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Chaney highlights Obamacare changes

While opinions vary regarding the Affordable Health Care Act – or Obamacare as it is commonly known – certain changes are inevitable, and Mississippi Insurance Commissioner Mike Chaney was on hand to help a room full of senior citizens know what to expect when the new law takes effect.

As a crowd of roughly 100 listened in, Chaney provided a detailed look at issues most likely to affect senior citizens, occasionally offering his own opinion of the changes in his presentation at Copiah-Lincoln Community College.

“I don’t like the federal health care act, but it is the law. It’s a lemon. So I’m trying to make lemonade,” Chaney remarked.

For 2014, current healthcare participants can expect some of the following market reforms, or changes, to their healthcare plans. Starting in the new year, there will be a prohibition of pre-existing condition exclusions, which includes over 86 separate pre-existing conditions according to the act.

Participants can also expect a guaranteed renewability of coverage, according to Chaney. This means, that under the new plan, a health insurance issuer that offers health insurance coverage in the individual or group market must renew or continue health care coverage at the option of the plan sponsor or the individual.

Seniors who now have original Medicare or Medicare Advantage will not see any changes to their current healthcare plan, and will not have to participate in open enrollment, said Chaney.

Earlier in the year, Mississippi counties received a community health rating based on demographic characteristics of the area such as age, gender, tobacco use, family composition and geographic area.

“Insurance rates in Mississippi are affected by geography. Not all counties will receive equal benefits or claims,” Chaney noted at the conference.

Geographically, Lincoln, Franklin, Pike and Lawrence Counties fall within “rating area six.” Copiah County, on the other hand, falls within rating area five.

Also earlier in the year, states were allowed to define “essential health benefits,” or EHB, for their state by selecting a “benchmark plan” from four potential plan options. An advisory board and advisory board subcommittee chose the largest small group product in the state to serve as the benchmark plan, according to the Mississippi Insurance Department website.

While the plan followed the provisions set forth above, the benchmark plan did not include pediatric services. These services will be supplemented, however, by the benefits under Mississippi’s Children’s Health Insurance Plan program, according to the Mississippi Insurance Department.

CHIP is designed to provide health care insurance for children in families without health insurance or with inadequate health insurance. However, children on Medicaid are precluded from the Children’s Health Insurance Plan participation, according to the program. CHIP is a coalition of public, non-profit and private health-related organizations committed to improving the health of Mississippi’s children.

Claim costs for health insurers are expected to increase in many states – including Mississippi – according to Chaney, as individuals covered through high-risk pools, as well as those who are currently uninsured, enter the commercial health insurance market.

Recent federal regulations do allow states to apply to operate Small Business Healthcare Options, or a SHOP marketplace, something Mississippi has moved forward with pursuing, said Chaney. A SHOP marketplace is designed to assist small employers and facilitate online enrollment of employees into a variety of health plans.

Currently, the Mississippi Insurance Department is in discussions with the Center for Medicare and Medicaid Services, or CMS, regarding Chaney’s proposal for a SHOP marketplace to be operational in early 2014.

According to the Affordable Care Act, states fall within three marketplace categories; seven states have planned for a federal partnership marketplace; 17 will be establishing a state-based marketplace exchange and 27 states will have a federally facilitated marketplace.

Mississippi’s blueprint for a state-based exchange was rejected by the federal government in May of this year.

“Haley Barbour and I fought for a state-based exchange. We thought it was a better deal than what we have now,” said Chaney. Despite the efforts of Chaney and former Gov. Barbour, the federal government ultimately designated Mississippi as a federally facilitated marketplace.

According to President Obama and his administration, the exchanges were intended for a number of reasons. Ideally, they were meant to help insurers comply with consumer protections, compete in cost-efficient ways and encourage the expansion of insurance coverage to more people. Exchanges determine the insurance companies that are allowed to participate in them.

In addition, a well-designed insurance exchange should promote transparency and accountability and lead to increased enrollment and delivery of subsidies. It should also spread risk across a larger pool of insured, which will help to minimize costs according to the act.

Chaney expressed deep reservations about the network exchange at Monday’s conference, and challenged assumptions of President Obama and his administration

“I am very concerned about the network. In fact, it is the biggest problem with the act in my opinion. The last 60 days have seen a paradigm shift in the health care marketplace. It’s one that I’m not too happy with,” Chaney remarked.

Chaney also seemed skeptical of progress in Washington given recent for gridlock over budgetary issues. However, he was equally damning of both parties when it comes to what he sees as essential funding for healthcare down the road.

“This is important. If Republicans and Democrats are dumb enough to delay funding on this, then they should all be kicked out of Washington,” he said to applause.

All exchanges must be fully certified and operational by Jan. 1, 2014.

Open enrollment for the new plans starts Oct. 1 and extends until March 31 of 2014.

Fundamentally, the network exchange is a set of government or quasi-government regulated and standardized health care plans, from which individuals may purchase health insurance eligible for federal subsidies.