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Connecticut & The Affordable Care Act

What The Affordable Care Act Means For Connecticuters
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For more information about the Affordable Care Act, visit CBSConnecticut.com/ACA.

In 2007, slightly more than nine percent of Connecticut residents reported they were unable to see a doctor when necessary due to cost. The cost of health insurance for single policyholders in the state increased by 34 percent between 2003 and 2009. Over the same period, premiums increased by 39 percent for family health plans. [1] The health insurance market in Connecticut is dominated by two large insurers, Wellpoint and United Health Group, with a 68-percent combined market share of the individual market, 59 percent of the small group market, and a 54 percent share of the large group market. [2]

Of the Connecticut residents who have health insurance, 59 percent are covered through their employers. The government programs Medicaid and Medicare insure 26 percent of the population, and five percent purchase private individual policies. Nearly 350,000 residents–10 percent of Connecticut residents–have no insurance. [3]

Who are the uninsured in Connecticut?

More than 52,000 children–six percent of the youth population–lack health insurance in Connecticut. Among non-elderly adults, those younger than 65 and ineligible for Medicare, 13 percent are uninsured. The uninsured rate more than doubles for children living in households with incomes less than 139 percent of the Federal Poverty level. Nearly one-third of adults in these lower-income households are uninsured. Twenty-two percent of Connecticut’s non-elderly Hispanic population lack health insurance. The uninsured rate among Blacks is 16 percent, and eight percent of non-elderly Whites are uninsured. [4]

How does the Affordable Care Act affect Connecticut residents?

The Affordable Care Act (ACA) requires states provide its citizens with access to an online marketplace where individuals and small businesses may compare, select and purchase private health insurance policies. States have the option of establishing their own exchange, operating an exchange in cooperation with the federal government, or turning all administration of the health care marketplace over to the federal government. Connecticut, along with 16 other states and the District of Columbia, is providing its citizens access to a health care exchange with its own state-run health care marketplace.

Under the ACA, all new policies, and in-force policies upon renewal, must cover a core of essential health benefits, including hospitalization, emergency services, and mental health treatments. Annual wellness check-ups and other preventative screenings must be covered with no co-payments or deductibles. Residents may not be denied health insurance for pre-existing health conditions, and insurers may not place a lifetime cap on benefits. Households with incomes at or below 400 percent of the Federal Poverty Level may be eligible for tax credits to offset premium costs.

Connecticut’s health insurance exchange

In July 2011, Governor Dan Malloy signed legislation creating the Connecticut health insurance exchange, which was later named Access Health CT. A 14-member board, appointed by the governor and legislative leaders, governs the exchange. The board has authority to seek competitive bids and negotiate rates with insurers, but the board decided, for the first year, to allow all qualified plans to participate, thereby acting as a clearinghouse for health plans. The board retains the option to act as active purchasers in future years. [5]

As required under the ACA, Access Health CT will offer consumers four levels of health insurance coverage, with premiums increasing with the level of coverage. The bronze level plans cover 60 percent of medical costs, silver plans cover 70 percent, gold covers 80 percent and platinum plans cover 90 percent of medical costs. Additionally, adults younger than 30 may purchase catastrophic plans with limited coverage. Access Health CT will also offer pediatric dental and vision plans.

Connecticut has opted to expand its Medicaid program, which provides no-cost health insurance to low-income individuals and families. Individuals with incomes up to $15,856, and families of four with incomes up to $32,499 may be eligible for Medicaid in 2014. Residents may enroll in the Medicaid program through Access Health CT.

Connecticut residents may access the state health insurance exchange at Access Health CT to shop for plans and enroll beginning October 1 for policies effective January 1, 2014. Access Health CT estimates it will take consumers 30 to 45 minutes to compare plans and enroll online.

Small Business Health Options Program (SHOP)

Under the ACA, small business employers with fewer than 50 full-time workers, or full-time equivalent workers, will not be required to offer health insurance to their employees. (Check here for a definition and calculator to determine who qualifies as a full-time worker.) However, the ACA encourages many small business employers to provide health insurance by offering small business health care tax credits.

Many small businesses were already offering health insurance packages to their employees before the ACA was passed and signed into law. These plans are accepted, or grandfathered in, under the ACA.

For small business owners who wish to change their coverage plans, or for those who did not offer health insurance before the new law, the ACA establishes the Small Business Health Options Program or SHOP. SHOP allows employers to compare and shop for quality insurance plans side by side for their employees. Connecticut small business owners may access SHOP through Connecticut’s health insurance exchange.

Enrollment assistance

Beginning September 2013, residents may access information and enrollment assistance in multiple languages through the Access Health CT call center. Visit the Access Health CT website for this number.

Access Health CT has launched a Navigator/Assistor program to provide in-person enrollment assistance, community outreach and education. Community and civic organizations, faith-based groups, businesses, labor organizations and health care organizations will serve as Assistors in six Navigator regions:

  • Fairfield County
  • Hartford County and Cromwell, Middlefield, Middletown and Rockfall from Middlesex County
  • New London County
  • Litchfield County
  • New Haven County
  • Tolland and Windham Counties

Assistors are trained and certified by the state. Access Health CT will be opening storefront offices in six cities: New Britain, Hartford, Bridgeport, New Haven, Waterbury and Stamford. Additionally, insurance brokers may be certified to offer enrollment assistance at no charge. These in-person resources will be available to help with enrollments beginning October 1.

External resources for Connecticut residents

See the full list of external resources from CBS Connecticut.

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Sources:

[1] http://www.commonwealthfund.org/usr_doc/site_docs/slideshows/PremiumTrends/PremiumTrends.html
[2] http://kff.org/state-category/health-insurance-managed-care/?state=ct
[3] http://kff.org/other/state-indicator/total-population/?state=ct
[4] http://kff.org/uninsured/state-indicator/rate-by-raceethnicity/?state=ct
[5] http://www.ctmirror.org/story/health-insurance-exchange-wont-negotiate-insurance-rates-start

Gillian Burdett is a freelance writer covering all things home and living. Her work can be found on Examiner.com.

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