Although there continues to be controversy and legal battles about aspects of the federal health care reform legislation, it currently is the “law of the land” and Arizona must consider what is in the best interest of our state. As part of the Affordable Care Act (ACA), all states must implement a Health Insurance Exchange on January 1, 2014 to assist with the purchase and sale of health insurance for individuals and small businesses. The exchanges are meant to create a competitive private health insurance market and will provide millions of Americans and small businesses with “one-stop shopping” for affordable coverage.
As it is designed now, tax credits will be available for many individuals, families and businesses to help them purchase coverage in the Exchanges. This subsidized health insurance option will be based on a sliding scale depending on a person’s income. The subsidies are for those people between 133% and 400% of the Federal Poverty Level (FPL)…recall that Medicaid eligibility will increase to 133% of the FPL. At the lower end of the income scale, the subsidies are as high as 93% of the premium cost for the insurance. Insurers cannot deny coverage for someone due to a pre-existing medical condition. The plans offered in the Exchanges will be required to provide at least a basic level of comprehensive benefits that include:
- Ambulatory patient services
- Emergency services
- Maternity and new born care
- Mental health and substance use disorder services, including behavioral health services
- Prescription drugs
- Rehab and habilitative services and devices
- Lab services
- Preventive and wellness services and chronic disease management
- Pediatric services, including vision and dental care
Health insurance exchanges will open up private health insurance to many people in Arizona who are currently not eligible for Medicaid, but have been unable to afford insurance. Insurers will not be able to reject them based on medical condition or exclude coverage for their mental illness or other physical illness. We can expect hundreds of thousands of Arizona citizens to become newly eligible and enrolled in Medicaid or enrolled in the insurance exchange. (We can also assume that many of these individuals will have mental health and/or substance abuse treatment needs!)
States have the option of establishing their own exchanges, but those that don’t will be required to use the program put in place by the federal government. Arizona strongly believes that it will be better served by designing and running its own Exchange than by allowing the federal government to impose its model on us. So, to that end, Arizona recently applied for a second grant (not yet approved) to further plan, design and develop the Arizona Health Insurance Exchange. The funds will secure the IT infrastructure necessary for a user-friendly website that is fully integrated with Arizona’s existing Health-e-Arizona system. The funds will also assist in developing the insurance plan certification, recertification, decertification processes to ensure there are qualified plans available in Arizona. There will be lots of work needed to educate and outreach to the public as well. I am pleased to be a member of the Arizona Health Insurance Exchange Steering Committee assisting in this work.
For more information: