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Affordable Care/Health Insurance Hot Topic at Pike Meeting

    Big changes in healthcare are on the horizon: on October 1st. Even if the federal government “shuts down,” the Health Insurance Marketplace will open. Three months later, in January, every American is required to have health insurance—or face a penalty. “It’s a new world,” Wayne Memorial Chief Executive Officer David Hoff told members of the Pike County Interagency Council on September 25th. The Council had asked Wayne Memorial Health System to help explain the changes coming with the Affordable Care Act at its regular meeting in the 911 Training Center in Lords Valley.
    It proved to be a lively meeting, as many of the 20 or so in attendance had numerous questions about eligibility, accessibility and what was happening in Pennsylvania. Speakers included Hoff, Wayne Memorial Chief Financial Officer Mike Clifford, Wayne Memorial Community Health Centers’ Executive Director Fred Jackson and local Certified Public Accountant Al Beck of Beck, Gogolski and Poska.
    The program was also timely. On September 16th, Governor Tom Corbett unveiled “Healthy Pennsylvania,” his administration’s version of an expanded Medicaid plan. The Governor’s proposal would extend coverage to another 600,000 Pennsylvanians, adding many low-income childless adults who were not eligible before. His plan calls for a realignment of benefits, some job training and work search requirements for those on assistance, and some cost-sharing whereby current Medicaid recipients might pay a monthly premium (from $0 to $25). Healthy Pennsylvania must be approved by the Centers for Medicaid and Medicare Services (CMS) before it can be initiated.
    The Health Insurance Marketplace and other aspects of the Affordable Care Act (ACA), however, will go forward as planned unless Congress intervenes significantly and quickly. Though the ACA bill was passed in 2010, the most sweeping changes are about to unfold. Hoff, Jackson, Clifford and Beck addressed many queries about health insurance coverage, Medicare, taxes on investment income and penalties for individuals and business owners.
The Interagency Council is comprised of human service and development groups, including Catholic Social Services, the Center for Independent Living, Pike County Drug and Alcohol, Children and Youth—groups that serve many of the area’s under-and-uninsured, homeless, aging, children at risk and the mentally and physically challenged.
“    Chances are if you or someone you know is covered by their employer, very little will change,” said Mr. Hoff, “but you may be able to find a less expensive plan in the Marketplace and if you do, your employer may have to pay a penalty for providing you with something more expensive. The key word is ‘may,’ because the rules are complex.”
     Hoff noted that depending on the size of a company and its benefits, some employers may actually qualify for a tax credit. And some individuals may be eligible for a subsidy from the federal government to help them pay for health insurance.
     Health plans in the marketplace will be tiered with different deductibles and co-pays- bronze, gold, silver, platinum- but they must all provide 10 essential benefits, Hoff explained:

• Ambulatory Patient Services
• Emergency Services
• Hospitalization
• Maternity and Newborn Care
• Mental Health and Substance Use Disorder Services, including behavioral health treatment
• Prescription Drugs
• Rehabilitative Services and Devices
• Laboratory Services
• Preventive and Wellness Services and Chronis Disease Management
• Pediatric Services, including oral and vision care

     Hoff added later that ambulance transportation is also an essential benefit in Pennsylvania although the mode of transportation (air, ground) must be determined by the doctor/provider.
     Good news for Pennsylvanians: shortly after the presentation, the federal government released data showing that Pennsylvania residents who plan to buy health insurance in the new Marketplace will pay below the national average.
     Pennsylvania had the 10th-lowest insurance prices out of the 47 states that had data available.
     The government’s website, has information on plans, eligibility and more—including the Marketplace when it opens next Tuesday.
Interagency Council President Christine Kerstetter thanked Wayne Memorial for a “great presentation, lots of good information.”

Enrollment Assistance: Wayne Memorial Community Health Centers will have certified enrollment counselors to help, free of charge, beginning October 4, 2013. Call (570) 251-6569 or (570) 251-6641.



Photo home page, left to right: Wayne Memorial Health System (WMHS) Public Relations Manager Lisa Champeau; WMHS Chief Financial Officer Mike Clifford; WMHS Board Chair Lee Oakes; Alfred Beck, president Beck, Gogoloski, Poska CPAs; WMHS Chief Executive Officer David hoff; Wayne Memoria Community Health Centers Executive Director Fred Jackson; Pike Interagency Council President Christine Kerstetter.


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