Exchanges Opened Oct. 1 For Uninsured To Compare And Purchase Health Plans

NY Times: Exchanges Provide Individuals With “Online Marketplace To Compare Health Insurance Plans And Then Buy The Coverage.” A September 27 New York Times guide to the Affordable Care Act (ACA) exchanges explained that they are designed to help people compare and purchase health insurance:

[A]fter much anticipation, the curtain will finally rise on the exchanges next week, providing millions of consumers with an online marketplace to compare health insurance plans and then buy the coverage on the spot.

The exchanges are likely to be most attractive to people who qualify for subsidized coverage. Individuals with low and moderate incomes may be eligible for a tax credit, which can be used right away, like a gift card, to reduce their monthly premiums. People with pre-existing conditions will no longer be denied coverage or charged more (this applies to most plans outside the exchanges, too). And all of the plans on the exchanges will be required to cover a list of essential services, from maternity care to mental health care.

“In today's individual market, it's like Swiss cheese coverage,” said Sarah Dash, a research fellow at the Health Policy Institute at Georgetown University. “Consumers should have an easier time figuring out what they are getting for their money.” [The New York Times, 9/27/13]

NPR: New Exchanges Will Benefit Uninsured Or Those Without Employer-Provided Insurance. A September 30 NPR blog post explained that the exchanges are meant to help those currently without insurance and those who do not receive insurance from an employer:

[M]ajor pieces of the federal health law are expected to kick in Tuesday.

[...]

These insurance marketplaces, or exchanges, have gotten the lion's share of attention lately, but who should be looking to buy insurance on the exchanges anyway?

Well, definitely not everyone. These exchanges are for two major groups of people: Those who don't have insurance now, and those who currently purchase their own insurance, meaning they don't get it through an employer. [NPR, 9/30/13]

FactCheck.org: Congress And Their Staff Are Required To Purchase Insurance Through Exchanges. Unlike other Americans who already have insurance through their employer, members of Congress and some of their staff must purchase health insurance on an ACA exchange. FactCheck.org explains:

Under the health care law, their insurance coverage will have to switch from the Federal Employees Health Benefits Program, the group of private insurance plans that cover 8 million federal employees and retirees, to the exchanges created by the law. Those exchanges are meant for those who buy coverage on their own, the currently uninsured and small businesses. Members of Congress and their staffs would be the only employees of a large employer in the exchanges, which are set to begin offering insurance in January. [FactCheck.org, 8/7/13]

Fox Pushes Myth That Democrats Wanted “Special” Health Care Subsidy For Congress

Fox Guest Betsy McCaughey: Senate Democrats Wanted To Keep “Special Subsidy” That No Other Americans Have. On Fox & Friends, Fox guest and serial health care misinformer Betsy McCaughey responded to a viewer's question from Twitter that asked, “Why do any citizens have to comply when the Congress, Senate, SCOTUS, Big Corps, and Unions don't,” by pushing the falsehood that members of Congress are receiving a “special subsidy” to help pay for health insurance on the exchanges and that Democrats insisted on keeping this “perk”:

McCAUGHEY: Great question. Section 1312 of this law says that members of Congress have to enroll in the health insurance exchanges, on the philosophy that what's good enough for the public is good enough for Congress. But in August, the president weaseled a special subsidy for members of Congress that nobody else in America--

STEVE DOOCY (co-host): Just on his own. Just out of nowhere. He did it on his own.

McCAUGHEY: Yes, he did. Out of nowhere, no legal authorization, he weaseled this special subsidy that no one else in America earning $174,000 a year, what Congress earns, could possibly get. Now, yesterday, the House of Representatives attached to their bill to fund the government, a provision stripping away that illegal and quite nasty subsidy, right. But when they sent it to the Senate, the Senate Democrats said we want that perk. And it's a major reason that they refused to compromise with the House, because they don't want to have to live under the same law they've imposed on everybody else. [Fox News, Fox & Friends, 10/1/13]

Congress Is Just Receiving Its Traditional Employer Contribution

FactCheck.org: "'Special Subsidy' ... Is Simply A Premium Contribution" The Federal Government Has “Long Made To The Health Insurance Policies Of Its Workers.” A Factcheck.org article from August 30 explained that a similar claim made by Rep. Robert Pittenger (R-NC) that the ACA includes a “special subsidy” that exempted Congress was “misleading” and that “lawmakers and their staffs face additional requirements that other Americans don't”:

Republican Rep. Robert Pittenger is misleading his constituents by saying that he will decline the health insurance offered to members of Congress next year because it includes a “special subsidy” from the president that “exempted” Congress from the Affordable Care Act.

Congress isn't “exempt” from the law. It wasn't exempt back in 2010, when we first debunked such a claim; nor were lawmakers exempt in May when the bogus bit surfaced again. Three months later, they're still not exempt. In fact, as we've said before, lawmakers and their staffs face additional requirements that other Americans don't. And the “special subsidy” to which Pittenger refers is simply a premium contribution that his employer, the federal government, has long made to the health insurance policies of its workers.

[...]

Our readers may recall that before this provision was created, there were claims circulating that Congress was “exempt” from the law. This twisted reading of the legislation was based on the fact that originally Congress, like other Americans with work-based insurance or Americans on Medicare and Medicaid, wouldn't be eligible for the exchanges. In other words, Congress was supposedly “exempt” when members couldn't participate in the exchanges, and now that they are required to do so, they're still somehow “exempt” from the law. Neither of these convoluted claims is true. [FactCheck.org, 8/30/13]

Wash. Post: Congressional Employees Will Be “Ineligible For Any Tax Credits Or Subsidies” Beyond Traditional Employer Contribution. According to a post on The Washington Post's Wonkblog, Ezra Klein explained that because the exchanges were not meant for employers, the entire cost of purchasing insurance would fall on members of Congress and their staffs. To remedy this, the “Obama administration's compromise is to permit the federal government to contribute toward employee insurance on the exchanges, but to render those employees ineligible for any tax credits or subsidies.” [The Washington Post, Wonkblog, 8/1/13]

New Republic: “Like The Death Panels And Immigration Myths, The Suggestion That Obama Made Congress Exempt From His Health Care Law Seems Impervious To Reality.” Jonathan Cohn explained in an August 13 piece in the New Republic that members of Congress and their staff would lose their federal health plans and enter into the new exchanges, but continue receiving their standard employer contributions:

The federal government, like most large employers, not only provides the opportunity for its workers to get insurance. It also pays a large portion of the premium. Now that lawmakers and their advisers were going into the exchanges, what would happen to that contribution? Would they just lose the money?

The answer, the administration decided last week, is no. Lawmakers and their staffs could keep their employer contributions, and apply that money towards the cost of whatever insurance they buy in the exchanges. It's actually true to Grassley's ostensible purpose, which was making sure members of lawmakers and their advisers have a stake in the success of the exchanges.

[...]

Like the death panels and immigration myths, the suggestion that Obama made Congress exempt from his health care law seems impervious to reality. [New Republic, 8/13/13]

Some Republicans Did Not Want To Remove Traditional Employer Contribution For Congress

Mother Jones: Some Republican Lawmakers Were Wary Of Removing Employer Contribution For Congress. A Mother Jones article on Republican congressional staffers angry about GOP efforts to remove the employer premium contribution reported that some Republican lawmakers also opposed ending the contribution:

There's a new front in the battle over Obamacare: Republican congressional staffers are angry at their bosses for trying to deprive them of affordable insurance.

[...]

Some Republican lawmakers agree: Rep. Peter King (R-NY), said Monday that junior staff members were being “sacrificed” for a political game. Sen. Rand Paul (R-Ky.) told ABC that bumping up health care costs for staffers was “probably not a good idea,” adding that low-paid staffers will “suffer.”

Julian Zelizer, a professor of history and public affairs at Princeton University, thinks the GOP has picked a losing strategy. “You never want your staffers unhappy,” he says. [Mother Jones, 9/30/13]

NY Times: Republicans Had “Significant Qualms” About Removing Employer Subsidy For Congress. The New York Times reported on the Republicans' shifting demands to avert a government shutdown, noting that some Republicans were wary of a GOP plan to attach a ban on employer contributions for members of Congress and their staff to a government funding bill:

House Republicans will attach language to a government funding bill that would delay the mandate that individuals purchase health care and would ensure no government subsidies for members of Congress and their staff who purchase insurance on the health care law's new exchanges.

[...]

Unlike Saturday, when House Republicans emerged excited and unified by their proposal, this time there were significant qualms. Representative Chris Stewart, Republican of Utah, said members were standing to say they have sick children who will be difficult to insure,'or they themselves will struggle to purchase insurance, whether because of their age or their health conditions.

The House will vote again this evening, but this time passage is not ensured.

“There are definitely some people who are very much not for it. We'll see what happens on the floor tonight,” said Representative Bill Shuster, Republican of Pennsylvania. [The New York Times, 9/30/13]

Fox Pushes Myth That Health Care Law Cuts Medicare Benefits

Fox Guest McCaughey: “Seniors Can Expect Less Care” Due To Medicare Cuts. On Fox & Friends, when asked if people receiving Medicare would have to move to a new insurance plan under the ACA, McCaughey responded:

McCAUGHEY: Obamacare is for people under 65, if you're on Medicare that qualifies as insurance, but be aware that cuts to Medicare funding pay for over half this law. So the chief actuary of Medicare has warned that seniors can expect less care, hospitals are going to receive less money because of the Medicare cuts, so they're already laying off nurses and spreading care a bit thinner. [Fox News, Fox & Friends, 10/1/2013]

ACA Doesn't Cut Medicare Benefits

Wash. Post: Medicare Cost Reductions Do Not Cut Any Benefits. The Washington Post's Wonkblog explained that the majority of cuts to Medicare “come from reductions in how much Medicare reimburses hospitals and private health insurance companies,” but made clear that “there's one area these cuts don't touch: Medicare benefits. The Affordable Care Act rolls back payment rates for hospitals and insurers. It does not, however, change the basket of benefits that patients have access to.” [The Washington Post, Wonkblog, 8/14/12]

FactCheck.org: “The Law Stipulates That Guaranteed Medicare Benefits Won't Be Reduced, And It Adds Some New Benefits.” According to FactCheck.org, the health care law “stipulates that guaranteed Medicare benefits won't be reduced, and it adds some new benefits, such as improved coverage for pharmaceuticals.” From FactCheck.org:

As we have written many times, the law does not slash the current Medicare budget by $500 billion. Rather, that's a $500 billion reduction in the future growth of Medicare over 10 years, or about a 7 percent reduction in growth over the decade. In other words, Medicare spending would continue to rise, just not as much. The law stipulates that guaranteed Medicare benefits won't be reduced, and it adds some new benefits, such as improved coverage for pharmaceuticals.

Most of those savings come from a reduction in the future growth of payments to hospitals and other providers (not physicians), and a reduction in payments to private Medicare Advantage plans to bring those payments in line with traditional Medicare. (MA plans have been paid more per beneficiary than traditional Medicare.)

And it assumes they actually happen. There's good reason to think that some of those reductions won't be implemented. The law calls for cuts in the future growth of reimbursement payments to hospitals and other health care providers -- that accounts for $219 billion of the Medicare savings in the law. But Congress has consistently overridden similar scheduled cuts in payments to doctors. [FactCheck.org, 6/28/12]

Kaiser Health News: Medicare Will Now Provide More Preventative Care Services. Kaiser Health News explained that Medicare officials “stressed” that the reductions to Medicare spending “will not reduce Medicare benefits.” The article also explained that Medicare beneficiaries will be provided with more preventative care services:

Beneficiaries receive more preventative care services - including a yearly “wellness” visit, mammograms, colorectal screening, and more savings on prescription drug coverage.  By 2020, the law will close the Medicare gap in prescription drug coverage, known as the “doughnut hole.” Seniors will still be responsible for 25 percent of their prescription drug costs. [Kaiser Health News, 9/23/13]

Fox Pushes Myth That Insurance Exchange Plans Will Only Offer Minimum Set Of Benefits

Fox Guest McCaughey: All Plans On Exchanges Will Only Have Essential Benefits Included. On Fox & Friends, while answering a viewer's question about what an exchange is, McCaughey claimed that the exchanges will only sell one set of benefits:

McCAUGHEY: The president says it's like a shopping mall, but in fact, it's more like going to a supermarket that only sells cereal. It's just going to sell one thing, the essential benefit package required by the government. You'll see different levels, bronze, silver, gold, and platinum, but it's definitely not the jewelry store, all those plans have the same benefit package. [Fox News, Fox & Friends, 10/1/13]

Essential Health Benefits Are Just A Minimum Requirement -- Plans Can Offer Additional Benefits

HealthCare.gov: Essential Health Benefits Are “Minimum Requirements” For Plans Sold On Exchanges, And Plans “May Offer Additional Coverage.” From HealthCare.gov's explainer about the essential health benefits required in all plans sold on the ACA exchanges:

All private health insurance plans offered in the Marketplace will offer the same set of essential health benefits. These are services all plans must cover.

The essential health benefits include at least the following items and services:

• Ambulatory patient services (outpatient care you get without being admitted to a hospital)
• Emergency services
• Hospitalization (such as surgery)
• Maternity and newborn care (care before and after your baby is born)
• Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
• Prescription drugs
• Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
• Laboratory services
• Preventive and wellness services and chronic disease management
• Pediatric services

Essential health benefits are minimum requirements for all plans in the Marketplace. Plans may offer additional coverage. You will see exactly what each plan offers when you compare them side-by-side in the Marketplace. [HealthCare.gov, accessed 10/1/13]

NY Times: Plans Can Offer Additional Benefits Or Services. A New York Times guide to the ACA exchanges explained that the coverage offered by plans on the exchanges can include additional benefits besides the minimum required essential benefits:

Q. What sort of coverage will be offered?

A. All plans will have to provide the same set of essential benefits, including prescriptions, preventive care, doctor visits, emergency services and hospitalization (this also applies to most individual and small-employer group plans sold outside of the exchanges). But plans can offer additional benefits, or different numbers of services like physical therapy, so you'll need to do a side-by-side comparison to see what fits your needs -- or at least the needs you can anticipate. [The New York Times, 9/27/13]