Kansas Insurance Commissioner Sandy Praeger answered questions about the Affordable Care Act during a nearly two-hour chat today on WellCommons.
Praeger, a Lawrence resident and Kansas University graduate, has been insurance commissioner since 2003. She is responsible for regulating all insurance sold in Kansas and overseeing the nearly 1,700 insurance companies and more than 94,000 agents licensed to do business in the state.
She also is working to implement new regulations that fall under the Affordable Care Act and to educate the public about the changes.
Here are excerpts from today’s chat:
Q: Do you think that the Affordable Care Act is good for Kansas?
A: The law, like many that get passed, has some good qualities and some areas that will need to be worked on as we go forward. But many Kansans are already benefitting from some of those provisions. Children can stay on their parents policies until the age of 26, no lifetime limits can be imposed on health policies, refunds will be given if the policy fails to pay at least 80 percent of the premium in health care costs (85 percent in companies with more than 50 employees). Today, insurance companies begin allowing women access to important preventive services without a co-pay or deductible. In 2014, one of the most important provisions becomes law: No one will be denied coverage based on health status. In general, there are many good benefits for Kansans. It does not, however, do enough to control health care costs, and that will be an ongoing project.
Q: I read a summary of the insurance exchange in the Affordable Care Act. How could that work in Kansas? How would it be different from what we have now?
A: The exchange will be an online marketplace where consumers can go to find out about the health plans that are available in their area and compare those plans on benefits and costs. The plans will have to conform to a standard set of benefits to be determined by looking at what is currently available in the Kansas market. The goal here is to provide access to health insurance that covers a standard set of benefits so we can attempt to control the cost shifting that occurs when folks don’t have coverage or their insurance coverage is minimal and they find themselves unable to pay for necessary medical services. The cost of those services not paid for is ultimately shifted to the rest of the insured population.
Q: I am female, age 59, make approximately $15,000 annually, have no insurance benefits, and have pre-existing conditions. Will I qualify for Medicaid in 2013 if the program is expanded? I am scheduled for my annual mammogram today courtesy of and thank God for the Kansas Early Detection Works program.
A: The rules have not been established yet for Kansas but, given what we know today, if Kansas does participate in the Medicaid expansion, I would expect that you would be eligible for the program. I am glad that you are using of the services that are available to you, especially your annual mammogram. Early detection can save lives.
Q: A majority of people have health insurance through their employer or their spouse’s employer. What are some of the biggest changes, if any, that could take place for the average person who has health insurance under the Affordable Care Act?
A: If you have comprehensive coverage that is equal to or better than the essential health benefits, EHB, you probably will not see much, if any change. Your employer will still be buying private insurance from private insurance companies. There may be some additional services, not currently included in your employer-based plan, that could be added. For example, many plans today do not cover vision and dental services for children and the EHB does require that plans add those services if they are sold through the private marketplace, either the exchange market or the market outside the exchange.
Q: Are there any changes in Obamacare for Medicare? Will it help people who haven not worked enough quarters to qualify for coverage and therefore have to pay $600 per month?
A: The Affordable Care Act does make a few changes to Medicare. It adds one wellness visit a year and it begins to close the so-called “donut hole” in the prescription drug benefit. It does not change the basic provisions of the Medicare program which is part of the Social Security Act and does involve a certain level of participation to be eligible for those benefits.
Q: Can you explain how the Affordable Care Act will affect small businesses that may or may not offer health insurance to their employees?
A: There is no requirement that businesses with fewer than 50 employees provide health insurance for those employees. The law does offer a tax credit for companies with fewer than 25 employees and an average wage of less than $50,000. If the employer provides insurance for those employees and pays at least half of the premium, he or she receives a tax credit equal to 35 percent of that amount and that credit increases to 50 percent after 2014.
Q: This is an election year, and there is a lot of misinformation out there. Where can people get reliable information about health reform or ask questions?
A: People can check the Kansas Insurance Department’s website at ksinsurance.org for more information regarding implementation of the Affordable Care Act in Kansas. More information can be found at the Kansas Health Institute news service at KHI.org. For national issues the Kaiser Family Foundation at KFF.org is a reliable source of information on health issues.
To see the complete version, visit WellCommons.com/chats.