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From Debate to Reality… The ACA Rolls!

I am so excited!  After many months of discussion, debate, controversy and political fodder…   after much ado, we find ourselves only days away from the October 1 launch of the open enrollment period for the Affordable Care Act – or ObamaCare, as it’s  affectionately become known.  While there is little doubt the ACA will evolve, and controversy and challenges are expected to continue, what’s exciting is the actual movement from philosophy to implementation, and for North Dakota, this takes shape in two separate programs – Medicaid Expansion and the Marketplace. 

Medicaid Expansion was approved by the 2013 Legislative Assembly as a means to provide Medical Assistance to low income individuals, between the ages of 18 and 64, who do not have minor children in their household.  Currently – and without this expansion – an adult without minor children cannot receive medical assistance if they were to find themselves in need.  An example of this might be a young, working individual who must contend with a serious illness or injury.  As treatment begins and work becomes limited or eliminated, his insurance lapses and his assets deplete.  As an adult with no children, (s)he would not qualify for assistance under the current system.  Through the expansion of Medicaid to include childless adults, we’ll now have a safety net in place for all eligible North Dakotans.

All North Dakotans, regardless of income category, will now also be able to explore health insurance options through a new system called simply, “Marketplace”.   Whether shopping for price and coverage comparisons or looking for solutions due to income limitations, the Marketplace is a new resource to assist in the search.

The basis of the Marketplace is to “level” the playing field among insurance carriers, and to insure that an essential, minimum amount of coverage is made available to all, regardless of the plan selected.  Privately purchased insurance options will be categorized by Bronze, Silver, Gold and Platinum and will offer a range of coverage – from 60% to 90%, respectively.  A cost-share program, based on income and family size, will be made available to help ease the financial burden for individuals and families where the employer doesn’t offer affordable or adequate coverage.

It’s expected that as many as 20,000 to 30,000 low-income North Dakotans will be affected by these changes as it opens to cover income levels up to 133% of the federal poverty level.  In rough terms, that’s $15,282 for a family of one, $31,322 for a family of four.  In addition, it will impact another 253,000 North Dakotans through the lift of the lifetime limits on health benefits, and 17,700 small businesses will qualify for tax credits.

Already certain aspects of the ACA have been implemented, and since 2011 over 9000 North Dakota Medicare recipients have saved on prescription drugs as the infamous “donut hole” is being filled.  Young adults are now allowed to continue to be insured through their parent’s insurance plans up through their 26th year.  Well-care and preventative services are available through private insurance plans with no co-pay and no deductible.  And, pre-existing conditions will end for children this month and for adults this coming January 2014 – affecting approximately 34,000 children and 240,000 adults in North Dakota.

As October 1st draws near, questions abound – and individuals and businesses are finding themselves in need of direction and information.  I had the opportunity to sit in on a panel discussion in Grand Forks this past week and was so pleased to hear of the great work that has quietly been taking place behind the scenes – specifically to help people navigate this new system.  A wealth of information and resources were provided, and I wanted to be sure to share these out before the 1st arrives.  Additionally, the approach of a panel discussion was so effective I’ll be working with several of our local partners and service providers to bring a similar forum to our neck of the woods soon.

In the meantime, the Grand Forks ACA Forum at www.gfhealthreform.com has a recording of the panel discussion held this past week.

There are a variety of online sources for information and guidance…

For immediate, personal guidance at no cost, you can look to your local County Social Services Office.

Or, contact a local CMS (Center for Medicare & Medicaid Services) certified application counselor in your area.  To locate a certified counselor, go to LocalHelp.HealthCare.gov.

In Cass County area, contact:
Family HealthCare, Fargo

  • Samantha Kundinger, Director of Development • 701-271-6385, skundinger@famhealthcare.org.

 In Grand Forks area, contact:
Valley Community Health Centers, Northwood.  Valley Community Health Centers are recognized by the Centers for Medicare and Medicaid as a Certified Application Counselor Organization. They have Certified Application Counselors available who can answer questions and help determine what types of healthcare options are available. This service is provided at no cost.

  • Mary Reyerson, Outreach and Enrollment Specialist • 701-587-6000, ext. 2005 • email: certifiedapplicationcounselors@valleychc.org
  • Rae Ann, Family Services & Healthy Neighbor Plan, 701-757-1137 • email: certifiedapplicationcounselors@valleychc.org

As we move to implementation there’s bound to be an abundance of questions, concerns and frustrations.  It’s a relief to know we’re not alone in this – and that navigational partners will be there along the way.

Together, all will be well.  Now let’s rock and roll!

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