Mike Fierberg may have one of America’s toughest jobs.
Mr. Fierberg, a public affairs specialist with the federal Centers for Medicare and Medicaid Services in Denver, Colo., just wrapped up a three-day tour of Montana, giving 11 interviews and traveling 600 miles. His mission: to provide information about signing up for healthcare exchanges under the Affordable Care Act, better known as Obamacare.
His mission isn’t made easier by federal budget cuts that have restricted travel by government employees. He flew on this trip to Bozeman rather than Billings because airfares were so much cheaper that way.
“We’re subject to sequestration like everybody else,” he said.
Polls have shown that, despite a massive and highly partisan political debate and a legal fight that went all the way to the U.S. Supreme Court, most Americans don’t know much about how the act will actually work. But on Oct. 1, Americans without health insurance can begin signing up for healthcare plans.
For most Montanans who qualify, tax credits will be available to defray the cost. For Montanans who haven’t been able to get insurance before because of the high cost or preexisting illness, the healthcare exchanges could literally be a life saver.
But Mr. Fierberg is under no illusions that the new government program will be universally popular. Republicans have unanimously opposed the act, and Republicans in the U.S. House have voted dozens of times to repeal the legislation.
Of the six Western states in the region served by Mr. Fierberg’s office, five have declined, in whole or in part, to set up healthcare exchanges, leaving it to the federal government to do the job. And Montana is among the states that have rejected the expansion of Medicaid envisioned by the Affordable Care Act, creating a possible hardship for those who make too much money to qualify for Medicaid but not enough to afford even the cheapest health insurance.
Mr. Fierberg acknowledges that even some people who are likely to benefit from the act still oppose it because they see it as a government takeover. Others may be stymied by the complexity of health insurance.
Mr. Fierberg says he prefers to stay out of the political debate that still swirls around the legislation. The important thing, he says, is that the act will make health insurance available to millions of Americans, and thousands of Montanans, who have until now been unable to get it.
How well that will work remains a matter of considerable dispute. The Obama administration recently delayed by one year employer mandates included in the Affordable Care Act, primarily because of the difficulty of complying with paperwork requirements.
“We’d rather get it right than get it fast,” Mr. Fierberg said.
Critics of the act cite the delay as evidence that the law is unworkable, but Mr. Fierberg points out that 96 percent of businesses have fewer than 50 employees and are exempt from the requirement. More than 90 percent of businesses that do have more than 50 employees already provide insurance, he said.
And companies with fewer than 50 employees that nevertheless offer health insurance are eligible for tax credits under the new law, he noted.
Other critics say the act will cause insurance costs to rise. In an op-ed released last week, the National Association of Health Underwriters claimed that the taxes included in the act will cost consumers some $100 billion over the next 10 years by increasing premiums about 2 percent.
But some states, such as California, that have set up their own healthcare exchanges say that costs appear to be lower than projected. Even in Montana, which declined to set up its own exchange, insurance premiums are expected to be lower than they would be if Obamacare had not passed, according to Monica Lindeen, the state’s insurance commissioner.
Ms. Lindeen’s office recently commissioned a study by an independent actuary who found that an individual buying comprehensive health insurance could expect to pay $273 a month under Obamacare. If the act had not passed, the cost would be $290, the study found.
Mr. Fierberg said it’s too early to be sure how much insurance will cost on the healthcare exchanges, or even how many different plans will be available. He expects at least three companies to be on the exchanges, and each company is likely to offer several levels of coverage, from bronze to platinum and even catastrophic coverage.
Some existing insurance plans won’t be available under the law. For example, Mr. Fierberg said, some fast-food businesses offer “junk insurance” with low premiums but also a low cap on how much the insurance company will pay, so people with even relatively minor medical problems quickly exhaust their insurance.
“It’s worthless,” he said. “It won’t be allowed anymore.”
Some people will pay more for insurance under the law, such as healthy young people. Some critics speculate that many young people will pay the fine for failing to have insurance rather than buying insurance, which is more expensive. Then if they do get sick, they will simply go buy insurance since the new law requires insurance companies to cover pre-existing conditions.
But the cost of avoiding insurance rises as income rises, Mr. Fierberg said, and, of course, those who refuse to buy insurance may end up with high, or even catastrophic, medical costs.
In general, Mr. Fierberg said, the law will shift costs from older Americans to younger ones, and from women to men – although that last effect won’t happen in Montana because Montana law already prohibits insurance discrimination against women, who generally have higher medical expenses.
Billings is a targeted area for the awareness campaign, in part because it is the largest city in the state and in part because U.S. Sen. Max Baucus warned that the Affordable Care Act could be a “train wreck” if citizens were not properly informed about how it will work.
It’s time now for citizens to begin learning about Obamacare, Mr. Fierberg said. About 18 percent of Montanans have no health insurance at all, he said, and another 9 percent buy an individual policy rather than receive coverage through work. Most of those people will be eligible for tax credits when they buy insurance on the healthcare exchanges, he said.
To begin learning about how the law may affect you, go to healthcare.gov. Healthcare exchanges aren’t set up yet, but the website does have information about different kinds of insurance and who will qualify.
Once the exchanges are in place, by Oct. 1, citizens should be able to examine the different plans and enter their adjusted gross income from last year on the website and find out what tax credits, if any, apply. They should have last year’s tax return, their Social Security number and the Social Security numbers of any dependents.
Rather than making applicants wait to claim tax credits on next year’s tax return, the government will pay credits directly to insurance companies. The applicant simply pays the difference between the company’s premium and the government tax credit.
In another outreach effort, a call center has been set up at 1-800-318-2596 to answer questions. The center is open 24 hours a day, seven days a week, except for Thanksgiving and Christmas.
Finally, the government also is training “navigators” to help citizens negotiate the new healthcare law beginning around the middle of August. Two navigators will be assigned to Montana, and one is likely to be in Billings, Mr. Fierberg said.
During the first year of implementation, applicants will have from Oct. 1 to Dec. 15 to sign up for coverage that will take effect on Jan. 1, 2014. They will still be permitted to enroll as late as March 31, 2014.
Although problems with implementing Obamacare may continue to arise, Mr. Fierberg said the law is a step toward solving the profound healthcare problems that arise in a country where 47 million people are uninsured. And he noted that his office also dealt with numerous problems implementing the Medicare Part D program before it eventually became popular and successful.
But that program wasn’t dogged by relentless and all but unanimous opposition from one political party.
“You said that, not me,” Mr. Fierberg noted. “If Republicans want to fight this tooth and nail every step of the way, they can do that. This is America. It will make our job much more difficult.”
Will this program, too, eventually become popular and successful?
“I do my best not to speculate, especially about what people think,” Mr. Fierberg said.