A panel of experts tried to explain some of the vagaries of the Affordable Care Act at a forum Sunday at the Allen County Public Library, answering questions for an audience of about 20 people, some who were bewildered and others who just wanted to learn more about the plan.
While occasionally audience members attacked the law or its opponents, panel members tried to keep the discussion on point, dealing with concrete questions.
One audience member said he had gone to the online insurance exchange looking for insurance for his unemployed son, only to be told he wasnt eligible and that he should try to get insurance through a state plan. Indiana has the Healthy Indiana Plan.
Panel members explained that those who make less than 100 percent of the poverty level ($11,490 for a single person) are not eligible for any subsidies through the Affordable Care Act. They can get inexpensive insurance through HIP, but that plan is limited to 36,500 people and is full, panel members said.
Mary Haupert, president of the Neighborhood Health Clinics, said low-income people can get Medicaid in Indiana, but only if they are disabled, pregnant or a child. Otherwise healthy individuals are not eligible.
Another woman said she was unemployed and trying to get insurance through the ACA, but she was required to state her annual income, and she has no idea how much she would make in 2014 and wondered why she couldnt use her 2013 income as a benchmark.
Yet another woman said she was able to pick several possible plans and call individual insurance companies to find out what hospitals, doctors and pharmacies were covered by the plan, and it didnt take very long.
Haupert, who said it takes a couple of hours to sign up for insurance through the plan, pointed out that the Neighborhood Health Clinic has what are called navigators to help people sign up who cant make sense of the process online.
Haupert acknowledged that there are winners and losers in the plan. People with pre-existing conditions can get insurance now, while young, healthy people will find insurance costs more.
One major problem, Haupert said, is that most people now have to decide how big a premium they want to pay, how big they want co-pays to be, and how big their deductibles should be. Until now they have gotten insurance through their employers and didnt have to decide.
Abe Schwab, a medical ethicist and associate professor of philosophy at IPFW, tried to simplify the dollars-and-cents aspect of the law, displaying a table that showed exactly what premiums and out-of-pocket expenses would be, depending on a persons income.
A person at the poverty level ($11,490) would pay $300 a year in premiums for a silver plan and have a maximum out-of-pocket expense of $6,350, but two-thirds of that out-of-pocket expense would be covered by a subsidy, leaving a maximum out-of-pocket expense of around $2,400.
A person living at four times the poverty level would get no subsidies at all.
Schwab fended off one audience members comment that the whole ACA-Medicare-Medicaid system was unsustainable, saying he wasnt there to praise or condemn the ACA but to explain how it works and answer questions.
The session was opened by Dr. Jonathan Walker who put on a slide show saying the American health care system has the highest per-capita cost in the world. He showed one graphic that said 86 percent of all health care dollars are spent by 20 percent of the population. Uninsured people prove expensive, Walker said, because they delay seeking medical care until they are very sick and cost more to care for. They also clog the system when they hit it, he said, delaying care for others.