• WisPolitics
2/26/2013

Questions about Affordable Care Act remain, along with plenty of jargon

By Peter Frittitta, Al Campbell

The column below reflects the views of the author, and these opinions are neither endorsed nor supported by WisOpinion.com .

Those of us in Badger land are watching and waiting as changes occur resulting from Congress' enactment of the Patient Protection and Affordable Care Act (PPACA). PPACA is going to change the health care and health care insurance landscape decidedly over the next few years. Four "metal" health insurance plans will be available; these will range from Bronze at the bottom (least amount of coverage that qualifies for this new world) through Silver, Gold and finally Platinum at the top so far as the amount of benefits provided. There is something referred to as an 'actuarial' rating that ranks such plans in terms of the relative benefits each will provide. The Bronze plan has a minimum actuarial value pegged at 60%. From there, each plan increases in actuarial equivalency until the Platinum level is reached.

Something that began by being named an "exchange" will be at the center of PPACA; exchanges are now being more appropriately called a "marketplace" which is probably a more accurate way to describe it. The marketplace will be web-based and the insurance companies that will participate will display their versions of each metal-level of plan along with the costs of each on that site. The marketplace will be equipped to enable a person to shop for and enroll in health insurance over the Internet, while it will also gather employment information and tie the employer and any contribution that will come from that employer to the individual. As employment changes, this information will be updated.

There will be people called "Navigators" available to assist shoppers in deciding what plan of benefits is best suited to them and/or their family. These people may or may not be licensed as insurance agents; that decision remains to be made by the federal authorities. Those who are licensed insurance agents qualified to work in the health insurance arena apparently will be able to assist people whether or not the name "Navigator" will be attached but that has not yet been finalized. That debate continues in Congress and inside the agency charged with making all this work, the Department of Health and Human Services (DHSS) and the Secretary of DHSS, Kathleen Sibelius who is the former Insurance Commission of Kansas. She actually has been given more authority in determining how all this will work than any other single person in the country.

There are new taxes that will be dedicated to supporting the new cost created by PPACA. There are penalties to be levied against employers who do not provide health insurance or whose health insurance isn't at least at the Bronze level. There are new taxes levied against all health plans that will go into the pool of money used to fund PPACA. There are taxes levied against medical device manufacturers that will be used to fund PPACA.

All this is intended to make PPACA capable of functioning as it was supposed to function. We all know about "unintended" consequences. Questions exist that are in the world of unintended consequences. How many insurance companies will participate versus how many that simply decide it isn't worth it to them to stay in this business? Will the marketplaces be available and robust when they are needed (by October of this year), or will there be delays? Will these complex marketplaces work as they were intended or will there be glitches? Will our current providers be available to us in the new PPACA plans or will we need to find a new provider? Will physicians decide to retire rather than adapt to these new requirements? What will PPACA do to the already short supply of primary care physicians?

These are some of the questions that people have and for which there are not certain answers until after the fact. We can be sure that PPACA will bring changes to what we now know as health care. We all hope the changes we experience will be for the better.

-- Frittitta is president of the Wisconsin Association of Health Underwriters. Campbell is a WAHU board member.
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