At Mountain State Blue Cross Blue Shield, Fred Early has severe misgivings about the new rules of the road, but his company, which insures more West Virginians than any other, is getting ready.
"We're doing preliminary analysis, sharpening our actuarial models," he said. "It's a whole different dynamic about how those products could be marketed, particularly with an exchange involved, and we need to be prepared for that."
The Senate passed its bill on Christmas Eve. The Republican leadership calls it a legislative train wreck, and the Democratic leadership calls it the greatest deficit-reduction act of all time.
The Congressional Budget Office says it would reduce the deficit by $132 billion in the first decade. Critics say the CBO is dead wrong. The Chamber of Commerce says many jobs will be lost. The RAND Corporation says jobs will be basically unaffected.
In West Virginia, people are asking practical questions:
Where will all these new Medicaid people get treatment? Will bills drop after hospitals don't have to write off as much charity care?
The federal government pays nine out of 10 dollars of new Medicaid cost. What happens when and if it drops back to seven dollars?
"Those kinds of questions have to do with the difficulties of implementing new policies," WVU's Plein said. "As they play out over the next few years, maybe we can move away from simplistic, hot rhetoric and really grapple with access to care, quality of care, and efficiency."
Near Paw Paw, Susan Corbin and her boss at the Stony Creek Store are hoping. They would love to have health insurance, but may pay the penalty instead.
"Wait and see what happens and hope we don't get sick in the meantime," she said.
Tomorrow: Worries about health care overhaul from a large employer.
Reach Kate Long at katel...@wvgazette.com or (304) 348-1798.
Want to know more?
Detailed side-by-side comparisons of the two bills
Analysis of the two bills and related studies
Comparison of the bills as they affect West Virginia and links to other resources
Reports from consumer advocate point of view
Variety of information from a small business perspective
Excellent listing of informational articles
The "exchange": How would it work?
In 2013 or 2014, an "exchange," (insurance marketplace) would open on the Internet. Individuals and small business owners could log on and:
The House bill specifies one national exchange. Under the Senate bill, each state creates its own or teams up with other states for more buying clout. People keep their own doctor. Insurers keep their preferred provider networks.
A state-level exchange operated by the Insurance Commission, would:
Under both bills, policies must include coverage of:
The House would also cover rehabilitative services and emergency services.
Premiums, deductibles, co-pays and amount of coverage of each item would vary.
Source: Kaiser Family Foundation, Commonwealth Fund.
How can I afford health insurance?
Prices after subsidies under the Senate bill
For a policy that ordinarily costs $9,435 a year:
A family of four
that earns... would pay
For a policy that ordinarily costs $3,500 a year:
A single person
that earns... would pay
People who make less than $14,400 would qualify for Medicaid insurance, as would a family of four that earns less than $29,300. Young people and those in need could sign up lower-cost catastrophic policies.
Source: Kaiser Family Foundation, Kaiser Subsidy Calculator. (To check other income levels, type "Kaiser subsidy calculator" into a search engine.) These figures assume a comprehensive silver-level policy with a 70 percent actuarial value.