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Saturday, February 24, 2018

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According to a New York Times article earlier this month, the Affordable Care Act may actually live up to its promise of making health insurance affordable for individuals and families who currently pay too much or are uninsured or underinsured.

As of October 1, 2013, state and federal health exchanges will offer people who cannot get adequate coverage through their employers a marketplace for health insurance coverage at four levels: bronze, silver, gold and platinum. The health plans will be categorized into these levels on the basis of offerings and price. In New York, people who are now paying $1,000 a month for coverage not provided by an employer could pay only $308 a month.

uninsuredSubsidies will be offered according to the person’s ability to pay and the level of the plan they have selected. The silver level will be used as the benchmark. So if someone purchases a gold or platinum level plan, their subsidy will not be as much as those who purchase the bronze or silver plans. And the individual’s or family’s annual gross income will also determine how much the subsidy will be. People with incomes up to 400% of the poverty level will be eligible for subsidies. An individual earning $17,000 a year would pay about $55 a month for the silver plan.

Not all states are forming health exchanges (people living in states that have opted out will be able to access a federal exchange), and those that do are varying in their approach. But California and other states are locking in lower premium prices for insurance coverage offered through their health exchanges (businesses that particiate in the exchange are unlikely to see the same cost reductions, at least for now). How is this happening? First, competition is forcing insurance companies to lower their prices. New players are entering the insurance market, including large health systems such as North Shore-LIJ Health System. Second, the individual mandate and the subsidies will spur more people who previously went without coverage to now buy it.

state health exchanges

Earlier this year, I wrote a blog post for JAMA News Forum on the role of health professionals in educating the public about state health exchanges. This week, someone asked me whether health professionals who oppose “Obamacare” should have to tell their patients and the public about the exchanges and whether they should be able to voice their opposition to the law.

My answer is: It depends.

A recent survey of physicians by, an online job site for physicians, physician assistants and advanced practice nurses revealed that the physicians are not knowledgeable about the state exchanges. In my conversations with physicians and nurses, I’ve found that both groups are woefully uninformed about what’s in the ACA. If the practitioner doesn’t know what’s in the law, then what is the opposition based upon? If someone who opposes the law is truly knowledgeable about what’s in it, how it’s being implemented and what the pros and cons are for the public’s health, then perhaps.

But first and foremost, all health professionals have an ethical responsibility to inform their uninsured patients about the opportunities for obtaining health care coverage. How could you ethically not tell an uninsured patient who has been unable to afford the surgery he needs or get an important diagnostic test that he could qualify for subsidized coverage through a state or federal exchange?