Navigating the October Launch of Health Insurance Exchanges for Americans

Polls show that a majority of Americans don’t understand how the health reform law and the new insurance exchanges — slated to open Oct. 1 — work. Who can sign up and what will be covered? Ray Suarez poses your frequently asked questions to NPR’s Julie Rovner.

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    Next: the health care reform law and its impact on insurance coverage.

    New insurance marketplaces, called exchanges, are getting set to open in October. But there's still much frustration and confusion about the law. A new poll finds 53 percent of the public is opposed to it. Just 25 percent say they have a very good understanding of it. And only about half of the uninsured Americans surveyed are supportive of it, with many questions about how it works.

    We're starting a series tonight in which we will try to answer some of your more frequently asked questions.

    Ray Suarez is in charge.


    The exchanges are intended to provide new insurance options for those who are uninsured or in some cases need to change their coverage.

    What we have heard online and from people we have interviewed are basic questions: Who can sign up and what's covered? That's where we start tonight.

    Julie Rovner from NPR is with us again to help us walk through this.

    And, Julie, we have been hearing about the exchanges for a really long time. The window finally opens up on October 1. What is an exchange and who are the customers?

  • JULIE ROVNER, National Public Radio:

    Well, an exchange is just a marketplace where people can go and sign up for health care coverage. In this case, October 1 is the date that you can start signing up.

    But insurance doesn't begin until January 1 with these health care exchanges. And who can sign up? This is a really important question. For everything we have heard about these exchanges, they're not intended for everybody. In fact, they're not even intended for most people.

    For most people, nothing is going to change. Most people get their insurance on the job. That will continue. The exchanges are for people who don't have insurance or who buy their own insurance, people who are self-employed largely. That's who these exchanges are aimed at, and those are going to be the customers for these exchanges.

    In fact, the first year, the Congressional Budget Office estimates that only about seven million people are going to sign up for the exchanges out of more than 300 million Americans.


    So, if you don't have insurance, this will provide you a way to, what, easily compare prices, more easily buy it than before?


    That's correct, both of those things, easily compare prices, easily compare plans, and easily sign up for insurance.

    The exchanges will also be a place where if you are eligible for Medicaid, either the expanded Medicaid in the states that are expanding Medicaid or regular Medicaid in states that have not expanded Medicaid, if you go to the exchange and you're eligible for Medicaid, the exchange is supposed to direct you to your state's Medicaid program.


    I have been talking to regular Americans on the street about the confusions they still have, the concerns they still have, including one woman who's worried about a friend.

  • WOMAN:

    My name is Stephanie Greaux. And I'm from Austin, Texas.

    And my question is specific to one of my girlfriends who needs gynecological surgery. She doesn't have health care. She's self-employed. So, I'm just very curious how the Affordable Care Act is going to help her, how she is going to be able to access insurance, so that she can get the surgery that she needs, so that she can resume her full-time working schedule.


    There must be a lot of people in that predicament. What's out there for them?


    These are the people who have been waiting most eagerly for the exchanges to open, for the Affordable Care Act.

    One of the big changes that happens January 1 is that insurance companies can no longer discriminate against people with preexisting health conditions. Right now, people like this woman's friend may have gone to try to buy insurance and simply been turned away. Insurers basically said, we can't afford to take you because in the individual market, basically only sick people would sign up, because individual insurance has been very expensive.

    Now, with the requirement that most people have insurance, insurers have said, OK, now we can afford to insure both healthy people and sick people. So, indeed, October 1, the friend can go to exchange, pick from whatever insurance policy she likes, sign up. January 1, she can get insurance, irregardless of her preexisting condition, get the care that she needs. A lot of people have been waiting for exactly this coverage.


    We have also been getting a lot of questions through the "NewsHour" Web site. George Smith writes from Los Angeles: "I keep hearing about levels of coverage from bronze all the way to platinum, but thought that Obamacare not only would provide affordable medical care for all, but would do so with the same level of care for everyone, which does not seem to be the case."

    And he was openly a skeptic about the law.


    That's right.

    And it is a little bit confusing. There is — there are set benefits that every plan has to provide. And every plan has to pay basically 60 percent of your medical — your covered medical bills. That's the floor, and that would be the bronze plan.

    But from there, you can decide, do you want to pay a higher premium and get sort of more of your benefits paid, or do you want to pay a lower premium and run the risk that, if you get sick, you are going to have to have more of your bills — you are going to have to pay more of your bills out of pocket?

    So, higher premium gets you more covered. Lower premium would get you less covered if you get sick. So if you think you are going to stay healthy, then you might want to pay a lower premium that would cover a smaller percentage of your bills.

    But, basically, they're all the same types of benefits. It's just how much you would have to pay out of pocket if you have medical bills. So, basically, you're going to have to estimate what you think you might have in medical bills and go from there. And, again, there's a bronze, silver, gold, platinum plans. They cover different percentages of your out-of-pocket spending.


    What I found when I was speaking with people was that they had fundamental, basic questions about the operation of that system, the new system.

    And that would seem to match up with what Pew found in its latest numbers. Tell us about that.


    That's right.

    I think people are still really, really confused. A lot of people, polling have found — indeed, a lot of people aren't sure that the law is still the law. A lot of people think that with these repeated repeal votes in the House of Representatives that the law might have been repealed.

    People don't understand the basics. Some people think that everybody's going to go to these exchanges. Some people simply have no idea how their own insurance works, so it's not that surprising they don't know how this new law works, because they don't understand how the basics of the health system works.

    So it's easy to see why this is all so confusing to people.


    Well, we're going to help people out this week and allay some of their fears and also explain the mechanics of the law.

    Julie Rovner, thanks for joining us.


    My pleasure.


    Julie continues to answer questions at her home base for public media, of course, NPR.

    For our part, we want to continue to hear from you. Online, we're collecting questions about the new health care law, and we will be answering those in the coming days.