As implementation of the Affordable Care Act approaches Jan. 1, local insurers are scrambling to keep up with changes in federal interpretations and getting the industry and the customers up to speed.
“Things change on this just about daily,” said Phil Hux, co-owner of G.W. Hux and Co. in Roanoke Rapids, which sells group insurance and individual health plans.
Locally, the impact of the Act has already been felt with cost reduction measures announced Tuesday by Halifax Regional resulting in the loss of 13 positions and pay cuts for remaining employees due to a lack of Medicaid expansion to offset reductions in federal Medicare payments.
Hux said impacts such as these are just one of the many consequences he’s seen coming from the act so far.
The Act mandates health insurance for every American, with failure to comply costing penalties on income taxes which escalate each year. Businesses not in compliance — businesses with more than 50 employees don’t have to be in full compliance with the Act until Jan. 1, 2015 — face a penalty of $2,000 per employee.
The rising cost for government comes, Hux said, with subsidized individual health plans. One example given during training for agents illustrates how a family with three children making $27,000 with an insurance cost of $900 a month would get $800 of that subsidized by the government under the Act, leaving them with a $100 insurance cost per month. Those numbers are not concrete numbers, they were only used as an illustration, Hux said, and subsidy rates have not been determined.
Who gets subsidized policies? That question, Hux said, has yet to be fully answered, though rates for policy holders who aren’t subsidized are expected to rise 30-35 percent, since the full costs of procedures such as mammograms, prostate tests, colonoscopies and birth control pills are going to be completely covered under the Act.
Also under the act, Hux said, anyone will qualify for insurance and there are no pre-existing conditions, which means someone with a terminal condition can get a policy, but the cost of actually treating that person, Hux said, would be carried by the healthy customers insured by the same company in the form of higher rates.
Enrollment in the new policies under the provisions of the Act begins Tuesday, Hux said, and estimates are roughly 60 percent of individual policy holders in the Roanoke Valley could qualify for subsidized policies.
The only way to know for sure, however, is to contact an agent.
“All of this could change tomorrow,” Hux said. “That’s why anyone with any questions has to be in touch with an agent.”
Hux said the Act has put a strain on the industry, because agents have to constantly get trained on new interpretations of the Act and everyone is busy trying to change over existing individual policies to comply with the Act.
In North Carolina, Hux said, there are 1.2 million people impacted by the Act’s implementation, and they’ve got 90 days to see how this will affect them. Hux stressed those people must see or speak with an agent.
All this shows how little the lawmakers who championed the Act and passed it actually know about it, Hux said.
“I think they passed it along party lines,” Hux said. “And what they passed and what we have now are two different things because they didn’t understand it when they passed it.”
Hux stated something needed to be done to improve health care in the United States, including tort reform to limit damages from lawsuits, but the Affordable Care Act, he said, isn’t the solution.
“I think the Affordable Care Act was rushed through,” Hux said. “More insurance companies, doctors and medical facilities needed to be consulted.”
Hux added he has only seen negative repercussions from the Act so far, with stories of hospital cutbacks throughout the state causing him concern for one of the Valley’s largest employers — Halifax Regional.
“One of my fears is our hospital is going to close,” Hux said. “It’s not just one of the biggest employers, it’s also a very good hospital and an asset to our community and it helps tremendously with economic development for the surrounding counties.”
For more information on The Patient Protection & Affordable Care Act, see page A6 in Thursday editions of The Daily Herald for a weekly column by Michelle Singletary.