Affordable Care Act: Tips to navigating

Cooley law professors offer advice on how to navigate the Affordable Care Act


LANSING – With the Affordable Care Acts' (ACA) Health Insurance Exchange (HIX) set to open Wednesday, the public will have their first chance at seeing how much individual insurance plans will cost under the new law.  Thomas M. Cooley Law School Professors Lisa DeMoss and Monica Navarro, who are experts on insurance law and the ACA, are offering the following suggestions to individuals who will be looking to the HIX for medical insurance coverage.

DeMoss is the director of the Masters of Law Program in Insurance at Cooley Law School. Before joining Cooley, she was senior vice president, general counsel, and corporate compliance officer for Blue Cross Blue Shield of Michigan in Detroit. DeMoss teaches courses in insurance law and health care reform at Cooley. DeMoss offers the following information:


"Americans have three months to explore the best health insurance coverage options for themselves, their families and small businesses.  It costs nothing to shop for coverage on the state and federally facilitated exchanges and so long as you enroll in coverage by December 15, 2013, you will be covered on January 1, 2014.  You may enroll after December 15th and before March 15th, and still avoid the penalty for failure to acquire minimum essential coverage in 2014. Individual plan coverage will go into effect on the first day of the month for any application processed before the 15th day of the preceding month.


According to a preliminary Health and Human Services Information report issued on September 24th,  the Federally Facilitated Exchange (which will be used by consumers in 36 states) , will offer ,on average for each state, 53 Qualified Health Plan options offered by at least two competing carriers. Premiums within each state will vary based on a number of factors including the level of cost sharing selected, family size, family location, and the age of each enrollee. Premium tax credits or subsidies will vary based on household income projections for 2014. Premiums for 2014 coverage may be higher or lower for similar coverage offered in that state in 2013. The best way for small group employers and consumers to determine how they and their families or employees will be impacted by these changes is to spend some time investigating the options on line at healthcare.gov or on the applicable state exchanges. Inevitably, there will be implementation glitches given the structural and operational complexity of the new data hubs and consumer tools available on the state shopping exchanges, as well as the relatively short timeframe for design, testing and implementation of these systems. For example, on-line enrollment of small employer groups (those employers with less than 50 FTEs) has been delayed until November 1st. Available plan options and pricing are nonetheless available from and after October 1st, on the exchanges and through insurance agents and brokers. Other states are reporting delays in the availability of some of the online tools that enable seamless data transfer and application of consumer specific information to available financial assistance.  Yet, for every on-line issue identified to date, there are process redundancies that allow consumers to complete the application process using telephone based customer service representatives, Navigators or others to receive and process application information.


As with any other on-line shopping experience, consumers must exercise control over the distribution of personally identifiable personal information such as social security numbers and household income. This type of information should only be shared over secure data exchanges and with individuals who have been trained and authorized to receive confidential information and protect and maintain it securely. These include Navigators, Certified Application counselors, in person assistance personnel, and licensed insurance agents and brokers if authorized by their states and trained and certified under Federal and state requirements.


Health care coverage decisions are important financial decisions for any family. Health care insurance mirrors the complexities of the health care delivery system itself. Consumers need to spend time educating themselves about the many new coverage options, their comparative pricing and whether one plan or another best meets the unique medical needs of the shopper and her family. Fortunately, there is plenty of time and many different types of individuals who have been trained and are available to answer questions before an application for coverage is submitted."

                                                                                    -Professor Lisa DeMoss


Navarro, who teaches Health Law at Cooley, is a Council Member for the State Bar of Michigan Health Law Section, a co-chair of the Health Law Committee of the Federal Bar Association for the Eastern District of Michigan, and the Vice-Chair and an Editorial Board member of the ABA's publication The Health Lawyer. Navarro offers the following information:


"There are many misperceptions about who needs to do something when the Health Insurance Exchanges roll out on October 1st in order to avoid the individual mandate penalty. Most people have to do nothing.  The eighty-percent of Americans who already have health insurance through work or who are enrolled in a government program, like Medicare or Medicaid, don't have to do a thing.  For these people, the vast majority of the population, the individual mandate will be a non-event.


The people who need to talk action through the Exchanges are the uninsured.  The uninsured must buy at least basic health insurance (bronze plans on the Exchanges) through the Exchanges or in the private market.  But the only way to receive the financial assistance available to those who earn less than four times the federal poverty level ($45,960 for a single person) is to buy such insurance through the Exchange.  Subject to some hardship exceptions, failure to obtain such basic health insure will trigger a penalty of $95 dollars or 1 percent, whichever is larger, of the uninsured's annual income, which amount will rise every year until it hits $695 or 2.5 percent by 2016.

The expectation, therefore, is that seven million people with no health insurance will purchase it through the Exchanges and that another nine million people will use the Exchanges to enroll in Medicaid, now expanded in many states, including Michigan. That doesn't mean that workers with health insurance benefits will keep what they have over the long run.  Many employers have taken a wait and see approach regarding making changes to their benefit structure until they can see what is available in the marketplace after the Exchanges are deployed.  All the same, for those covered workers, October 1st will be a non-event."

                                                                                    -Professor Monica Navarro

Special Section: Health Care Reform