Tomorrow is the first day of open enrollment in Ohio’s health insurance exchange at www.healthcare.gov. Even if the government shuts down tonight, Obamacare will still be fully funded (it’s a law, it’s not part of the discretionary budget) and the exchanges will be fully functional.
Well, largely functional. Here’s what to do, and then what to watch out for.
What To Do
You’ll get a list of health care plans that you can enroll in. Pick one.
That’s pretty much it. Your subsidy will already be reflected in the prices that you see. If you’re older, or you don’t earn much money, there will probably be some plans that don’t cost anything at all.
Your coverage won’t start (and you won’t be billed) until January 1.
Then tell people how awesome it was! If you ask me, positive reviews of www.healthcare.gov will quickly end the government shutdown.
What To Watch Out For
There are some glitches that we know about, and there might be some surprises. Most of this stuff will be worked out within a month. Since coverage doesn’t start for 3 more months, it shouldn’t be a big deal.
Ohio has sabotaged our Navigators. Navigators are community groups that get grants to help people enroll. The Ohio legislature has made it basically impossible for health care providers to act as Navigators, and Ohio’s congressional delegation has worked to intimidate them.
As a result, it’ll be trickier than it should be for people to get answers about insurance. The best bet is to call 1-800-318-2596, though there should still be Navigators around. Volunteer for one!
Ohio hasn’t expanded Medicaid. Around 1/3 of uninsured Ohioans will qualify for Medicaid (once we expand it). People earning less than minimum wage will go to the exchange and be told they don’t qualify for any subsidies–because they’re supposed to be enrolled in Medicaid.
Listening to Diane Rehm today, people kept asking how Obamacare would effect single moms making minimum wage–they can’t afford health insurance on the exchange! Yeah, they’ll be eligible for Medicaid1.
Strangely, Ohio’s Medicaid is enrollment is on a separate site. Last week, the Kasich administration had a sizable rollout of the state’s new Medicaid enrollment website. Almost every other state will handle online Medicaid enrollment through the exchange. Ohio will instead transfer users from the federal exchange to the state benefits site and back to the federal exchange.
While the replacement of the 1983-era CRIS-E system will make Medicaid a lot better for Ohioans, hosting it on a separately secured server is a pointless risk. That said, any problems with data transfer should be fixed by the time Medicaid is expanded2.
The small business exchange won’t open for another month. If you work for a company with fewer than 50 employees, your HR department will pick your next health plan on the exchange. The delay is a real shame politically, but won’t have any practical effect since coverage doesn’t start until January.
The political timebomb here is that people on the small group market pay a ton for insurance if they work with older people or pregnant people. With a statewide risk pool, this will drop substantially even before subsidies and tax credits are applied.
Small business owners are more likely to be Republicans, and they’re going to get a big surprise when they’re able to save 25% or more on their insurance costs. That surprise, unfortunately, won’t come until November.
The subsidy calculations are wonky. They only started testing the software last week, and it’s having some trouble applying the subsidy to all plans. Here’s some disingenuous concern-trolling from Avik Roy about it.
This isn’t a huge deal because the subsidies are tax credits. If you tell the exchange that you earn less than you actually do, then you’ll have to pay that back when you file your taxes. This is identical to withholding taxes on your paycheck, so Avik Roy should only be terrified about this if he thinks that withholding taxes has been an ongoing cataclysm.
If you don’t want to cross-reference the Kaiser subsidy calculator, then maybe wait a week. They’re about to get a ton of beta testing.
So, happy shopping tomorrow!
1 I call this Ezra Klein Syndrome. Nationally-syndicated journalists are too personally interested in unsubsidized rates (because, if those rates are low, they can go freelance). 88% of people who go to the exchange will get subsidies or Medicaid.
I’d bet that every “Young Invincibles” article was written by somebody who has health insurance. I’d also bet that they pay more for that employer-provided plan than the median 25-year old will on the exchange.
2 The rollout tells me that Kasich is certain Medicaid will be expanded before next November. The only reason I see to set up a separate Medicaid enrollment site is so that new enrollees give Ohio credit for the expansion, rather than lumping it in with “Obamacare”.
If people go there and can’t enroll, though, they’ll blame Ohio for it. So, the Medicaid site is doubling-down on expansion for Kasich.