Kansas State University


Issues in Health Reform

Category: Uncategorized

Variation in 2015 Marketplace Plan Selection Rates by Income

Open enrollment in the federal and state Health Insurance Marketplaces is over for the 2016 insurance year but we’re still learning from prior years’ experiences.  The focus of the following issue brief written by RWJ and the Urban Institute  http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2015/rwjf424382 presents March 2015 data (end of Open Enrollment 2) showing:

  • how many estimated people who were eligible for Marketplace coverage actually signed up, and of those,
  • how many were eligible and applied for assistance in paying for premiums, and
  • how many of those in total “effectuated” coverage, that is paid premiums and filled out all necessary paperwork to start the policy coverage.

The data are presented by state, with some data on how people of different income levels behaved in these markets.

The general picture shows that there are many people in all states who are likely missing out on using the Marketplaces for affordable health insurance coverage.  The selection rates…number of people eligible for financial assistance paying for Marketplace plan divided by the total number of people estimated eligible…are still lower than might be expected.  There is also large variation between states as to how many are enrolled, and whether or not it was a state-based exchange, or a state with a Medicaid Expansion, were not necessarily the defining factors.

Some key findings:

  • 24.1 million people were eligible for Marketplace tax credits
  • 10 million, 41%, selected plans but only 8.6 million “effectuated” their coverage for a more accurate enrollment rate of estimated eligibles of 35%.
  • the 13 state based marketplace states had more variation between each other in effectuated plan rates (5-50%) than those in the 37 states using healthcare.gov (18-57%).
    • Florida’s high effectuation rate (57%), the highest of all states, skews the non Medicaid expansion states’ rates when combined.
    • Rates in Minnesota and DC were impacted by special programs they have that cover individuals under 200%FPL.  Over 200%FPL, Minnesota and DC look much as the other states.
  • the higher the income, the less use of the Marketplace. This was true for all states. That is, even with tax credits, out of pocket premium costs for those with higher incomes get increasingly more expensive and appear to be discouraging Marketplace enrollment.  (Some of the drop off may be due to under estimated alternative insurance options like employer based insurance.)

Report conclusions:

  • The relatively low effectuation rate could be improved by additional outreach efforts, especially in states with very low rates.
  • Premium tax credits, cost sharing reductions, and premium criteria are the same across all states so Marketplace enrollment data provide insights into people’s willingness to pay for insurance given some level of financial assistance.
  • The limits of a willingness to pay more of the premium costs could hold back significant decreases in the number of people uninsured.  While the fines for remaining uninsured may weigh into families’ decisions as those fines become increasingly expensive, it may be that without a policy change to improve affordability overall insurance costs may remain a barrier to fuller insurance levels.



Countdown to Supreme Court Decision about ACA Tax Subsidies

By the end of June 2015 the Supreme Court of the United States will hand down their decision in King v Burwell that will impact around 8 million Americans who are currently receiving tax subsidies to help pay insurance premiums for policies they have bought in their state marketplaces.  Either those 8 million will sleep easily knowing that all is as it was and they will continue to get help paying for their subsidies OR they may be quite a bit more agitated with lots of unknowns.

The issue is whether or not the language of the Affordable Care Act (aka Obamacare) that permits subsidies for residents only in those in states running their own Exchanges/marketplaces is the way the law must be interpreted and enacted OR if the intent was indeed broader.

In a large sense all of the Exchanges/marketplaces are “state” Exchanges since the insurance policies approved for sale in those are set up for each state specifically.  The sticking point is that some states (34 of them) had the federal government facilitate the operation of their marketplaces.  Those are called “federally-facilitated” exchanges/marketplaces and are considered, by the challengers, to be non-state marketplaces.

The challenge about the wording has been an attempt to gut one of the main provisions of the law that makes insurance policies offered in those Exchanges/marketplaces more affordable.  In some cases, it is very much more affordable with individuals near 138% federal poverty line ($16,242 for one in 2015) paying ~$20/month for a policy.

Depending on whom you ask the law’s reference to state Exchanges 1) was sloppy wording, but seen in context of the whole law, could not have intended to cut off from subsidies residents of states not operating their own Exchanges OR 2) the intent was not to give subsidies to states not operating their own Exchanges, perhaps as an incentive to get the states to operate their own Exchanges.  The SC Justices are either going to assume the language was sloppy within the full context of the law thereby allowing the subsidies to exist in all states OR they will be true to the language of the law and say: if Congress intended subsidies to be for residents of all states then Congress has to fix the wording.  There exists concern that Congress is not in any position to agree upon new wording.  Certainly, there are many legislators who would welcome the damage a ruling in favor of the plaintiffs would do to the ACA.  However, since those directly impacted negatively would be residents of many states, and these are their legislators, some are looking to temporary fixes including:

  • extending the tax subsidies through the end of the year so there would be less disruption (this would leave no good alternative for affordable policies going forward), and
  • Governors are considering taking on the responsibility of running their own Exchanges (but this is a huge undertaking, as evidenced by the fact that some states tried and decided to let the federal government takeover: e.g. Maryland)

I spoke to this issue on Nov 19, 2014 and in depth in a July 22, 2014 post when the issue about ACA tax subsidies was just heating up with circuit and district court rulings.  The specifics remain relevant.

How do American’s feel and what do they understand about this judicial case?  “A brand spanking new Kaiser Family Foundation poll finds a broad majority of Americans wants Congress to pass a law to make subsidies available in all states if the Supreme Court guts them…about 6 in 10 (63 percent) say Congress should pass a law so that people in all states can be eligible for financial help from the government while about a quarter (26 percent) say Congress should not act on the issue.” (Washington Post, Sargent, June 16, 2015).


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.”

Enrollment in Kansas Marketplace

Open Enrollment in the Health Insurance Marketplace is officially closed for most.  Nationally the numbers show that over 11 million Americans signed up, either for the first time or with a renewal of their last year’s insurance plans.   http://www.hhs.gov/healthcare/facts/blog/2015/02/open-enrollment-week-thirteen.html

The number of Kansans enrolled in 2015 is 96,226, almost double the 57,000 from 2014.   That is just under the 100,000 likely eligible to enroll in Marketplace as estimated here:  http://kff.org/health-reform/state-indicator/state-marketplace-statistics-2014/

Early estimates continue to report over 80% of those enrolled being eligible for assistance in paying for premiums, with a subset of those also eligible for cost sharing assistance for out of pocket expenses.


Tax Implications for ACA: How to Avoid Tax Penalty for 2015

While the general Open Enrollment in the Marketplace ended February 15, the IRS has announced a new Open Enrollment period between March 15 – April 30, 2015.  It is only for those who discover that they will be paying a penalty with their 2014 taxes because they do not have health insurance, AND who can claim that they did not understand the consequences of not being insured impacting their taxes.  This will not impact their penalties for 2014 if they were uninsured in 2014 for but allow folks to avoid the penalty for their 2015 tax year. See this CMS news release for the full details: http://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2015-Press-releases-items/2015-02-20.html

Consumers seeking to take advantage of the special enrollment period can find out if they are eligible by visiting https://www.healthcare.gov/get-coverage Consumers can find local help at: Localhelp.healthcare.gov or call the Federally-facilitated Marketplace Call Center at 1-800-318-2596. TTY users should call 1-855-889-4325. Assistance is available in 150 languages. The call is free.

This year 2014 that penalty is 1% of annual income above the tax filing threshold (or $95, which is GREATER).  And next year the penalty goes up to 2%.  So, remaining uninsured is not only a financial risk for health reasons, it costs money upfront.  Of course, it also makes sense to have good coverage especially since that now has to include preventive care at no upfront cost and no one can be excluded because of health reasons.

If Open Enrollment in the Marketplace is through Feb 15, why is Dec 15, 2014 so important?

It is true that consumers have until Feb 15, 2015 if they intend to find and enroll in an insurance plan through the Kansas Health Insurance Marketplace. However, for benefits to begin Jan 1, 2015, you must sign up by Monday Dec. 15. Otherwise, benefits won’t begin until Feb 1, or March 1.

So the time is now to enroll. Go to healthcare.gov or all 1-800-318-2596 24/7 to start your application or renewal today.  You can find more information at:  https://www.healthcare.gov/keep-or-change-plan/

If you signed up last year, you will be automatically re-enrolled in the plan you had UNLESS it is no longer available OR you actively choose a new plan.  Since plans change it is wise to review your coverage and the network of health care providers to see if you still have the plan you want.  If you had assistance paying for premiums make sure that that assistance will continue in 2015.  If you allowed the Marketplace to access your tax records, you should still be eligible.  If you did not, you will have to resubmit income information.

Remember almost all are required to be insured and report it on with their tax returns. For the year 2014, your status will be reported on the return you file before April 2015. Your insurance status for this coming year will be reported April 2016.



Will health insurance cost me more this year?


Health insurance premium costs in the US have been rising every year since number crunchers have been watching this.  In the past some of those numbers have been very high, double digits for years.  The Affordable Care Act (ACA) is working to keep the rate of those increases down to a minimum, below where they have been in previous years.

However, for Kansas there is a report showing that we are not doing as well as other states. Perhaps not surprisingly given the political nature of evaluating the success of the ACA, there is disagreement by analysts over the accuracy and the relevance of those numbers.

The national report singling out premium increases in Kansas as being higher than all but Alaska came from PricewaterhouseCoopers (PwC) (http://www.pwc.com/us/en/health-industries/health-research-institute/aca-state-exchanges.jhtml).  That report projected Kansas’ health insurance premiums overall up more than 15 percent this year compared to about a 5 percent average increase nationwide. As reported in the NY Times, these reports, however, are misleading on several levels. http://www.nytimes.com/2014/11/19/upshot/how-much-did-health-insurance-rates-go-up-its-complicated.html?_r=1&abt=0002&abg=1

For one, if you are concerned with what consumers are really paying, these national analyses muddy the waters by including premiums for all plans offered in each state as opposed to only using data for those plans people are actually enrolling in. In reality most consumers purchased one of the lower cost bronze or silver plans.

To correct this bias, they commissioned an analysis looking at the costs of those bronze and silver plans for all federally facilitated marketplace states, including the one in Kansas.  For Kansas, the cost increase for an average lowest bronze plan for a 50 year old non smoker was 8 percent, compared to 3 percent increase nationally, but the average lowest silver plan for the same person went down 6 percent in Kansas compared to a 4 percent increase nationally. http://avalere.com/expertise/life-sciences/insights/avalere-analysis-2015-exchange-premium-file

A more detailed analysis of the Kansas marketplace is provided by the Kansas Health Institute (KHI) (http://www.khi.org/news/2014/nov/15/kansas-marketplace-opens-year-two/).  Their report said that the average premium for all plans offered in the marketplace increased just 0.1 percent from 2014 to 2015, while acknowledging that individual Kansans could see a wide range of price changes for specific level plans. As an example, premiums for some silver plans are anywhere from 11.6 percent more to 13 percent less in 2015 compared to 2014.

When considering what these premium increases really mean for consumers we also have to remember that last year the Kansas marketplace was ranked as having the 5th lowest premium costs of all states. Even an 8 percent increase of a smaller starting amount will likely yield an affordable premium compared to others.  So, coupled with the lower starting point, these reports provide evidence that Kansas premium increases are at minimum comparable to other states, in some cases better, and that the actual premium costs still provide value at a good cost to Kansas consumers.  It is surprising and encouraging that even as Kansas has a small number of insurance companies offering plans in the marketplace, those insurers seem to be offering affordable products to Kansans.  We might expect with less competition prices could be higher.

As time goes on we would expect insurers to adjust their premiums based on the collected health care expense experiences of all insureds in those plans.  According to the Henry J. Kaiser Family Foundation (http://kff.org/health-reform/state-indicator/marketplace-enrollment-as-a-share-of-the-potential-marketplace-population/#table), this past year only 19 percent of Kansans expected to be eligible for enrollment in the Kansas marketplace actually signed up.  This was less than the 28 percent national average. Still Kansas had a good number of the valued younger (under 35) adults enroll, 38 percent, helping to ensure a workable mix for insurance rates overall.  All states are expected to see growth in their enrolled populations for 2015.

Tax Subsidies

This year it is likely to be the change in the tax subsidies rather than premium increases that have the potential to make health insurance more expensive. Over 80 percent of families nationwide and in Kansas are using these subsidies to help pay for insurance. This financial assistance to pay for premiums is based on the premium of the second lowest cost silver plan offered.  So, if there are plans that have lower premiums in that tier compared to last year…and there are…then the subsidy will be based on the cost of those new plans resulting in a smaller subsidy. Re-enrolling in the same silver plan may cost more even if the premium hasn’t changed because the subsidy one gets to pay for that premium is now based on a different plan. This difference is one of the important reasons why people need to consider plans carefully this year.  It could be that an individual finds the higher price she has to pay worth it but one needs to be aware and make this decision with full knowledge.  The reason there are less expensive plans in the same tier is that some of the plans offered for the first time this year have larger restrictions on network providers than those plans offered last year.  Restricted networks vs paying a higher portion of the premium is the choice many Kansas families may have to make.


The cost-sharing arrangements constitute a major part of the cost of health insurance.  These are payments you make outside of the monthly premium.  They include deductibles and actual copayments or coinsurance.  They are cost-sharing mechanisms when you actually use care and receive a bill.  Even those payments schedules may change within the insurance policies being offered so this is another feature people have to pay attention to when choosing a plan for this coming calendar year.  The bottom line is to be careful to see if you may be paying more for the types of health care services you may usually receive.


When one considers the overall costs of insurance she should also consider the cost of not being insured.  Besides the real risk of financial consequences if one has an unexpected major illness (one hospitalization can wipe out personal finances for those uninsured), there is also the tax penalty.  Kansans who fall under 138 percent of the federal poverty level (FPL) won’t incur a tax penalty for being uninsured.  With a few other exceptions everyone else who’s uninsured will face a penalty much higher for 2015 than in 2014. People who obtain health insurance through their employers, Medicare, TRICARE, Veteran’s Affairs, or KanCare, Kansas’ Medicaid program, are considered insured and will not face penalties.  Tax penalties will continue to go up every year. For 2014, you will face a tax penalty when you file in April 2015 of $95 per person or 1 percent of annual household income above the tax-filing threshold (about $10,000 for an individual), whichever is greater. You will face a penalty every year that you continue to be uninsured, and that penalty will increase every year.  If you choose not to enroll in 2015, you will face a tax penalty when you file in April 2016 of $325 per person or $975 a family or 2 percent of annual household income above the tax-filing threshold (about $10,000 for an individual), whichever is greater.

How to get insured

Open enrollment in the marketplace began Nov. 15 and goes through Dec. 15 to be covered beginning Jan. 1. People have until Feb. 15 to sign up for health insurance next year, though, for coverage to begin March 1. Whether or not a person buys in the Health Insurance Marketplace, as long as the coverage by some qualifying insurance plan starts by April 1, that person is meeting the federal mandate and will not be subject to penalties.

If obtaining insurance through the marketplace, log on to www.healthcare.gov. To learn more about how to enroll in the marketplace or KanCare, Kansas’ Medicaid program, call the marketplace, available 24/7, at 800-318-2596.

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




Remind me….how are people going to be insured?

Starting April 1, 2014 most Americans are going to have to have health insurance or face financial penalties. 

1.       Many will already be insured through:

a.        the public health programs (Medicare, VA, TriCare, Medicaid, Indian Health Service)

b.      Employer sponsored insurance

                                                               i.      Including adult children up to age 26 when employer offers a family plan

2.       Those who are not insured will be required to purchase health insurance IF their income falls above income guidelines requirements.  (for example, over $15,856 for a single individual, $32,499 for a family of four).  

a.       Options for those above income cutoff include purchasing:

                                                               i.      Employer sponsored insurance

                                                             ii.      A policy in the private insurance market

                                                            iii.      A policy in the Exchange (through healthcare.gov)

b.      Penalties for not complying

                                                               i.      Will be reconciled at tax time

                                                             ii.      Will increase each year. 

                                                            iii.      In 2014 it will cost per family member 1% of income or $95 whichever is MORE

1.       Fines for children are half those of adults

2.       The fine for the total family maxes out at $295

c.       To expand options and to offer comprehensive insurance coverage, insurance policies are being offered in state Exchanges.  Anyone can buy a policy in their state’s Exchange.  No one can be denied health insurance coverage for a pre-existing condition nor can they be charged a higher premium because they are sick.

d.      The Exchanges in all states are open for business.  For some, the website version is working better than in others.  In most of the states that chose to coordinate their own Exchanges those sites are working well.  For the rest of the states, the federal website, healthcare.gov is working much more smoothly than when the website was originally launched Oct 1 and consumers are signing up. 

e.      Most of those who do not already have insurance and choose to purchase a policy through the Exchange will find that they are eligible for assistance for paying for health insurance premiums and even for copays for the actual care.

                                                               i.      If household income is below 400% of the Federal Poverty Level (FPL) ($94,200 for a family of four) AND they are not offered affordable and adequate health insurance at work, families are eligible for assistance to pay for premiums.  These are called tax credits.  How much assistance is given depends on income.  Families in these categories are limited to between 2-9% of that household income as the maximum amount of premium they have to pay.

1.       An adequate employer based policy will cover on average 60% of the costs of medical care in a given year.

2.       An affordable employer based policy will cost no more than 8% of an individual’s annual household income.

                                                             ii.      If household income is below 250% of the FPL ($58,875 for a family of four) families are also eligible for assistance to pay for medical care.  These are called tax subsidies.  How much assistance is given again depends on income.

3.       Those living below this income cutoff:

a.       In states that have expanded their Medicaid eligibility criteria, these individuals 

                                                               i.      will be enrolled in Medicaid when they submit their application through the Exchange.  The federal government is paying 100%of these costs til 2017 when states will then be asked to share the costs by contributing 10% while the feds will pay 90% of total costs.

b.      In states that have not expanded their Medicaid eligibility criteria (including Kansas), these individuals

                                                               i.      Will not be fined for not purchasing insurance

                                                             ii.      Will still be able to private pay and depend upon safety net providers and the good graces of health care providers who provider care to those who cannot pay.

How well is ACA doing getting the uninsured insured? Better than the press tells you.

What about all of those newly insured numbers? While it take many years to evaluate all of the impacts of ACA on insurance status, and certainly on the true impact of having insurance on health status, the numbers of newly insureds are impressive. As of January 15, 2014 there are almost 11.6 million Americans who have health insurance who did not have it before ACA. Almost 2.2 million people have enrolled for new insurance policies through the Exchanges. Almost 1.6 million have been added to state Medicaid rolls. And approximately 7.8 million young adults (under age 26 ) have already been added to their parents’ employer sponsored health insurance plans because of the ACA requirement that employer sponsored family plans expand coverage. This last group is often not cited when considering the success of ACA in getting previously uninsured people insured. Most of the articles focus on how successful the Exchanges are in getting the uninsured into those private plans. They also seem to ignore the success in getting individuals into state Medicaid programs. Almost 12 million folks newly insured has to be counted as a success for ACA accomplishing one of its major goals…to get uninsured folks insured.

Health Exchange Enrollment Picked Up in December, By HAEYOUN PARK, DEREK WATKINS and WILSON ANDREWSJAN. 13, 2014, NY Times.
Covering Young Adults Under the Affordable Care Act: The Importance of Outreach and Medicaid Expansion Findings from the Commonwealth Fund, Health Insurance Tracking Survey of Young Adults, 2013
Sara R. Collins, Petra W. Rasmussen, Tracy Garber, and Michelle M. Doty, August 2013.