The Top Five Questions Your Constituents Are Asking About the Affordable Care Act

Yesterday, the Colorado Health Institute hosted the first Lunch & Learn of 2014 for legislators. With the hustle and bustle of the Capitol, we try to bring non-partisan, grounded research and analysis to lawmakers to help facilitate informed decision-making. In light of the rocky rollout of HealthCare.gov and some unintended consequences, Jeff Bontrager and Michele Lueck answered the top five questions constituents are still asking their elected representatives about the Affordable Care Act (ACA).

1. Is the ACA just a public entitlement program?  There has been much focus on two major components of the ACA, health insurance marketplaces and Medicaid. Almost 102,000 Coloradans have enrolled in Medicaid as part of its eligibility expansion, and 63,407 bought insurance through Connect for Health Colorado. Several factors may influence the fact that more people have enrolled in Medicaid than bought insurance through the marketplace. Medicaid is an established program and already has an infrastructure for enrollment, and there are no premiums. Meanwhile, it’s important to remember that the law addresses issues beyond insurance. The ACA includes insurance market reforms, the individuals mandate, employer incentives and health care workforce provisions. It also targets safety net and public health issues.
2. Is it affordable for me and my family?  Earlier this fall, Summit County was brought to center stage by U.S. Representative Jared Polis for having high-priced insurance premiums through the Connect for Health Colorado marketplace. This is referred to as geographic rating. While the numbers are striking, the law has brought transparency and these geographic differences are now more apparent. Further, insurance plans purchased by Coloradans with lower incomes through the marketplace are eligible for subsidies and tax credits, with an average advance premium tax credit of $248. Plans bought in the marketplace have a required base level of benefits called essential health benefits to try to address the issue of underinsurance.
3. How will employers be affected?  The jury is still out on how employers will respond to new incentives to provide health insurance to their employees. Small employers (2-25 employees) in Colorado have been slow to sign up for coverage through Connect for Health Colorado’s small business marketplace. As of December 2013, 100 small businesses - equating to about 1,000 individuals - signed up. Many small employers already offering health insurance were given the option by their carrier to renew their plans early, thus buying another year to make decisions. Others are not motivated to purchase in the marketplace because they are not eligible for tax incentives. Large employers (50 employees and over), on the other hand, have another year to come into compliance with the law because the President postponed the employer mandate penalties to 2015.
4. How is the ACA being paid for?  Changes to Medicare, taxes and fees on “Cadillac” insurance plans and some medical devices, along with employer and individual mandate penalties, are bringing in money on the federal level. Colorado is paying for the Medicaid expansion through savings from the expansion over the next 10 years, an enhanced federal match, the hospital provider fee, and other Medicaid reforms like the Accountable Care Collaborative, use of technology and fraud and abuse protection.
5. Will we have enough doctors and other health care providers?  The answer is that it depends both on where you live and the type of insurance you have. Rural areas tend to have fewer providers for their population, and some providers do not accept Medicaid clients. On February 11, the Colorado Health Institute will be unveiling a new primary care workforce analysis to help answer this question.

The Colorado Health Institute still continue to provide timely information to our lawmakers. On this blog, we will update the community on what CHI is providing to legislators as well as what we’re tracking. We do not take positions on bills or lobby for them, but we are always watching the hot topics of the day. Stay tuned.