In the first Arizona CD8 debate, Ron Barber  was vague about his support for the Affordable Care Act (Obamacare), so  I’ve prepared a list of provisions in the law that most Americans support (and one or two they don’t).

In the next debate, I’d like Ron Barber to ask Jesse Kelly why he would repeal these provisions. I would suggest he start with the one that gives seniors a 50% price-cut on their brand drugs when they end up in the Part D donut hole.

CHANGES ALREADY IMPLEMENTED UNDER THE AFFORDABLE CARE ACT (from the American Medical Association):

Created a temporary high-risk pool with subsidized premiums for certain people with pre-existing conditions.

Ended health insurance rescission abuse.

Banned coverage exclusions of pre-existing health conditions for children.

Requires public disclosure of overhead/benefit spending by health insurance issuers.

Eliminated lifetime limits on benefits and restrictions on annual limits on benefits.

Requires insurers that offer dependent coverage to allow children to be covered on their parents’ insurance policy up to age 26.

Developed uniform explanation of coverage documents for enrollees.

Medical loss ratios set at 85% for large group plans and Medicare Advantage plans, and 80% for individual plans: In the past, some companies bragged about spending only 50-60% of premiums on medical claims. The rest went to profits and million dollar salaries and bonuses for top management, while premiums went up every year.

Requires plans to cover certain preventive health services at no cost. With most plans, especially individual plans, having $1,000 to $5,000 deductibles, some people were paying $800 per month but had to pay out-of-pocket for every medical service until they reached their deductible. Now they get a little something for their money because their annual checkup and a list of preventive screenings (like mammograms) will be paid for by their plan.

Provides tax credits to small employers with 25 or fewer full-time employees and average annual wages of no more than $50,000 that purchase health insurance for their employees.

CHANGES TAKING EFFECT IN 2014

Bans coverage exclusions of pre-existing health conditions or rating or coverage restrictions based on health status for adults.

Requires guaranteed issue and guaranteed renewability of coverage.

Allows states to form compacts for the interstate sale of insurance.

Increases transparency by requiring health insurers to provide a summary of coverage to applicants and enrollees.

Insurance exchanges: Creates by 2014 state-based and state-administered health insurance exchanges (marketplaces) for the individual and small group market.

Premium subsidies to individuals: Provides refundable, advanceable, and sliding-scale premium credits for individuals and families with modified gross incomes up to 400 percent of the federal poverty level.

The Individual Mandate: Requires most individuals to have minimum acceptable coverage or pay a tax penalty beginning in 2014; exemptions allowed for those who cannot afford coverage, religious objectors or if the individual has income below the tax filing threshold.

MY TWO CENTS:

The mandate was a Republican idea until it was put into the Affordable Care Act. This is about personal responsibility and everyone paying something into the system that protects us all.  If healthy people can opt out, but then opt in when they get sick, the entire system will fail – much like it does now.

One of the Supreme Court justices compared the mandate to requiring everyone to buy broccoli, even if they don’t like it or want it. Health care is not like broccoli because nobody really needs broccoli – but everyone will need health care at some point in their life. And if they don’t have health insurance, the rest of us end up paying for them.

And Ron, please ask Jesse Kelly to explain his statement that health care is a privilege and not a right. What would he tell a parent with a young child born with serious health problems? If the parent worked for a small company, his sick child could be refused health insurance. Before the Affordable Care Act, the parents of that sick child had no right to buy health insurance because that child had a pre-existing condition.  Does Jesse Kelly think it’s a good idea to repeal the provision that guarantees those parents the right to buy health insurance for their child?

In the recent Arizona 8th Congressional District debate, Republican Jesse Kelly came across as a moderate. When Kelly finished his list of what the American people need with regards to health insurance, I said to myself, “That sounds like Obamacare!”

Jesse Kelly said people should be able to buy health insurance across state lines. The Affordable Care Act allows states to form compacts for the interstate sale of insurance.

Jesse Kelly said businesses should be able to get together and buy one “blanket plan”, so their health insurance costs would be lower as a large group. His proposal is more restrictive than Obamacare because, under Obamacare, multiple plans will be listed on each state exchange. Small businesses and individuals will be able to select a plan that fits their needs. Because of the exchange, these small businesses and individuals will be part of a big group, resulting in lower premium costs and multiple plan options.

Jesse Kelly said people should get tax breaks for their health insurance costs, just like businesses. Obamacare provides tax breaks for everybody (below a certain income level) who buys health insurance.

Jesse Kelly said people should not have to be worried about losing their health insurance if they lose their job. Under Obamacare, people will not be dependent on their employer for their health insurance because they will never be denied coverage due to a pre-existing condition.  So if they want to retire before 65, or work for themselves, everyone will be able to buy health insurance – even if they are overweight, or diabetic, or a cancer survivor.  Without Obamacare, these people are uninsurable as individuals.

Listening to Jesse Kelly’s debate comments, two things come to mind: 1) He doesn’t know what’s in the Affordable Care Act, or 2) He agrees with some of the most important parts of Obamacare. I suppose he is against the mandate, despite the fact that this was originally a Republican idea promoted by Newt Gingrich, John McCain and, of course, Mitt Romney in his Massachusetts health insurance program.

I give Jesse Kelly credit for having a well-thought-out and well-rehearsed presentation on his plan for health insurance reform. Ron Barber needs to beef up his response to questions about his position on the Affordable Care Act. Why didn’t he say to Kelly, “Hey, guy, what you just said about your plan for fixing  the problem is Obamacare!”?

I would have liked to see Ron Barber run through the long list of good things in Obamacare. Then he should have asked Jesse Kelly which ones he would keep and which ones he would eliminate. Of course, Kelly wants to repeal the entire Affordable Care Act, which makes him extreme rather than moderate, in my opinion.

Here is a video clip of Jesse Kelly’s solution for our current health insurance problem:

In the last two weeks, I have talked to several people who delayed enrollment in Medicare Part B because they were working beyond their 65th birthday or were covered by their spouse’s employer health insurance. Every one of them was a bit confused about what they needed to do to get Part B.

Steps to take to get Part B:

If people plan ahead, they can take care of their delayed enrollment in Part B by mail. But everybody I have spoken with waited until the last minute and wanted their coverage to begin on the first of the next month. So they needed to move quickly to get their paperwork in order.

Katherine, who is 66, called Social Security to tell them she wants her Part B to begin on June 1st. She asked about getting the necessary paperwork on-line and was told the forms are not on the Social Security website. (I wonder why?) She was told to google the following:

CMS-40B     This form is used to apply for Part B using a special enrollment period.

CMS-L564   This form must be signed by the person’s employer to certify that he/she has had employer group health insurance.

These two completed forms can be taken to the local Social Security office, and the enrollment in Part B can be in the system in just a day or two. It’s a good idea to call Social Security (800-772-1213) to see if you can make an appointment at the local office. When talking to Social Security, ask if  there are any other documents you need to provide. I have heard of some people being required to provide a birth certificate.

When I talked to Connie, who is 66 and just quit work, she asked me to email her the two forms mentioned above.  When she called Social Security to make an appointment at the Tucson office (3500 N Campbell), she was told she would have to go into the local office, take a number, and wait her turn.

Part B is required to apply for Medicare Advantage or Medigap.

A person cannot submit an application for Medicare Advantage or Medigap until their Part B is in the system. Last month I worked with Fred, who waited until Monday, April 23rd to submit his forms to Social Security. Two days later, we sent in an application for  a Medicare Advantage plan with a start date of May 1. I was worried the application would be rejected because his Medicare record would not show he had Part B.  My fears were unfounded because he was in the system – just two days after submitting his paperwork for Part B.

Medicare Advantage: When a person has delayed enrollment in Part B because he had employer health coverage, a specific code must be put on the Medicare Advantage application. If the wrong code is used, Medicare will reject the application. (Note to new insurance agents: This is not an IEP or ICEP.)

Medigap: A person who has had employer health coverage can get a Medicare supplement with “guaranteed issue”, no matter what his age or what health problems he has.  The Medigap application has some confusing questions that actually pertain to guaranteed issue. (Experienced insurance agents know what I’m talking about.)

I have been pleasantly surprised at how efficiently the local Social Security office performed for people who waited until the last moment to submit their paperwork for Medicare Part B.  If a person takes care of this two months before they want Part B to begin, they can receive and submit their paperwork by mail. But it seems like a lot of people are not aware of what they need to do to get their Part B started if they delayed enrollment for good reasons.