Understanding AHCA
by BRIAN GRAVES Banner Staff Writer
Dec 04, 2013 | 774 views | 0 0 comments | 7 7 recommendations | email to a friend | print
SKYRIDGE MEDICAL Center CEO Coleman Foss takes some questions about the Affordable Health Care Act from individuals at an information session at Cleveland Public Library. Banner photo, BRIAN GRAVES
SKYRIDGE MEDICAL Center CEO Coleman Foss takes some questions about the Affordable Health Care Act from individuals at an information session at Cleveland Public Library. Banner photo, BRIAN GRAVES
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SkyRidge Medical Center CEO Coleman Foss spent an evening at the Cleveland Bradley County Public Library Tuesday in an effort to inform the public about the Affordable Health Care Act.

But even he admitted some of the information he was providing “might only have a shelf life of less than 48 hours.”

Foss was speaking of the ever-changing landscape of the act and its provisions since the government website went online Oct. 1.

The forum was arranged by the library because the facility has been getting a large volume of calls about the new law and the library’s computers have been busy with individuals trying to sign up with the new program.

Foss said the evening was meant to be just “a global overview” of what the act is, how to sign up and some of the basic benefits it covers.

“There are a number of individuals who are working hard and simply cannot afford health insurance,” Foss said. “Unfortunately, if you don’t have insurance and you spend a few days in critical care, it could bankrupt you. That’s not any hospital’s design, it’s just a fact.”

He said the reform is a much-needed process, but it remains to be seen if the new law is the answer.

“I don’t know if we’ll know the answer in six months or six years,” Foss said.

He noted two of the items the law requires have already made a major change in the way insurance is handled.

“From this point forward, you can’t be turned down for pre-existing conditions, but I have heard there may be some conditions such as drinking alcohol or smoking that might increase premiums,” Foss said. “The other is being able to cover your children up to the age of 26, and they do not have to live in your household. That’s a big plus for a lot of people.”

He pointed out the initial enrollment period was to end March 31, but there are efforts to push those dates back due to the problems with the health care website.

“The key thing to remember is if you sign up between the first and the 15th of the month, your coverage will begin Jan. 1,” Foss said. “If you sign up after that, your coverage will not pick up until the following month.”

He said they are expecting an open enrollment period every year.

“If you don’t opt in this year, you will have the opportunity next year,” Foss said.

A person must be a lawful citizen, not have access to affordable employer or sponsored insurance to apply, not be eligible for public coverage such as TennCare, and have a household income that is between 100 and 400 percent of the federal poverty level.

Foss noted there are many people in the poverty range who are covered under CoverTN, but they will have to switch over because that program will be discontinued.

He said the rates are “much more affordable, but still steep.”

He also noted it is estimated 56 percent of the people who are now employed would be eligible to participate in the new plans.

“That’s a pretty startling statistic when you consider these people have full-time jobs and are working just to make ends meet,” Foss said. “But just one catastrophic event can wipe them out financially.”

He described the four levels of coverage, which are: Platinum, which covers 90 percent; Gold, which covers 80 percent; Silver, which covers 70 percent; and Bronze, which covers 60 percent. Prices range from $700 to $300.

Depending on circumstances and family size, those prices could be higher or lower.

Foss said the website also hosts a calculator which can determine the eligibility for credits that can dramatically reduce the costs of a plan.

But, he said costs in this area are “fairly inexpensive” to other states.

He also discussed Gov. Bill Haslam’s quandary in deciding how to handle Medicare after turning down the federal government’s assistance to expand the program.

“The governor is trying to figure out if there are some other models to look at,” Foss said. “Basically, if the state had put up $1.9 billion to run the program, the federal government would have given the state of Tennessee $26 billion.”

He said the reason it was not accepted is because that money from the federal side was “one-time money.”

“Next year, it would be, ‘Would the federal government give us money?’ Probably not. The governor’s in a very difficult place,” Foss said.

He said the government is pushing hard for all states to create their own exchanges, which Tennessee has not done.

“According to what we’re hearing, if states don’t implement a state-run plan then the dollars we get for other things such as education and transportation and roads may not be coming,” Foss said.

He said SkyRidge does have trained personnel on-site available to help navigate the application process, and interested persons can call 423-559-6377 to make an appointment.

The library will be hosting another forum on the subject on Saturday, from 2 to 4 p.m.

The speaker will be Dr. Mary Headrick and the forum is sponsored by the Tennessee Health Care Campaign.