Obamacare: Health Exchanges, Coming Soon
Colds and sore backs may be a lesser problem for you come the new year.
Under the Affordable Care Act workers without employer-provided health insurance can enroll in Health Exchanges beginning Oct. 1, 2013.
These Health Exchanges will make quality health insurance available to workers without health insurance, such as the self-employed , temp and hospitality industry workers, and workers in many gay bars, restaurants, sex clubs, and bathhouses. Let us not forget the "masseurs", erotic dancers, and porn stars.
Many partnered straight workers in these fields have access to health insurance through their legal spouses, but partnered LGBT workers do not. Consequently, Health Exchanges may be especially beneficial to our communities. The Health Exchanges will be fully functional by Jan. 1, 2014. We had better start learning about them.
Florida has until February to choose between the Federal Health Exchange and a Federal-State Partnership Health Exchange, but is more likely to choose a Federal Health Exchange for both practical and political reasons. On a practical level, setting up a Health Exchange requires a great deal of work. On a political level, the GOP dominated state government would have less "ownership" of a Federal Health Exchange.
The Federal Health Exchange in Florida will offer all health plans that meet the minimum federal standards. These minimum standards, called Essential Health Benefits, include ten essential services. Unfortunately dental, vision, abortion, and gender re-assignment/confirmation surgery are not required to be included. The Federal Health Exchange will be online and will function similarly to sites like Travelocity. People will be able to enter search criteria for plans that cover domestic partners.
Subsidies to purchase a plan on the Health Exchange will be available to people with household incomes between 100 percent and 400 percent of the Federal Poverty Level, a standard measure of poverty. People may be surprised to see that an individual making $44,680 per year will be getting subsidies, particularly those with that income who consider themselves middle class. The amount of the subsidy is based on limiting personal health insurance expenses to a percent of income. Personal health insurance expenses would be limited to 2 percent of income at the 100 percent of the Federal Poverty Level, but go up to 9 percent of income at 400 percent of the Federal Poverty Level. The more money you make, the more you pay for health insurance. The subsidy will make up the difference. As the subsidies would be paid directly to the insurance company in advance, individuals will not have to "loan" money to the government. If this seems complicated, it is.
But what about people making less than 100 percent of Federal Poverty Level?
Originally, people with household incomes up to 100 percent of Federal Poverty Level would all be eligible for an expanded Medicaid; people with incomes above that would be eligible for Health Exchanges. The Supreme Court has since ruled that states can decline to expand Medicaid. At present, Florida severely restricts eligibility for Medicaid, leaving large numbers of very poor people dependent on charity and expensive emergency room health care. It is not clear what Florida will do, but it may end up being a key issue in the 2014 Governor’s race.
Within the LGBT communities, three groups have a great deal at stake in changes to health care: HIV positives, transgenders/transsexuals, and health care providers.
Ryan White Care (RWC) provides coverage for HIV positives without adequate health insurance. Joey Wynn, Co-Chair for the statewide Florida HIV AIDS Advocacy Network (FHAAN), estimates that about two thirds of RWC clients would be eligible for Medicaid Expansion, and up to on third would move to the Health Exchange.