Kansas State University


Issues in Health Reform

What does it mean when politicians say health care is a right?

Of late President Obama and others have been touting the recent Supreme Court (SCOTUS) decision in King v Burwell that upholds tax subsidies for every state as proving health care is a right. Hmmm. That’s still a stretch. Let’s look at who is likely to either have health care paid for with the assistance of insurance, or have health care directly provided to them and who is still left out.

We have the public plans that do make health care a right for those who fit the eligibility criteria. There is:

  • Medicare for those over 65, the disabled, and selected other special disease interest groups (End Stage Renal Disease, Lou Gehrig’s disease).
  • Medicaid for those poor enough who are over 65, or under 19 (those who are in the state Children’s Health Insurance Programs (CHIP)), and now adults under 138% FPL ($27597 for family of four) in the 31 states that have expanded their Medicaid programs (as of July 2015)
  • The Veteran’s Administration system that provides care directly to veterans.
  • The Tricare system for active military that also provides care directly; and
  • The Indian Health Service for members of tribal nations that also provides care directly. Members also have access to all of the insurance options available for others (Medicare, Medicaid, CHIP, employer sponsored insurance, marketplace plans and plans in the private market)

We have a complicated private insurance system that now does offer health care as a right to all who qualify or can afford it. The “right” parts are the consumer protections where no one can be turned down because of a pre-existing condition, have a policy cancelled or maxed out, and because certain large employers are mandated to provide insurance. People covered under this “right” are:

  • Those who work for employers with over 100 employees, since January 2015 mandate
  • Those who work for employers with over 50 employees, mandate begins (if still in effect) January 2016
  • Those not covered through work who can afford private insurance without assistance if they are over 400% FPL ($97000, family of four), or between 100-400% if they can afford insurance with subsidies

That leaves out the 126000 in Kansas (Families USA data) who are like the 6.4 million others in states that also have chosen to not yet participate in the ACA supported Medicaid Expansion. Those folks fall between a state’s standing maximum eligibility to qualify for Medicaid (33% in Kansas for parents, 0% for childless adults) and 138% FPL. These folks are too poor to qualify for financial assistance paying for a marketplace insurance plan and too “rich” to qualify for Medicaid in states with very stringent criteria for eligibility.

Therefore, while it is true that things would have been even more difficult for the 80-90% of people in the marketplaces who depend on those tax subsidies to afford those insurance plans had the Supreme Court ruled otherwise in King v Burwell, to say that the SCOTUS decision means that health care is a right is more than a stretch of the implications of that ruling.

The SCOTUS has ruled on tax subsidies: What does this mean and can we now move on to fixing things?

On June 25, 2015 the Supreme Court of the United States ruled to uphold the health law tax subsidies. (Here is full ruling) One might easily say all is as it was before the ruling. That is, in the new marketplaces of insurance that began in January 2014 because of the Affordable Care Act, things would continue as they were. Anyone who was eligible to receive a tax subsidy and had been receiving those subsidies for assistance in paying for insurance purchases through those marketplaces would continue to do so. The threat had been to consumers in the almost 3 dozen states (34) where the federal government was facilitating their marketplaces. The ruling for those subsidies to continue for all allows implementation in a “more certain and predictable environment for the health care industry, states, and consumers.” (WSJ)

Over 11 million previously uninsured Americans are now insured (Kaiser Family Foundation). Approximately 80% of those enrolled in marketplace plans (some previously insureds included) are receiving financial assistance (Kaiser Family Foundation in JAMA). Tax credits to help pay premiums for those plans are available to those with income less than 400% federal poverty level (FPL) ($97,000 family of 4). Those with incomes less than 250% FPL ($60,625 family of 4) qualify for additional assistance in paying out of pocket expenses. That financial assistance to an estimated 6.4 million was what was in jeopardy.

If you are looking for a good resource showing a state-by state effect with a map to accompany it (showing numbers of potential lives that were affected and the amount of dollars at stake), see this Kaiser Family Foundation brief.

Others have well described the intricacies of the ruling discussing such issues as why the 6 justices who ruled in favor of the administration thought it was important to see the law in its full context. There were 3 fairly strongly worded descents and there are many who continue to see this ruling as a political decision. Conservative media were outraged though I was surprised to see even Fox News op ed piece by a physician/health care executive focusing on trying to improve health by giving access to care.

Here are some words representing opposing and supportive views,

  • Brookings Brief that explains well the ruling and talks about upcoming challenges.
  •  Washington Post article was accepting of the ruling and includes a video on what you need to know about it.
  • In this National Journal piece the focus was on the argument of one of the most vocal dissenters, Justice Scalia.
  • CBS summed up the Republican point of view in this article.
  • Media Matters for America focused on balancing the conservative media reactions.

What I would like to point out is:

  1.  I’ve been surprised that I’ve not seen talk about what state marketplaces really are. In fact, whether facilitated by the feds or or in partnership with the feds, operated solely by a state all marketplaces are state based. They include insurers who offer policies specific to that state’s population and only a particular states’ residents can buy those policies. The insurers had to get approval from the states’ insurance commissioners offices to offer insurance products in those states. Yes, in the federally facilitated exchanges the feds had to do a lot of the work, especially the website aspects, but all state insurance offices were fully engaged in the discussions with the insurers.
  2. That we have spent a lot of time and energy worrying over the potential implication of a ruling that would have been detrimental to residents of those living in federally facilitated exchanges/marketplaces states. Given the particular wording in the decision, that is up to the SCOTUS to sort this out, this aspect can’t go back to Congress, though other parts could and I suspect might. As this aspect of the national conversation is put to rest, others may arise.
  3. Even those who believed the contested language referring to state Exchanges was precise–written with the intent to push states toward setting up their own exchanges else their residents would be ineligible for those tax subsidies (a major stick approach)– understood that major turmoil would ensue if 6+ million or so newly insured were suddenly in jeopardy of having that insurance become unaffordable again.

There are many who now say that with this latest legal challenge behind us, the focus can be on improving the law, and these suggested improvements are from both supporters and non.

  •  For a perspective on not “surrendering” but block granting ACA instead see US News and Forbes
  • See the Wall Street Journal for a perspective on how the ruling raises the bar for Obamacare opponents, basically requiring political movement to improve on the perceived failings of the law.
  • See the National Center for Policy Analysis for more specific changes the author believes would improve the insurance aspects of the law
  • For a list of possible improvements, including improving the value of the care we receive (see Health Affairs)
  • For an understanding of ongoing challenges such as the costs of the subsidies (and the price of health care in general), see The Hill.

And there are still some who prefer a single payer for all system, an expansion of Medicare. Some of us recall that the reason we got the ACA from a Democratic President is that Obama believed an expansion of the private insurance industry would garner bipartisan support. We’ve seen all too clearly through the years with a law that passed with not one Republican legislator supporting, through dozens of repeal attempts, that that bipartisanship did not materialize. Check out this Huffington Post site for a collection of essays on the perspective of Medicare for All.


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.”

Medicaid Expansion for Kansas?

Next week Kansans and the Kansas legislature finally get to voice opinions about expanding or not Kansas’ Medicaid program, in line with the original intent of the ACA.  This will be watched closely nationally as Kansas is one of several states that have yet to have a hearing on this.  While the Kansas legislature told the Governor two years ago that no Medicaid Expansion could pass without their approval, there really has not been any hearing or public airing of this. The bill would override that previous legislation and allow the Governor to negotiate more freely an expansion option that might further allow public hearings on the matter.

As noted in this KHI news briefing observers expect both proponents and opponents to have much to say.

The proponents include:

  •  provider groups (the Kansas Hospital Association and such) who will benefit from having to provide less uncompensated care
  • consumer advocacy groups who believe that the ACA intended to make insurance more affordable to all, including those too poor to qualify for tax subsidies in the Marketplaces
  • community organizations who argue that all in community are affected by uncompensated care in terms of costs of health care in that community, and a healthier workforce when more are insured


The opponents include:

  • those who in general are against the ACA and believe its costs are not sustainable such as Americans for Prosperity
  • those who believe Medicaid is a failed an unsustainable program so expanding it is not the way to go

Over half of the states have already expanded their Medicaid programs, taking advantage of federal funding assistance as offered through the ACA. Some have done this as a direct expansion of their current programs. Others have tried more private pay models, requiring copayments or even premium payments on the part of participants. Families USA explains the impacts of these Medicaid Expansion decisions in a series of useful graphics. The Kaiser Family Foundation has a detailed list of what each state has chosen to do to date. Note that states can choose to request federal assistance with expanding at any time.

Who gets tax subsidies to pay for health insurance anyway?

As the Supreme Court is set next week to hear King v Burwell, the case against tax subsidies’ eligibility for non state Exchange state purchasers of health insurance, earlier post, this essay points out how most of us receive subsidies to pay for health insurance..whether it’s the Medicare population who paid into the system no where near what they are taking out, or those of us whose employers get our insurance premiums as a business write-off, and we get the benefit as pre-tax income.  As Rampell points out, these facts are important to understand in the face of the resistance many have to the tax subsidies received by most of the folks who purchase insurance through the Marketplace Exchanges.  The tax subsidies for those who work but don’t have employer sponsored insurance levels the playing field.   http://www.washingtonpost.com/opinions/if-you-want-to-know-who-gets-health-care-handouts-look-in-the-mirror/2015/02/26/53e2de84-bdf9-11e4-bdfa-b8e8f594e6ee_story.html?wpisrc=nl_opinions&wpmm=1

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.