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An 'independent' idea

Work to begin Monday on creation of new state-based insurance exchange

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Posted: Sunday, April 21, 2013 12:00 am

The debate is over. The law has passed, and starting Monday the work will begin to create a new state-based insurance exchange that will transform the way healthcare is paid for in the state of Idaho.

"The exchange will be as independent as you can get without getting the government completely out of it," said Idaho State Rep. Frank Henderson, R-Post Falls. "This is as close to private system as we could possibly get under the new federal laws."

Henderson joined two other state legislators at a Post Falls Chamber of Commerce luncheon last week to explain the politics behind establishing Idaho's new exchange.

The exchange is essentially a marketplace for the consumer, and eventually employers, to find and compare health insurance plans that are designed to comply with the new Patient Protection and Affordable Care Act (PPACA), which is commonly referred to as Obamacare.

Once the legislature established the exchange, Gov. Butch Otter appointed a 19-member healthcare exchange board to set the rules and regulations that will be necessary to implement the exchange by Jan. 1, 2014. Open enrollment begins Oct. 1 this year.

"It will take a lot of work to get there, but I think we'll get there," said Tom Donovan, deputy director of the Idaho Department of Insurance. "The real nuts and bolts are just beginning to be developed."

The exchange board meets for the first time on Monday, and after appointing an executive director, the board will hit the ground running. The board is charged with designing an exchange that will comply with the new PPACA regulations, while ensuring the needs of Idahoans are met in the process.

Some insurance reforms were already implemented in 2010, such as extending coverage for pre-existing diseases, raising the age of dependent coverage to age 26, and eliminating lifetime caps on what the insurance companies pay for healthcare.

"But the big one is coming in January 2014," Donovan said. "Rates for health insurance will no longer be based on an individual's health condition, pre-existing issues or gender."

The new rating system, he said, will take into account things like tobacco use, geographic area they live in and their age to set rate structures.

For instance, Donovan explained that the new healthcare plans will consider three age groups, people in the 0 to 20 age group will initially increase, but will remain stable until people reach the 21 to 64 age group. That age group may face a small increase every year. At age 65 and up people may see another adjustment, but most of those folks are expected to transition to Medicare.

"The impact we think we'll see is that people in the older age group will see a decrease from what they are paying now," he said, adding that people in the younger age groups may see an increase from what they are paying today.

Idaho State Senator John Goedde, who owns Panhandle Insurance Agency in Coeur d'Alene, agrees with Donovan.

"The cost will definitely go up for the young, and the old will go down respectively," Goedde said. "When you add in all the folks who are currently uninsured with pre-existing conditions, the younger folks could wind up paying quite a bit more."

Goedde said health insurance costs for the younger consumer group are expected to rise up 180 percent due to the new rating system. But there is also an advanced payment tax credit that will offset those increases for people who are within 400 percent of the federal poverty level.

For a family of four, that would be a household income of roughly $90,000 per year or less. That would make over 85 percent of Idahoans eligible for a federal subsidy - if they don't already have an employer-provided healthcare plan.

Under the new rules, anyone with access to an employer-provided health insurance will not be eligible for the tax credit subsidy.

"That's called the family glitch," said Mark Fisher, owner and president of Advanced Benefits Insurance.

"Often times an employer will offer to pay the health insurance premiums for an employee, and that employee has the option to pay additional premiums to add a spouse and other dependents," Fisher said. "If that option is available, that spouse and their dependents will not qualify for the subsidy, whether they choose to take that option or not."

But if they don't have insurance by 2014, they will face a fine, Fisher said.

"Those individuals had better be thinking about what they are going to do," Fisher added.

Donovan said the fines for individuals will start relatively low and increase year after year as the PPACA is implemented. In 2014 the fine for not securing insurance will be $95 a year per individual. By 2015 that will increase to $325, and it will rise to $695 by 2016.

"For the first year, we suspect a lot of the currently uninsured people will opt to pay the fine," he said. "But that will change as the penalties increase."

Small business impacts

Other big changes are expected of employers in 2014, Fisher said.

A business that employs under 25 full-time employment slots - known as full-time equivalencies, or FTEs - will qualify for some level of a federal subsidy, but that employer will not be required to provide insurance until they reach 50 FTEs.

The new law also redefines a full-time employee as one who works 30 hours per week.

"That is something most employers aren't aware of," said Fisher, who is now a PPACA Certified Professional.

That change could be significant for employers who are approaching the 50 FTE threshold, which will require them to provide health insurance in 2014, or pay a fine.

He gave an example of an employer who may have 40 full-time employees and 15 part time-employees who work 20 hours or more per week, may actually have 50 FTEs.

"In that case they would be required to provide coverage for their 40 full-time employees," he said, adding they would not be required to provide it for their part-time staff.

Another trouble spot for employers will be variable-hour employees, such as substitute teachers who work sporadically.

"There is a formula that you'll have to use to track their hours," Fisher said. "It's complicated, but it will be important to watch those hours."

Fredrick Roh, a partner in Paycheck Connections out of Scottsdale, Ariz., will be speaking about the impacts on business at two free seminars and one luncheon in Post Falls, Coeur d'Alene and Hayden this week. (See related story)

"The burden that everyone will face is figuring out where they qualify under this new law," Roh said. "I think the most important thing a business owner can do right now is attend as many meetings and seminars on the subject that you can and call your broker to educate yourself."

He said the new rules under PPACA can be complicated for some employers and some of the formulas that are necessary to project impacts on specific businesses are still being developed.

"This is a moving target at best, all of the regulations are fluid right now," he said. "And it's all going to play out in 2014."

However, waiting for the regulations to firm up could prove costly for some businesses, especially those on the cusp of 50 FTEs.

"Those employers need to be thinking now about how to manage the time of their workforce," Roh said. "They may have to make adjustments now because there will be a look-back period to determine how they are classified."

He said the look-back period has not been set yet, but could go back 90 to 180 days, or maybe even a year. No matter what the case, he said businesses that don't understand the nuances of the full-time equivalency rules and how they impact them may be in for a shock.

The paperwork is also going to be cumbersome, Roh predicts. He said individuals and businesses alike are going to have to determine for themselves where they fit within the new system, and if they misrepresent something, there will be penalties.

"The IRS just hired 116,000 new agents to deal with this," he said. "It's not a time to be playing games."

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  • greyhound2 posted at 7:55 pm on Tue, Apr 23, 2013.

    greyhound2 Posts: 776

    Healthcare reform was a good idea at the outset. However, with the Public Option taken off the table in a closed door meeting at the WH with insurance company lobbyists and Medicare forebidden to buy wholesale drugs in bulk like VA, Canada and Mexico, the whole process turned into a huge joke.

    The United States ranks number one is cost at about 16% Gross Domestic Product but ranks 37th in quality of care behind Costa Rica which ranks in 36th place.. The number one country in quality in care for the average citizen is France at a cost of about 8% GDP, or about half (They have a socialist system, oh horrors). Meanwhile, ignorant peasants in the US squabble over the table scraps to minimize their bankruptcy. "Stupid is as stupid does", says one dumb shrimp farmer..

  • max power posted at 11:45 am on Tue, Apr 23, 2013.

    max power Posts: 559

    Idahoguy, People like Randy don't believe in personal responsibility, self reliance or accountability to themselves and others. They represent the give me, get me, provide me crowd. Modern day libtards that have been steeped in an entitlement mentality. Part & parcel of the 47% of deadbeats that don't pay any Federal income taxes and are always looking for a government handout. In this case "subsidized" healthcare...

  • JBear posted at 11:03 am on Tue, Apr 23, 2013.

    JBear Posts: 88

    Idahoguy, Where in the Constitution is this right of happiness you keep going on about?

  • Randy Myers posted at 9:06 am on Tue, Apr 23, 2013.

    Randy Myers Posts: 1635

    How soon before you leave again ?

  • idahoguy posted at 5:56 am on Tue, Apr 23, 2013.

    idahoguy Posts: 932

    Randy...Patriotism is not based on the willingness of paying the way of others not willing to make something of themselves. Or is there some new amendment to the Constitution I am not aware of? Patriotism is not allowing others to vote away your hard earned wealth so others can reap from what you sowed and sacrificed for. Again something new I am not aware of.

    The right to obtain, secure and hold onto personal property is a Constitutional right and Randy just in case you did not know it financial wealth is tangible and it is personal property. Not common or public property. Randy your reasoning also infringes on my Constitutional rights to my elected legal pursuit of happiness for me... not you opinion of what should make me happy. What part of you applying your beliefs to your life and checkbook and staying out of my life and finances do you just not get?

    Why is it people like your type and breed are never happy until you impose yourself on all the others? You got some degenerative complex or what... if so omaba meds can fix that and I am sure I will see the bill for them in my mail box as well.

  • Randy Myers posted at 10:11 pm on Mon, Apr 22, 2013.

    Randy Myers Posts: 1635

    I am not now, nor have I ever been a member of the Communist Party, Mr. McCarthy.

  • Randy Myers posted at 10:08 pm on Mon, Apr 22, 2013.

    Randy Myers Posts: 1635

    Your commitment to your country is self wealth based ehh ? We can do without "patriots" like you then. You are given citizenship in the greatest country in the world. and can't see past your own greed.

  • EddieCox posted at 9:35 pm on Mon, Apr 22, 2013.

    EddieCox Posts: 50

    You really can't trust any of the "facts" in this article. Roh says that the IRS has just hired 116,000 new agents to deal with this. Is he kidding? That story has been debunked over and over again and the GOP keeps bringing it back to be debunked over and over and over again.
    The fact is, the IRS budgeted for 860 new employees in FY13. Only 10% of those positions would be agents, and none of those agents are specifically assigned to handle the health care law.
    When people lie so blatantly about something so easily verified and that has already been debunked, it's hard to believe anything they say.

  • idahoguy posted at 7:12 pm on Mon, Apr 22, 2013.

    idahoguy Posts: 932

    Joe.. Thanks and I know all that. I am just trying to reveal stupid is as stupid does in Randy....

    If it keeps going this way we will someday sell out and take out wealth and leave this country...just like my great grandparents came here I will go elsewhere.

  • idahoguy posted at 7:10 pm on Mon, Apr 22, 2013.

    idahoguy Posts: 932


    My policy is top end stuff. Pre-existing is fine if I am willing to cover their additional risk. I am happy to as any condition I might have is not their fault and they have noi dog in my fight for life. Get it? Not much different than drivers insurance. Goos driving record = good rates. Bad driving record = higher rates if any... Insurance is not a freaking right my dumb friend is an option.

    If someone is obese they should be sur-charge a by the pound additional charge... if they have more, if they smoke pay more, if they are correct weight, non smokers, and no cancer... guess what fella? Pay less ;-) Rewards go to good behavior...penalties go for bad behavior. Got any questions now?? ha ha ha

  • JoeIdaho posted at 6:51 pm on Mon, Apr 22, 2013.

    JoeIdaho Posts: 2841

    Idahoguy, here's the deal:
    Communists like Randy need YOU and me to PAY FOR OTHER PEOPLE.
    They will HAPPILY conficate your money, resources & time in order to ensure that other people "have the right to happiness".

    Here's my message to Randy:
    GET A JOB.

  • idahoguy posted at 3:01 pm on Mon, Apr 22, 2013.

    idahoguy Posts: 932

    If this insurance for all was supposed to reduce costs...then why is it costing us working class even more of an increases... huh?? I could care less if everyone else had insurance or not.... just saying. It was never a big subject in my life because I made enough out of myself to afford it. I never got up in the morning to run my business year after year with any intent to insure others or feed them or house them either.

    At least I am honest on this subject. The press seems to not like the fact I and many others really are not interested in going broke so others can have medical care under insurance they do not fully pay for. Survival of the fittest which also includes the hard working smartest.

  • Randy Myers posted at 1:54 pm on Mon, Apr 22, 2013.

    Randy Myers Posts: 1635

    1. Some people would love to work but cannot. 2. Your self-centered position is duly noted.

  • Randy Myers posted at 1:52 pm on Mon, Apr 22, 2013.

    Randy Myers Posts: 1635

    It just shows you aren't able to look past your own nose. OK, so let's just look at YOUR situation. What are the limits on your policy ? Is there a limit related to pre-existing conditions / What if you have 2 medical catastrophies ? Are you covered on the second or did you use up all your benefits on the first? The issue of Universal Healthcare and/or Obamacare is more complicated than you might like to think. Study the issue a bit instead of just looking at what's best for YOU. Think a bigger picture where others also have rights to happiness. Not just you.

  • idahoguy posted at 12:28 pm on Mon, Apr 22, 2013.

    idahoguy Posts: 932

    May I add both our rates have increased more than ever before just when the liars said they would go down. I do not wish to hand over tens of thousands of my retirement monies to fund any other persons health wants or needs. That means I run out sooner and that places me on the hand out wagon. Is that smart planning???

    I was doing just fine when only those who wished to or could afford insurance got it. It never bothered me much then and after all this now it is bothering me a lot. Is it fair that those who pay their own way must now be forced to pay for others? Wrong.... I ain't a Musketeer and it ain't all for one and one for all and I am paying for it.

    This whole thing is infringing on my right to pursue happiness anymore...what about that?

  • idahoguy posted at 11:59 am on Mon, Apr 22, 2013.

    idahoguy Posts: 932

    Randy... Since when is it your right or any person's right to ask me what I should do about others lacking the hard working back bone to buy their own health insurance, car insurance, home insurance, life insurance, daily food, housing and all the other things which are can come with being alive.

    I a simply do not care if you have coverage or not. What part of that do you not get? I also do not believe for a moment anyone else really cars much if I have any insurance either. But it does make them all warm an fuzzy feeling if they think others can pay for those without.

    Bottom line with me... have the cash, go into debt, buy insurance or go away and die somewhere. I was not placed on this earth to pay your way or any other person;'s way here. I have the option to assist if I so elect to but being forced to is another commie mental illness entitlement disorder.

    That kind of thinking we all need to cover those not wanting to cover themselves does need medical drugs and a rubber room to boot.

  • JoeIdaho posted at 8:23 am on Mon, Apr 22, 2013.

    JoeIdaho Posts: 2841

    rivercarps, you have NO clue.
    You said:
    "85b to help home owners or 180mill. to a guy who steals from medicare and does not pay for claims"
    The money given by YOU & ME is NOT for "helping home owners". It is used to prop up BANKERS from their losses. You & Oblowma are; every day, giving (FOR FREE) banks $2.83 BILLION DOLLARS, that's 7 days a week, 365 a year, open ended.

    And peter, the "other" lib flavor:
    Boobamacare has NO chance of "working". HOW, do you pay for everyone in America to have healthcare when a sizeable percentage will never pay ANY money towards it? You think that "savings" & a huge increase in costs for the people who still have a job will make this debacle work?
    Nancy Pelosi hadn't even READ it when she signed it, but you thik it's a great idea.

  • Justin Cottrell posted at 7:43 am on Mon, Apr 22, 2013.

    Justin Cottrell Posts: 157

    And what if frogs grow wings so they don't hit their behind when they hop. It hasn't worked for the frog, and it won't work for us.

  • Peter posted at 7:30 pm on Sun, Apr 21, 2013.

    Peter Posts: 616

    What if "Obamacare" works? What if more people are covered at a lower cost? What then? It is not perfect, but having worked in the healthcare industry for almost 15yrs it is better than the fend for yourself system we have now. The PCIP program is already covering the indigent who are terminally ill who otherwise would not be covered by medicaid or medicare. Personally I would like to see a single payor program or a model like that in Switzerland (not to confuse the uneducated with Sweden/two diffterent countries).

  • riversharkes posted at 7:04 pm on Sun, Apr 21, 2013.

    riversharkes Posts: 98

    hold on, joe is right...180mill a year is honest money...just like gov. rick scott in florida....he defrauded medicare of 3 biliion and is not in jail....corporate crime pays...thanks joe...good to know where you stand

  • riversharkes posted at 7:00 pm on Sun, Apr 21, 2013.

    riversharkes Posts: 98

    joe, dude, are you going to spokane to buy some dope? you sure talk like a dope....85b to help home owners or 180mill. to a guy who steals from medicare and does not pay for claims....peace out dude

  • greyhound2 posted at 6:43 pm on Sun, Apr 21, 2013.

    greyhound2 Posts: 776

    The United States ranks 37th in the world for the quality of healthcare available to the average citizen but number one in cost at about 16% Gross Domestic Product (GDP}. Medicare has an overhead cost of 5% while private insurerers run 30% or more (inculdes sales commissions, executive bonus and stockholder dividends which have nothing to do with sick people). The number one country in quality ranks only 8% GDP (France).

    The alledged Healthcare Reform Act went down the drain with a closed door meeting at the WH with insurance lobbyists where the Public Option was taken off the table and Medicare was not able to bulk buy drugs like VA, Canada and Mexico for lower prices. The people of the United States were sold a shuck again and would believe the Wizard of Oz if he said the sky was green. There is nothing on the table to control costs only how much you can steal without going to jail.

    Some companies, like Aetna, specialize in corporate plans which insure only young healthy workers who never file claims but pay good premiums. It is a very profitable business.

  • JoeIdaho posted at 5:35 pm on Sun, Apr 21, 2013.

    JoeIdaho Posts: 2841

    rivercarps says:
    "why did the ceo of united health make 1.8 billion in ten years? that is a crime...against humanity"
    My response:
    See; this is how ignorant communists are; he thinks 180 million (a year) is a lot of money but when it comes to 85 BILLION a MONTH well that's not even worth mentioning.

    Liberals are H Y P O C R I T E S.

  • Randy Myers posted at 5:21 pm on Sun, Apr 21, 2013.

    Randy Myers Posts: 1635

    So you have been depending on state government to take care of you Keven ? How do you propose to solve the health crisis in the USA ? Besides being a naysayer I mean.

  • Randy Myers posted at 5:18 pm on Sun, Apr 21, 2013.

    Randy Myers Posts: 1635

    Bob....We have been letting insurance companies do their thing. That's how we got here. So, your solution is "leaving things alone " ? I think we have to do better than that. Our healthcare is the most expensive in the world. For that we get a ranking of 19-20 (depending which studies...there are many ) in terms of our nation's health. I think we have to reduce expenses. Middleman expenses (insurance company) have been outrageously costly. Most policies also have pre-condition and overall coverage limits.

  • riversharkes posted at 3:05 pm on Sun, Apr 21, 2013.

    riversharkes Posts: 98

    single payer, like ssi...every body needs to go to doc sometime....
    E-verify for employees....
    did not pass in idaho a few years ago...thanks republicants
    why did the ceo of united health make 1.8 billion in ten years? that is a crime...against humanity
    pay your premium..get no coverage..good capitalist, profits before people
    will the owners of the fertilizer plant face charges for the damage they caused and people they killed by storing more than is allowed? are they not terrorists too? corporate terrorists they are
    money before people
    gotta love it

  • Keven Johnson posted at 2:31 pm on Sun, Apr 21, 2013.

    Keven Johnson Posts: 1289

    The state legislature was our last line of defense against this incredible federal tyranny known as the 'Affordable Care Act". They could have - - and should have - - said "NO" to setting up a state exchange and cooperating with the federal government in this unconstitutional power grab. But the legislature and Governor Otter betrayed us. Idaho now has the dubious distinction of being not only one of the most heavily republican states, but also the first state controlled by republicans to capitulate and do the bidding of the feds by establishing a state run insurance exchange. I applaud our local representatives Vito Barbieri, Kathy Sims, and Ron Mendive, and Senators Steve Vick and Bob Nonini for trying to stop this abomination. Unfortunately they were outnumbered by the likes of Ed Morse, Luke Malek, Frank Henderson, and Senator Goedde who showed their true statist colors with this vote. For the life of me, I don't understand why these big government proponents don't do the honest and honorable thing and run for reelection as democrats next time around.

  • JoeIdaho posted at 12:55 pm on Sun, Apr 21, 2013.

    JoeIdaho Posts: 2841

    Mine went up $4257.00 a year.
    But hey, Randy sez that we're just "decrying oblamacare & offering no solutions".
    THAT is funny.
    And stupid.

    See, for Randy & the rest of his comrades, it's all about "reducing the rate of uninsured"" at what is definitively the cost of THE insured, folks like me who PAY THEIR WAY.

    Larger welfare state, that's what Randy & the commies are all for, and they're happy to steal from those of us who work for a living.

  • Bob Loblaw posted at 11:03 am on Sun, Apr 21, 2013.

    Bob Loblaw Posts: 381

    Randy, who will you blame when you can't get decent health care at all? It's not going to take long for everyone to find out how rotten this idea is. My insurance has already gone up $2500/year for all the mandated Obamacare crud. As for "alternative solutions", how about simply letting insurance companies compete for business instead of having a government-enforced monopoly for them? Even leaving things alone would be better than this current cluster-freak.

  • Randy Myers posted at 9:46 am on Sun, Apr 21, 2013.

    Randy Myers Posts: 1635

    LOL The usual suspects here decrying Obamacare and offering no alternative solutions. Progress in implementing the act will show just who has been overcharging and will also point out the need for services to be priced lower. We started with nearly 50 million uninsured ....roughly 1/6 th of the population. Reducing that rate is the key.

  • hiway90 posted at 9:32 am on Sun, Apr 21, 2013.

    hiway90 Posts: 61

    Chickenpox......."Crazy republicans who barked at the moon ???? I believe there were some smart Democrats as well who in fact actually...LISTENED TO THEIR CONSTITUANTS...They listened to the ones who elected them!!!! Instead of silly kneejerk reaction people like you.
    Do we now need background checks on knives and pressure cookers in response to the two latest acts of violence done by PEOPLE...?
    Do spoons make you fat? Do cars driven by drunk drivers kill? Do guns fire by themselves? Get a clue...
    Take some personal responsibility for your own actions and words, and try to understand PEOPLE make choices...PEOPLE!!!!!!
    Stop blaming inanimate objects, and Republicans for your woes?
    I hear the East Coast calling you home....

  • librtyhuntr posted at 9:19 am on Sun, Apr 21, 2013.

    librtyhuntr Posts: 317

    WOW I hope the tax credit is as much as the grocery tax credit. Don't ya just love government!

  • max power posted at 8:39 am on Sun, Apr 21, 2013.

    max power Posts: 559

    *** Have You Seen The Survey? ***

    The one being conducted on this website. The one entitled: How do you think Obamacare will impact your healthcare starting next year? Is it just me or do you see a graph that is flipping you off. It's Obamacare and it's giving you the "bird". Pretty much sums up Obamacare...

  • JoeIdaho posted at 6:49 am on Sun, Apr 21, 2013.

    JoeIdaho Posts: 2841

    I agree, Vox, but I think the repubs did everythign they could to stop it, including taking it to the Supreme Court, and losing, because it is in FACT a tax.
    There never was "reform", it was all about protecting attornies & insurance companies.
    The healthcare industry itself will be paid far less, the average nurse will make less money, and the person needing the care will GET less as he or she pays more.

  • voxpop posted at 5:49 am on Sun, Apr 21, 2013.

    voxpop Posts: 738

    And in just a few short months we'll all discover how well our current system had worked but it will be too late. In 5 years, when the phrase "unintended consequences" is discussed it will be this moment in time which will lead the list of examples. It's just too bad those same crazy republicans who barked at the moon over background checks didn't put the same effort into stopping this life altering event. But then the insurance companies and those like Goedde are salivating over their soon to be new found income source. And we all know who REALLY runs the republican party.

  • JoeIdaho posted at 5:44 am on Sun, Apr 21, 2013.

    JoeIdaho Posts: 2841

    The boondoggle of idiocy starts. Your healthcare quality dives, your costs rise, fast. dimmocrats cheer, until they can't GET legitimate healthcare, but not to worry, the boston bombers, they got obamacare; just like all the illegal aliens.
    YOU paid for it, and AMERICA was stupid enough to vote the imbeciles into office that forced it down our collective throats.
    CAN'T WAIT for this to really get crankin' you libs will cry terrible when you realize how bad this will get.

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