations. This includes questions like: what happens if an individual does not have health insurance now, what if an individual doesn’t qualify for Medicaid but can’t afford insurance through the Health Insurance Marketplace, and what if an individual owns a small business?

To view the answers to these and other questions, view Kaiser Health News’ web page. After The Election: A Consumer’s Guide To The Health Law.

Consumer Guide 300

What does the public know or understand about ACA?

The Kaiser Family Foundation poll results are detailed in this KFF brief. Their summary highlights why this is a public education challenge for those of us working with communities:

As government officials, community organizations and advocates gear up the consumer information and assistance efforts that will surround this fall’s open enrollment for the health insurance exchanges created under the Affordable Care Act (ACA), much of the public remains confused about the status of the health law, according to the April Kaiser Health Tracking Poll. Four in ten Americans (42 percent) are unaware that the ACA is still the law of the land, including 12 percent who believe the law has been repealed by Congress, 7 percent who believe it has been overturned by the Supreme Court and 23 percent who don’t know whether or not the ACA remains law. And about half the public says they do not have enough information about the health reform law to understand how it will impact their own family, a share that rises among the uninsured and low-income households. When it comes to where they are getting information about the law, Americans most commonly cite friends and family, “newspapers, radio news or other online news sources”, and cable news. About one in ten report getting information from a health insurer, their doctor, an employer, or a non-profit organization. Similar shares say they have gotten information from “federal agencies such as the Department of Health and Human Services” or “state agencies such as your state Medicaid office”.”

Webinars on the Affordable Care Act hosted by the Department of Health and Human Services, some in Spanish

May 2013 Webinars on the Health Care Law



The HHS Partnership Center continues to host a series of webinars for faith and community leaders. All webinars are open to the public and include a question and answer session.


To participate in one of the webinars, please select your preferred topic from the list below and submit the necessary information. Please click on the title of the webinar and fill out the registration form. After registering you will receive an e-mail confirmation containing information about joining the webinar. Please contact us at ACA101@hhs.gov  if you have problems registering or if you have any questions about the health care law.


NEW! Update on the Navigator Program

May 7 at 3:00 pm ET

Please join our webinar to learn about the Navigator, In-Person Assister and Certified Application Counselor programs and how to enroll others in the Health Insurance Marketplace. Information on the Navigator proposed rules will also be discussed. Participation will be limited to the first 1,000 people who join the webinar.


NEW TIME! Questions and Answers on the Health Care Law

May 10 at 2:00 pm ET

Please join us for this interactive webinar. Questions that have been asked about the health care law will be answered as well as new questions submitted online. Please send your questions prior to the webinar to ACA101@hhs.gov.



Make the Call, Don’t Miss A Beat!


May 16 at 12:00 pm Noon ET


You are invited to a webinar titled Make the Call, Don’t Miss a Beat! a webinar seeking to educate and empower women age  50+ and to encourage women to call 9-1-1 immediately when they experience any of the seven symptoms of a heart attack, and to do the same for their mothers, sisters, and friends. The HHS Office on Women’s Health’s new campaign builds on OWH’s successful “Make the Call, Don’t Miss a Beat” campaign, that began in 2011.



Haga La Llamada¡No Pierda Tiempo!


El 16 de mayo del 2013 a las 1:00 PM (Tiempo del Este)


May 16 at 1:00 pm ET


Usted está invitado/a a participar a un Webinar en español sobre la campaña de concientización sobre ataques al corazón dirigida a mujeres latinas de 50 años en adelante. La campaña, “Haga la Llamada. ¡No Pierda Tiempo!” tiene como objetivo educar y motivar a las mujeres de habla hispana a llamar al 9-1-1 inmediatamente cuando se presente alguno de los siete síntomas de un ataque al corazón y a hacer lo mismo por sus madres, hermanas y amigas. Es una campaña lanzada por La Oficina de la Salud de la Mujer del Departamento de Salud  y Servicios Humanos y el webinar es en colaboración con la HHS Center for Faith-Based and Neighborhood Partnerships.



The Health Care Law 101 (in Spanish)


May 21 at 3:00 pm ET


A presentation on the main provisions in the Affordable Care Act, the health care law, and how to access care in your community in Spanish. Information on the Health Insurance Marketplace, how to help enroll others in health insurance, and how to receive updates on implementation of the law will be shared.



The Health Care Law 101


May 23 at 2:00 pm ET


A presentation on the main provisions in the Affordable Care Act, the health care law, and how to access care in your community. Information on the Health Insurance Marketplace, how to help enroll others in health insurance, and how to receive updates on implementation of the law will be shared.



Lisa M. Carr, MSW, Associate Director

HHS Center for Faith-Based and Neighborhood Partnerships