ESCANABA - The Delta County Chamber of Commerce and the Bay Area Economic Club hosted the second discussion on health care reform Wednesday afternoon at Bay College.
Speakers covered a variety of topics including health exchanges, employer mandates, and individual mandates, as well as answering audience questions about the Patient Protection and Affordable Care Act.
"It was very quickly put together, poorly put together, and so we in the field have been struggling to understand it ever since," said Johanna Novak of Foster Swift Collins & Smith PC's health care practice group.
The Affordable Care Act was signed by President Obama on March 23, 2010. Since that time, more than 30 separate lawsuits have been filed to challenge the reform law, which was deemed constitutional by the Supreme Court earlier this year.
The challenges to the law and a promise by former presidential candidate Gov. Mitt Romney to repeal the law if elected have led many Americans to put off understanding the effects of the act in hopes that it would be repealed.
"Here we are at the end of 2012, with basically about a year before a lot of the key the key provisions kick in and we're all still struggling to figure out how this impacts us and what's going to go on," said Novak.
Exemptions to the individual mandate
Individuals exempt from penalties for not having health care coverage:
An individual with a religious conscience exemption (generally meaning you are opposed to accepting benefits from health coverage for religious reasons)
A member of a health care sharing ministry
Not a citizen or national of the United States
Incarcerated because you were convicted of a crime
A member of an Indian tribe
Unable to afford health coverage because you would have to pay more than 8% of family income to purchase such coverage
Someone with household income below the income filing threshold (generally $9,500 for an individual or $19,000 for a married couple in 2011)
Experiencing a gap in coverage of generally less than 3 months
Source: Foster Swift Collins & Smith PC Attorneys
The act contains a provision to allow states to create American Health Benefit Exchanges, which are websites designed to allow citizens to compare insurance options.
"You'd go online. This is a portal for Michiganders to call in and compare rates, compare health plans and decide what is best for them and their family or for employers to decide what's best for their employees," said Dave Nyberg, director of the Northern Michigan Office of Gov. Snyder.
While the bill to create a Michigan-based health exchange was passed by the state Senate, it was not passed by the House.
"Michigan is no longer moving forward on making a Michigan-based exchange," said Nyberg.
Because some form of exchange is required by the act, the state of Michigan is currently working on creating an exchange that would be a partnership between the state and the federal government.
"The idea is when you go online to the portal ... the theory is that you should be able to access different insurance policies and compare them very easily," said Novak.
Novak does not believe the exchanges will really help people understand their policies.
"I personally think it's more complicated than that. People rely on their insurance agencies for a reason," she said.
Another concern for Novak is that if the Affordable Care Act is successful in providing insurance for the 45 million Americans who currently are uninsured, it will be difficult for doctors to provide services.
"They're not calling the doctor down the street to make an appointment, but if they have insurance I bet they will just like the rest of us," said Novak, who added Americans will be short around 45,000 primary care physicians if the demand for services increases.
For many, the most important and confusing issue about the Affordable Care Act is the individual mandate, which charges a penalty to Americans who are uninsured and do not meet income or other guidelines.
In 2014, those families who are not adequately insured will be charged a penalty of 1 percent of household income exceeding the tax filing threshold or $95 per adult and $47.50 per child in the household - with a maximum amount charged for children of $285 - whichever is greater.
"I think instead of this being a reason to buy coverage, the reason to buy coverage is because now there are programs available to help you afford it," said Novak, noting there are subsidies available through exchanges.
The penalties will increase in 2015 and again in 2016. In 2016, the penalty will be the greater of $695 per adult and $347.50 per child - up to $2,085 for children - or 2.5 percent of household income above the tax filing threshold.
"I don't know if they will go up more than that, I expect they will, but it probably will depend on how this plays out and if this really breeds any change," said Novak.