Insurance marketplace goes online despite federal shutdown

By Jamey Dunn

After the federal government shut down at midnight in a battle over Obamacare, the online health insurance marketplaces that are a cornerstone of the law rolled out across the country today.

Federal Government Shutdown
Some Republicans in Congress had been pushing to defund the Patient Protection and Affordable Care as a condition for their votes to approve a federal budget. Last night House Republicans approved a one-year delay in the Affordable Care Act’s requirement that all Americans have health insurance. The Senate rejected it, and the House refused to take up an extension of the federal budget previously approved by the Senate.

With no budget in place, all but what has been deemed “essential services” of the federal government have shut down. National parks and monuments are closed. Research labs have stopped their work. Many regulatory bodies will only maintain a bare bones staff. For instance, only 5 percent of the staff at the Environmental Protection Agency will work through the shutdown.

Social Security and federal entitlement programs, such as Medicare will continue to pay benefits. Mail service will also continue. So will services deemed necessary for safety or national security, such as the work done by the Federal Aviation Administration. However, most federal employees who report to work today will not be paid as long as there is no budget in place. Notably, members of Congress will continue to receive their checks, though some have vowed to forgo pay until the government is running again. The U.S. Constitution has a provision similar to the Illinois Constitution that prohibits any change in lawmakers’ pay during their terms. The 27th Amendment was intended to keep federal lawmakers from voting to increase their pay, but it will also keep their $174,000 annual salaries coming during the shutdown. Gov. Pat Quinn is currently trying to challenge that notion in Illinois after he vetoed the money for lawmaker’s salaries. Quinn says they should not be paid until the approve changes to the states troubled pension system. But a judge ruled last week that the move violated the state Constitution. Quinn is appealing to the Illinois Supreme Court.

Illinois officials say the federal shutdown would not halt state services in the short term.  State employees who are paid with federal funds will face temporary layoffs as soon as tomorrow. The timing of the layoffs could vary across agencies because some may have enough cash on hand to keep employees working longer. According to Quinn’s office, the agencies that could see layoffs include the Departments of Labor, Veterans’ Affairs, Military Affairs, Illinois Emergency Management Agency, Office of Health Information Technology and the Department of Human Services’ Bureau of Disability Determination, which evaluates applicants for disability benefits. When the federal government last shut down in 1995, the state laid off 1,200 employees.

If the shutdown drags on, federally funded programs could be in danger. Some states are already looking to tap into rainy day funds if Congress does not pass a budget soon. But Illinois, which cannot pay its bills on time under normal conditions, does not have that option. The biggest immediate impact on states will likely be an economic one as thousands of their residents are laid off. About 800,000 federal workers nationwide will be laid off until a federal budget is approved. According to the Pew Charitable Trust’s news service, Stateline, Illinois has 45,801 civilian federal employees, but some of them will continue to work. Retired federal employees will continue to receive their benefits. “Unfortunately, the possible consequences to state economies of a federal shutdown or not increasing the national debt limit are severe. States are partners with the federal government in implementing most federal programs. A lack of certainty at the federal level from a shutdown therefore translates directly into uncertainty and instability at the state level,” said a letter that the National Governor’s Association sent to President Barack Obama and congressional leadership. “That uncertainty can lead to the suspension of programs and services, increased borrowing costs or even layoffs — all actions that will weaken our economies and potentially stall the national recovery.”

Affordable Care Act Questions and Answers
While the political battle that held up approval of a federal budget was essentially over a push to defund the new health care law, the implementation of Obamacare will continue largely unscathed by the shutdown. The Affordable Care Act falls into a category of mandatory spending along with other federal programs such as Medicare. This spending actually makes up the majority — 57 percent — of the federal budget.

Do I have to buy insurance right away? No. The exchange is open for business. Any coverage you buy now will not kick in until January 2014. But you must buy your insurance before December 15 to ensure that your coverage will begin in January. If you wait longer, your coverage would begin later. The open enrollment period for 2014 ends on March 31, 2014. After that date, you can only sign up if you have a life event, such as a marriage or career change.

What kind of insurance coverage is available on the exchange? The plans offer a base level of coverage for 10 service categories, including ambulatory care and prescriptions. The plans have a metal ranking, with bronze being the lowest cost plans. Under such bronze plans, consumers would likely pay lower premiums but would have more out-of-pocket costs, such as copayments. Under the higher-premium gold and platinum plans, patients would likely pay less out of pocket. The rates in Illinois will vary across the state.

Does my employer have to help pay for my insurance? Starting in 2015, businesses with more than 50 employees will be required to offer coverage to full-time employees or face penalty fines. Small businesses can opt to use the exchange to buy coverage for their employees starting today, but they are not required to.

I already have insurance. Will I have to buy a different kind? Most likely no, especially if you get your coverage through your employer. Those with bare bones plans or catastrophic plans would have to get more coverage to meet the insurance mandate that is part of the Affordable Care Act.

Can I keep seeing my doctor? Yes, if you do a little research. Some plans sold on the exchange will only cover care within the provider network for that plan. You should check to see if your doctor is in the provider network of a plan before you buy. You should be able to find provider information for each plan on the exchange’s website. Here is more info from the federal website. 

I smoke or chew tobacco. Do I have to pay more for coverage on the exchange? Yes. Tobacco users will pay higher premiums for insurance. For instance a 40-year-old smoker in Cook County will pay $44 more per month for a basic bronze plan. The law allows insurance companies to charge smokers twice as much, but states can opt to keep the rates lower. Insurance plans offered on the exchange are also required to cover programs to help smokers quit. Here is more info.

I’m young, healthy and broke. Do I have to buy insurance? If your parents have insurance and are willing to let you stay on their plan, you can until you turn 26. If you are younger than 30, you may be eligible for catastrophic plans offered through the exchange. You also may be eligible for insurance subsidies or Medicaid.

How do I find out if I am eligible for subsidies or Medicaid? If you make between 138 percent and 400 percent of the federal poverty level — $15,856 to $45,960 for individuals — you will be eligible for federal subsidies that will cut your monthly premiums. If you make less than 138 percent of the poverty level, you could be eligible for Medicaid. You can use this subsidy calculator from the Henry J. Kaiser Family Foundation to assess your personal situation.

What happens if I am not covered? If you do not get coverage in 2014, you will likely face a penalty on your tax bill in 2015. The fee would be 1 percent of your household income, or $95 a person, whichever is more. Fees for having uninsured children would be $47.50 per child. That penalty is capped at $285. If insurance premiums are more than 8 percent of your household income, or you do not make enough to file federal income taxes, you are exempted from the individual insurance mandate. There are some other exemptions to the individual mandate, including a religious exemption. For more info on exemptions to the mandate, see this story in the Washington Post. 

How do I access the exchange? Go to www.healthcare.gov click the “apply now” button and then choose Illinois as your state. You can also go directly to the Illinois exchange, called Get Covered Illinois. Here is a checklist of the personal information you will need to purchase a plan. Note: As of this morning the federal site has a very slow load time, so you may be waiting a while. When I attempted to access the federal site, the system was down. It is likely overloaded by curious browsers and reporters like me trying to check it out on the first day. You may want to give it a little time before you try to use it to buy insurance. Or try out the direct state site. In the meantime, you can check out some of the information provided in this blog to do a little research.

I don’t have regular access to the Internet. How do I get signed up? I do have Internet access, but I find the marketplace confusing and could use a little help. Where can I find it? There is help available both in person and over the phone. You can find the numbers for a federal toll-free help line here. There are also local groups working to help people navigate the marketplace and get insurance. You can find one of these groups in your area by entering your ZIP code here. 

Here is more info from the state of Illinois, including a short video that explains some of the key components of the law.