Give us some example of people who are going to go to the USA health care system


AMY GOODMAN: Give us some example of people who are going to go to the system.

from: http://www.democracynow.org/2013/9/27/decoding_obamacare_a_guide_to_new

ELISABETH BENJAMIN: So, we like this example of Angie. She just graduated from college, she lives in Queens, she’s making $28,000 a year as a graphic designer. She decides to go — she is at 250% of poverty at 28,000. So, she is not really eligible for any special cost-sharing protection, but she is eligible for a significant monthly coupon. Her monthly coupon or discount, financial aid, whatever you want to call it, is around $176. If she goes for the bronze plan, which is around $300 in Queens, she will get $176 discount off of that. So, the most she’ll spend a month is $162.

AMY GOODMAN: And someone else?

ELISABETH BENJAMIN: So, we have a family of four in Brooklyn. They make around $47,000. The wife is a independent freelance photographer, husband just got laid off. They used to have job-based coverage. Let’s say it happened midyear. If you get — we should talk about the enrollment periods, but, if you get laid off midyear, you can go into the exchange during the year. If there’s good reasons you can go into the exchange. Otherwise you have a strict period.

AMY GOODMAN: So, let’s talk about that. October 1, if you sign up, you get your health insurance October 1?

AMY GOODMAN: No, you get your insurance starting January 1. The coverage starts January 1, and this is the only year where you have that gap. You start shopping in October. It’s called the open enrollment period. You have until March 31 to voluntarily get into a plan. If, for some reason, you don’t do that — maybe you had job-based coverage and you lose job-based coverage in July, then you can get into the exchange and get financial.

AMY GOODMAN: What if you get hurt in April so you decide, oh my gosh, I need insurance?

ELISABETH BENJAMIN: Then you really might be out of luck. You won’t get the financial aid.

AMY GOODMAN: But, talking about pre-existing conditions now, that is OK?

ELISABETH BENJAMIN: Yeah, there will be no pre-existing condition exclusion anymore.

JUAN GONZÁLEZ: And of the 48 million, roughly, Americans that don’t have insurance, how many are expected to be covered by the Affordable Care Act?

ELISABETH BENJAMIN: Well, it is a little confusing because of the Medicaid wrinkle that the Supreme Court did. But, originally they thought it would be 15,000 people on Medicaid and around 15,000 people getting financial aid. What I do know is that three quarters of the people that go to the exchanges, at least in New York, will be eligible for some kind of financial aid or Medicaid.

JUAN GONZÁLEZ: Three quarters of about, what in New York it’s about 2.3 million or so?

ELISABETH BENJAMIN: No, there’s 19 million people in the state, 2.3 million are uninsured, and so they’re expecting about 1.1 million people to go into the marketplace.

AMY GOODMAN: Now Elisabeth, I want to turn to a new ad on the Affordable Care Act that’s produced by Generation Opportunity, an activist group with funding ties to the conservative Koch brothers. The video shows a nurse escorting a young woman into an exam room for gynecological exam. For our radio listeners, I will do some narration for the parts you can’t hear.

NURSE: Oh, I see you chose to sign up for Obamacare.

PATIENT: Yeah, it’s actually my first time here.

NURSE: Well, here we are, then, change into a gown and the doctor will see you soon.

DOCTOR: Great, well, your vitals look good. Any change in your diet or exercise?

PATIENT: Uh-uh.

DOCTOR: Alright, can you swing on over, scoot on down and try to make yourself comfortable. OK, let’s have a look.

AMY GOODMAN: The doctor walks out of the room, the woman’s alone with her legs up in stirrups. And all of a sudden, Uncle Sam pops up between her legs. She screams. The note says “Don’t let the government play doctor. Opt out of Obamacare.” And he is holding up a speculum. And it says “Opt out” again. So, Elisabeth, the debate that is going on in Washington and what it means to say opt out, is it possible this won’t happen, that the Republicans will succeed in preventing the October 1 opening of the marketplaces from happening?

ELISABETH BENJAMIN: Absolutely not. The marketplaces are up and running. The beta tests have been done. You can go in already and start playing with your income amount. And October 1, there will be plans up and you will be able to start doing comparison shopping and qualifying for financial aid.

AMY GOODMAN: And reproductive health care for women, how women choose what is covered, if they can go to the clinics of their choices.

ELISABETH BENJAMIN: Well, one of the things that is really nice about the Affordable Care Act is that most plans will offer reproductive health care and you will be able to have contraception and no co-pays and it’s really and extraordinary thing.

AMY GOODMAN: That’s new under the ACA?

ELISABETH BENJAMIN: The Affordable Care Act. Correct. It’s considered preventative care.

AMY GOODMAN: And it happens no matter what, with the debt ceiling, it happens no matter what?

ELISABETH BENJAMIN: October 1 — the marketplaces are paid for, the insurance plans have made their — they basically laid their bids, they dropped their prices. They think people are coming in. The insurance industry, I think in this case, really understands what is going on. And for the insurance industry to drop their prices by over 50% in New York State means it’s going full steam ahead.

AMY GOODMAN: And in California?

ELISABETH BENJAMIN: California they say over 30%.

AMY GOODMAN: Oregon?

ELISABETH BENJAMIN: I thought it was over 20%.

JUAN GONZÁLEZ: And Elisabeth, those Americans who choose not to participate in the Affordable Care Act, what are going to be the penalties and how will they be — how will they be assessed since this is now a requirement for individuals?

ELISABETH BENJAMIN: I think they start — The Affordable Care Act now gets that people — not everybody may be able to do it at once, right? And they really expect sort of a phasing in of participation. So, the first year the penalty is relatively small. It’s $95 or one percent of your income. So, that’s not a lot of money. And how that would be levied, if you will, would be not this coming April 15 in 2014, but in 2015. So, it’s a year and a quarter away. So, you have to show that you got some kind of coverage next year and then you can avoid paying that penalty.

JUAN GONZÁLEZ: And in subsequent years it’s expected to rise?

ELISABETH BENJAMIN: Yes, it goes up to, for example, a maximum of 2% of gross family income and then 3%.

AMY GOODMAN: Elisabeth, I want to thank you very much for being with us. The Community Service Society is her organization and she’s Vice President of Health Initiatives there. And again, if people want to get in touch with Community Service Society, can they call call from other states?

ELISABETH BENJAMIN: They can. We would probably send you to healthcare.gov . I think it’s better, if you live in another state, to go to http://www.healthcare.gov . They also have a toll-free number with live answer operators. You know, it’s right there on the website.

AMY GOODMAN: So, you can be directed to a person who will help you navigate through this.

ELISABETH BENJAMIN: Absolutely, yes.

AMY GOODMAN: And the Community Service Society number?

ELISABETH BENJAMIN: For people in New York, it’s 888-614-5400.

About eslkevin

I am a peace educator who has taken time to teach and work in countries such as the USA, Germany, Japan, Nicaragua, Mexico, the UAE, Kuwait, Oman over the past 4 decades.
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