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Overview of Affordable Care Act for Washington Libraries

Aileen Luppert, Spokane County Library District
(last updated 10/23/2013)

ACA in WA Overview

The Affordable Health Care Act, the ACA, healthcare reform, or Obama Care…whatever you choose to call it, it means big changes are in store for the way individuals select and purchase health insurance.  In turn, libraries need to be prepared to answer complex questions to help their members, or get them connected to resources that can.

In a nutshell, the ACA is meant to increase access to affordable health care.  It provides for subsidies and tax credits to make premiums more affordable.  It allows families to keep their children on existing policies until the child is 26 years old.  It also requires most people over the age of 18 to have coverage by January 2014 or be assessed a penalty.  Insurance plans must cover ten basic services that include maternity care, mental health services, and prescription drug coverage.  Insurance companies may no longer deny coverage based on an individual’s pre-existing conditions.  They may not cancel a policy if you get sick, and they may not put limits on your benefits over your lifetime.

The ACA also established health insurance marketplaces.  Washington is one of 17 states that implemented a state-run insurance marketplace.  Additionally, Washington chose to expand Medicaid.  The Healthplanfinder website is be the place where the uninsured can apply for individual, family coverage, or Medicaid.  On the Healthplanfinder site a person should expect to enter information about their family and income.  In about 45 minutes, that person should know whether they will are eligible for a tax subsidy to help pay for insurance premiums, whether they qualify for Washington’s expanded Medicaid, or what their individual choices are for health insurance.  At this same site a person can compare all the plans for which they are eligible that are sold in their county and purchase one that best suits their family’s needs. 

The Washington Exchange has created a network across the state to provide customer support and training. The state has been split into 10 areas, each with a “lead” organization to oversee outreach and enrollment support.  For contact information about the lead organization in your area, please see this list.  Additional community-based organizations have received training to provide in person assistance and train additional IPAs (In Person Assisters). Keep in mind this list will grow. 

ACA and Libraries

Libraries should contact either a lead organization or trained community organization in their area for more specific information. Libraries should be able to order posters and promotional materials to hand out to your public through these agencies.  If libraries are seeking programming or want to facilitate one-on-one support for the public, these agencies should also be able to help them do so.  Public libraries in Washington plan to provide a variety of services.  Most expect to answer general questions, provide printed materials of some kind, and know what websites or phone numbers to refer their patrons to for further help.  Some libraries are planning on presenting public forums or programs for their patrons to attend for information.  Many have scheduled drop-in times for their computer labs in which a trained Navigator or IPA (in-person assister) will assist people who wish to enroll.  Some libraries also plan for their public internet computers to have direct links to the Healthplanfinder site and will make their scanners and copiers available as needed. 

It appears that Spokane County Library District is the only public library in the state that plans to send staff through the certified IPA training.  SCLD hopes that once their eight staff members have completed training, they will be able to provide one-on-one assistance directly to the public.  Should demand be large enough the library will then be able to host drop-in computer labs solely for the purpose of enrollment.   As of mid-October six of the eight have passed the IPA test and will soon begin providing support services.

Understanding the basics of ACA is only the beginning for frontline reference librarians.  Several complicated issues will pop up very quickly.  The list below contains some basic facts librarians should know and addresses the most problematic ones.

  • Open enrollment is October 1, 2013 to March 31, 2014.  The next open enrollment is October 15, 2014 through December 7, 2014.
    • There are special circumstances that an individual may enroll outside of open enrollment.  Those include things like losing a job or expired COBRA.
  • An applicant may save their work and return to complete enrollment. 
  • Enrollment is expected to take 30-60 minutes depending on the applicant’s circumstances.  In some cases, enrollment will be provisional until further documentation is provided.
  • You must be a legal resident of Washington to purchase insurance on the Exchange.
  • In Washington, to qualify for a federal tax credits you must use Healthplanfinder.  
  • You may apply online, by mail, or phone (1-855-WAFINDER).
  • To use the Healthplanfinder site, applicants should have an email address. 
    • The site may be browsed anonymously to review coverage options and in some cases an email address and online account is not necessary to apply.  Generally, it is better to create an account with an active email account.
  • Information needed to enroll (for each applicant in household): 
    • Social Security numbers
    • Birthdates
    • Passport, alien, or other immigration numbers for any legal immigrants
    • Income information for all adults and all minors age 14 or older who are required to fill tax returns
    • Information about health insurance available to the family
  • Payment must be made at time of enrollment for the first month’s premium.  This payment must be electronic--such as a debit card, e-check, or credit card.  After the initial payment, subsequent payments can be sent electronically through the Healthplanfinder, or the Exchange can accept other forms of payment such as a paper check. 
    • It is believed that a preloaded cash card for the exact amount of the premium will be acceptable.  Theoretically an applicant with no credit or bank account could apply for insurance and save their work when they get to the point of payment.  They could leave the library, get a preloaded cash card for the exact amount, and return and complete their enrollment and payment.  Subsequent payment may be made by check in the mail.  Libraries might want to consider helping patrons obtain a credit card and/or working with a local bank to offer further assistance.
  • The penalty for not having insurance in 2014 is 1% of yearly income or $95 per person for the year, whichever is higher. The fee increases every year. In 2016 it is 2.5% of income or $695 per person, whichever is higher.  In 2014 the fee for uninsured children is $47.50 per child. The most a family would have to pay in 2014 is $285.
  • There are penalty exemptions.  Uninsured people won't have to pay a fee if they:
    • Are uninsured for less than 3 months of the year
    • Are determined to have very low income and coverage is unaffordable
    • Are not required to file a tax return because their income is too low
    • Would qualify under the new income limits for Medicaid, but their state has chosen not to expand Medicaid eligibility
    • Are a member of a federally recognized Indian tribe
    • Participate in a health care sharing ministry
    • Are a member of a recognized religious sect with religious objections to health insurance
  • Applicants may need to scan and upload materials to the Healthplanfinder site. 
    • Scanning documents is not necessary for the general application process.  If an applications status is deemed provisional “pending further documentation,” that documentation, like a paystub, may be scanned and uploaded.
  • Current Medicaid recipients will have to use Healthplanfinder to reapply/recertify—will be under expanded Medicaid program. 
    • All Washington Medicaid (for adults and children) is now called “Washington Apple Health.”
  • Be aware of fraudulent sites selling health insurance.  One insurance broker purchased a similarly named website.  INCORRECT website:  http://www.washingtonhealthplanfinder.org.  If a consumer buys a plan from this site, they will not qualify for tax credits.  The correct web address is https://www.wahealthplanfinder.org.
  • Be aware of a potential “Family Glitch” that may happen to individuals who are employed and seeking less expensive coverage options for their spouse and children than what is offered through the employer. 
    • If an employed person is offered coverage for self and family, they might not qualify for tax incentives—regardless of their income and regardless if the family coverage is more than 9.5% of the individual’s income.  See USA Today article for further explanation.  Much more information is needed on this topic. 
    • Insurance may still be purchased on the Exchange for the spouse and dependents, but no tax subsidies will be available.
  • Healthplanfinder plans to notify applicants if they might qualify for additional state services with a link to Washington Connection where they can apply for those benefits directly.  However, this function is not currently working and may not be until November.
  • For Non-English speakers:
    • Washington Healthplanfinder will be available in both English and Spanish. Individuals needing assistance in other languages may receive customer support through a network of in-person assistance available through local organizations, or through toll-free interpreter services offered by the Washington.  Translated applications and customer communications will be available in Cambodian, Simplified Chinese, Korean, Laotian, Russian, Somali, Spanish and Vietnamese.

LINKS AND RESOURCES:

CUSTOMER SUPPORT

  • Customer Support Center: Toll-Free Customer Support Center is now open to answer questions about health coverage options, access financial help, and to provide other information about the enrollment process. Call center business hours will be 7:30 am – 8:00 pm Monday through Friday. Help will be available in up to 175 different languages. Call 1-855-WAFINDER (1-855-923-4633) or TTY/TDD 1-855-627-9604.

  • Find a Broker: Washington Healthplanfinder will offer assistance through registered Insurance Brokers. Brokers are educated and licensed professionals that can help select health insurance plans. Healthplanfinder’s brokers are the only individuals who are able to recommend an appropriate health care coverage plan for you. Please email Healthplanfinder at:  producer@wahbexchange.org if you need help locating a Broker.

  • Find a Navigator: A Navigator/In-Person Assister is a trained, certified representative who can help you enroll in health care coverage through Washington Healthplanfinder. Ten lead organizations have been selected to oversee outreach and enrollment in a specified geographic area starting October 1, 2013. Representatives from many community-based organizations throughout the state are receiving the training they need to provide assistance to community residents. Community partners who can provide assistance will be announced in each service area in August. Keep checking the map below to see additional locations where you can access in-person assistance this fall.