With the launch of Oregon’s new health insurance marketplace less than three months away, local and state officials, individuals and businesses are prepping for what will be a dramatic change in the way health coverage is bought and sold in the state.
Cover Oregon is the name of the state’s health insurance marketplace, where individuals and small groups will be able to purchase plans starting October 1.
The online portal will give users the ability to compare different plans, determine Medicaid eligibility and calculate financial assistance – all in real time, said Lisa Morawski, communications manager for Cover Oregon.
“It’s an extremely challenging project to put this system together,” Morawski said. “It is a very complicated endeavor. Our biggest focus is getting ready for October.”
Education is the other important component. Cover Oregon launched a massive PR marketing blitz last week and will continue training insurance agents around the state and holding community meetings in the months ahead, Morawski said.
Once inside the insurance marketplace, users will be able to choose from different plans at different levels of coverage, ranging from Bronze to Platinum. Subsidies will at least partially offset the rates for anyone with incomes up to 400 percent of the federal poverty level, or about $94,000 for a family of four. Anyone making 138 percent or less of the federal poverty level will qualify for Medicaid, according to Morawski.
“The system will automatically enroll the person in (Medicaid),” she said. “This will dramatically expand Medicaid. Right now, the cut off is 100 percent of the federal poverty level.”
Business leaders, meanwhile, are concerned because they still do not know the effects of the rollout on their business.
“Businesses are really concerned about the future of what Cover Oregon is going to do for them,” said Tim Casey, executive director of the Bend Chamber of Commerce. “There’s a vision, but not a lot of details, at least from what I
have seen.”
Eric Sande, director of the Redmond Chamber of Commerce & CVB, agreed.
“Obviously, they are spending a fortune on commercials and there is a big rollout going on, but I know nothing about it,” he said. “I think there’s going to be business as usual until there’s a wall hit.”
The education component will fall on the hundreds of trained agents around the state who can help individuals and business owners understand the state’s new health plan.
Patrick O’Keefe, owner of Cascade Insurance Center in Bend, has been speaking locally to different groups about the upcoming changes in the health care system.
The biggest adjustment will be in the way people think about buying health care coverage, he said.
“The health questions are out,” he said. “Instead of needing a detailed medical history, you’re going to need last year’s tax return, record of alimony payments if you have them and other financial instruments.”
When the Affordable Care Act takes effect January 1, all existing individual plans will be out of compliance because the new federal law mandates carriers to provide coverage for 10 essential health benefits. Essential health benefits required by law include: doctor visits, hospital stays, maternity care, emergency room care, prescriptions, preventive care and mental health services, O’Keefe said.
“Every individual health plan will change January 1,” O’Keefe said. “None of the existing plans meets the requirements of the essential health benefits.”
For businesses, Aelea Christofferson, owner of ATL Communications in Bend, says the new health care rollout is all about choice.
Christofferson, a business owner for 21 years, serves as a board member for Cover Oregon and is trying to clear up misunderstandings about the new health care law.
“I want every small business in Central Oregon to understand what decisions they need to make and whether they are affected by the changes in the law,” she said.
As a business owner, Christofferson has had her employees vote on what kind of deductible they wanted because the one-size-fits-all plan did not allow any flexibility among her employees.
Under the new plan, employers will have four options to offer employees, ranging from employees choosing from virtually every plan offered by a variety of carriers to employers choosing one carrier and one plan for their employees.
“Choice is good, but the issue is employers don’t understand what their choices are or the consequences if don’t make the choices,” she said.
For individuals with preexisting conditions such as Jenni Peskin, a community activist, musician and yoga teacher who has Lupus, the new financial criteria means that her preexisting condition will not negate her ability to buy affordable coverage.
After looking at the website, however, Peskin said she was still unclear on how the new system will work.
“My assumption is that the new program will provide me with less expensive monthly premiums and a copay situation that makes it affordable to go see the doctor,” she said.
She also potentially could be eligible for either automatic enrollment in Medicaid if her income is 138 percent or less of the federal poverty level. The previous level was 100 percent and many qualifying people still were denied access due to size constraints on the program.
Cover Oregon will host a community meeting to provide more information and answer questions about the health insurance marketplace on Tuesday, July 23 from 6-8pm at Central Oregon Community College.
www.coveroregon.com, 855-268-3767.
