Understanding health care: New options begin Oct. 1

Published: Sunday, Sept. 22 2013 3:28 p.m. MDT

For true reform to take hold, however, everyone must participate, said Dave Gessel, vice president of government relations and legal affairs for the Utah Hospital Association.

“There is something good in this law for everyone in the country,” he said “It won’t work unless young healthy Americans sign up.”

If everyone is insured, Gessel said the costs previously borne by providing care to the uninsured are spread more fairly. Another benefit comes from increased financial security among all Americans, as health insurance, like car insurance, protects against catastrophic and potentially financially crippling problems.

"It's sort of a conservative principle to protect yourself and society," he said.

Moving ahead

Politics aside, Gessel said that in its 2,700 pages of regulations, the health care reform law outlines provisions that intend to drive the costs of health care down, including a push toward electronic record keeping and enforcement of best practices through reimbursement incentives.

There's also a move to better transparency in the industry, allowing for easier comparison between plans and more competitive pricing.

Perhaps the most wide-reaching aspect of the new law is that individuals will no longer be rated on current health or preexisting conditions, which makes it possible for anyone to get insurance at any point of their lives.

Vanessa Watkins, of Ogden, has been lucky. She hasn't had to deal with too many health crisises in her 37 years and health care hasn't always been a priority.

"I need a roof over my head, electricity and heat, she said. "Insurance was the furthest thing down the list."

Now that it will be more available, however, Watkins intends to purchase her own plan. She's been on a limited state-funded plan for several years and hasn't used it much because it isn't accepted by many providers.

Like Jackson, Watkins wants to stay healthy to be a better mother.

Shopping for coverage

Because she's never "shopped" health insurance before, Watkins will be calling on trained navigators and certified application counselors, provided by the government, to assist her.

Three local organizations, including the Utah Health Policy Project (with the Association for Utah Community Health and United Way 2-1-1), Utah AIDS Foundation and the National Council of Urban Indian Health, have received grant money to facilitate call centers and provide assistance.

A number of community centers will also help to distribute information about the new law. Help can be found online, as well, at www.healthcare.gov.

Individual health plans from vendors throughout Utah have also set aside portions of their own websites to better explain the new law.

"The things that made it difficult for people to get insurance go away," Gessel said. "It’s a blessing for those who this is their first time having access to insurance, but the problem might be that for some people, it may still not be affordable enough."

Individuals and families who can’t afford health insurance through the marketplace may be able to apply for income-based tax subsidies to help cover insurance costs on the marketplace.

Or, depending on a decision yet to be made by Utah’s governor, many of Utah's nearly 360,000 uninsured may become eligible for an expanded version of Medicaid, taxpayer-funded insurance for low-income residents.

More than 150 stakeholders have been meeting this summer to discuss the prospects of such an expansion in the state, intending to inform the governor prior to his decision, which he has said is expected before the 2014 Legislative Session.

State agencies involved in accommodating the ACA will present a final update to lawmakers prior to the Oct. 1 marketplace opening, during a Health Reform Task Force committee meeting.

Email: wleonard@deseretnews.com

Twitter: wendyleonards

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