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4/ TheBucknerClarion.com October 23, 2014 ACA Heats Up Again Marketplace Open Enrollment Starts Nov. 15 eligible for Medicaid, but not enrolled. Marketplace financial assistance A provision of ACA allows people with incomes between 100 percent ($23,550 for a family of four and $11,490 for an individual) and 400 percent ($94,200 for a family of four and $45,960 for an individual) of poverty to be eligible for premium tax credits when they purchase insurance through the Marketplace. According to KFF, 55 percent of uninsured, nonelderly people in Missouri will be eligible for financial assistance. KFF estimates about 273,000, or one in three, uninsured Missourians, will be eligible for premium tax credits to help them purchase coverage in the Marketplace. Marketplace ineligibles Two additional uninsured groups are outside of reach for financial assistance for health coverage under ACA: People with incomes above the limit for premium tax subsidies, or who have an affordable offer (under eight percent of their income) of coverage through their employer are ineligible for financial assistance. However, some can purchase "unsubsidized" coverage through the Marketplace, which may or may not be more affordable and more comprehensive than coverage they could obtain on their own through the individual By Tonia Wright (Continued from page 1) eligible for subsidies, assumed plans on the Marketplace would automatically be too high and didn't know there was a penalty for not purchasing insurance. Among the people that enrolled the first time, many were eager to purchase plans on the Marketplace because they qualified for subsidies or had a preexisting condition. This time around, it will be about renewing plans for those previously signed up, increasing efforts to reach younger people, minorities, those still on the fence and those with little (or incorrect) information about the Marketplace. "When you look at those who remain uninsured, they are in many ways harder to reach," said Anne Filipic, president of Enroll America, a nonprofit group that helps people enroll in Marketplace plans. "This is really about doubling down and reaching folks who didn't get the message the first time." A recent poll by Transamerica Center for Health Studies found that 43 percent of uninsured respondents had not heard of Obamacare exchanges as the only places to buy health plans and potentially qualify for subsidies to offset costs. Another 22 percent of uninsured Americans did not obtain health insurance this year because they were not aware of the individual mandate to get insured or pay a fine equivalent to up to one percent of their income (this was the fine for the inaugural enrollment period). Paying the penalty As a result, health advocates plan to readjust their value proposition. Instead of focusing on Marketplace benefits, talking points will sway more toward financial assistance for consumers and the penalty for not having insurance. Now, the penalty for people who are uninsured is $325 per person in a household or two percent of their income, whichever is larger. However, is it important to note that people without health insurance can be exempt from the penalty if health insurance on the Marketplace, at work or through the individual market would cost more than eight percent of their income, or if they would have qualified for Medicaid had it been expanded in Missouri. The expansion would have covered individuals with income below $15,521.10 and a family of four with income below $31,720.50, according to Cover Missouri Coalition (CoverMissouri.org). There are also other exemptions from paying the penalty like for those who are incarcerated, a member of a recognized American Indian Tribe, a recognized health sharing ministry, among others. Anyone seeking to gain exemption from the penalty must request a waiver at HealthCare.gov, call 1.800.318.2596 or seek out a local navigator or CAC for assistance. Currently, there are 30 million to 40 million people still uninsured, with affordability remaining the issue for most. The coverage gap Among the people across the U.S. that remain uninsured, half are concentrated in the South, with the remaining residing in the 24 states that opted not to expand Medicaid, like Missouri. The latest figures suggest that about 5 million people fall within the coverage gap—they make too much to qualify for traditional Medicaid, but make too little to qualify for subsidies through the Marketplace. In June 2012, the Supreme Court ruled that Medicaid expansion would be optional for states. Missouri, which opted out of Medicaid expansion, has about 193,000 people in the coverage gap, according to the Kaiser Family Foundation (KFF). Other sources estimate the Missouri coverage gap as high as 300,000. ACA was initially designed under the premise that low income people would be served through Medicaid expansion. However, when the Supreme Court ruled that the federal government could not mandate that states expand Medicaid, many Americans found themselves in the coverage gap. Medicaid eligibility for adults remains limited in Missouri. As of January 2014, Medicaid eligibility (in Missouri) for non-disabled adults is limited to parents with incomes below 23 percent of the poverty, or about $5,550 a year for a family of four. Adults without dependent children remain ineligible regardless of income. As of 2014, children with family incomes of up to 305 percent of poverty, or about $71,800 for a family of four, will be eligible for Medicaid or Children's Health Insurance Program (CHIP). KFF estimates that the majority of uninsured Missourians (83 percent) are children who are already eligible for Medicaid but not yet enrolled. About four percent of uninsured adults are market. Additionally, uninsured, undocumented immigrants in Missouri are ineligible for assistance under ACA and are prohibited from purchasing coverage through the Marketplace. Repealing Obamacare This enrollment period, Connecticut-based Cigna and M i n n e s o t a - b a s e d UnitedHealthcare join Anthem Blue Cross Blue Shield in Missouri and Maryland-based Coventry Healthcare to sell insurance on the Marketplace for consumers in Missouri. Ceci Connolly, managing director of PriceWaterhouseCoopers Health Research Institute, said, "It's clear insurers see growth opportunity in the new exchanges and are meeting the market demand for choice." Dan Mendelson, CEO of Avalere Health consultancy, said the news that more insurers are jumping into the Obamacare marketplace bodes well not only for consumers, but also for the political viability of President Barack Obama's signature health care reform law. "Many of the plans that largely sat out the first year—like UnitedHealthcare—are diving in. The long-term stability of this program is largely defined by insurer reactions, so this is a good sign. It gets harder to repeal a program when it has a vibrant commercial market attached," Mendelson said.

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