Medical Maze

Top Five Questions About Health Care Reform—Answered

Jimmy Magahern | Oct 3, 2012, 9:47 a.m.

“The easiest way to describe the exchange is it’s like a Travelocity for health insurance,” says Monica Coury, an assistant director for the Arizona Health Care Cost Containment System (AHCCCS), the state’s Medicaid program. “You go onto the Web, search for a policy that will work for your needs, and it starts whittling away the different options based on your information, with tax subsidies available to people between 100 and 400 percent of the federal poverty level.”

At present, Gov. Jan Brewer is reviewing input from Arizona health care officials to determine which way to go. The biggest advantage in accepting the expansion proposed under the ACA is that it’s 100 percent funded by the federal government for the first three years and 90 percent funded after 2020. Nevertheless, six Southern states have already rejected it and five others, including Arizona, are considering nonparticipation. State sovereignty, or the ability of states to make their own laws, is the reason most have given for not complying.

For Arizona, whose Medicaid program is already suffering from drastic budget cuts, the federal funding would greatly benefit the state’s most vulnerable population. In June 2011, AHCCCS was forced to freeze enrollment for single, childless adults and children of low-income parents whose annual earnings fall above 100 percent of the federal poverty level. “Those individuals who are not aged, disabled, pregnant or under 18,” Coury says. “The federal funding could provide up to $1.5 billion to the state, so it’s critical for the governor and other policy makers to have an opinion on that pretty soon.”

Unfortunately the population that’s fallen between the cracks here (some 150,000 Arizonans have been un-enrolled in the program since the budget cuts) have also become a political football in this election season—part of that 47 percent Romney charges are reliant on government “entitlements.” Local health care officials have been urging our own governor to commit to the expansion.

“In 2000, Arizona voters voted to expand AHCCCS eligibility to 100 percent of the federal poverty level,” says St. Joseph’s Pfister. “We’re simply advocating our policymakers restore the will of the voters. We need to restore benefits to our working poor.”

5 What happens if I can’t afford to buy health insurance, or if I run a small business and can’t provide health care for my employees?


Marjorie Baldwin of ASU says people who have health insurance visit doctors more frequently than people who are uninsured.

Individuals who can’t afford health insurance because the cheapest plan exceeds 8 percent of their income will be exempt from the tax penalty, and subsidies will be available on a sliding scale depending upon income. For small business owners, penalties for not providing health coverage only apply to companies with 50 or more employees, and tax credits will be offered to employers with fewer than 25 full-time employees to offset the burden of providing insurance—up to 35 percent of their contribution toward employees’ premiums through 2013 and up to 50 percent after 2014.

Some larger companies have already vowed to pay the fines—between $2,000 and $3,000 per employee—rather than pay the cost of providing health coverage. But those companies do so at the risk of alienating a public that has already grown attached to some of the Affordable Care Act’s provisions. Earlier this year, Papa John’s Pizza spurned a boycott when its CEO threatened to pass the cost of covering its employees on to customers with a 14-cent increase in pizza prices.

“People are starting to realize the benefits of the Affordable Care Act,” says Plese. “Even Mitt Romney has recently come out and said there are a lot of pieces of the Affordable Care Act that he’d like to keep.

“The ability to keep your kids on your policy until they’re 26—people won’t want to give that up,” Plese illustrates. “They’re not going to want to give up the provision that you won’t be denied health insurance because of a pre-existing condition. They’re not going back to lifetime caps.”

“We like to use the phrase, ‘The genie’s out of the bottle,’” says Harris, noting that the new reforms have already answered at least a couple of health care wishes for nearly every American. “Nobody wants to put it back.”

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