Nathan Brown and Allyson Harper of south St. Louis embody the
opportunity and uncertainties in the air as new health insurance
marketplaces open for business.
"I've got to get something," said Brown, 23, who drives a truck
for a local thrift center that does not provide health insurance to
Starting on Tuesday, the Affordable Care Act's open enrollment
period begins across the United States for new state- and federal-
run online marketplaces. The marketplaces, also known as exchanges,
will present millions of consumers with various coverage options.
The new law requires most adults to have health insurance
beginning in 2014. Those without coverage will be penalized by the
Internal Revenue Service. But the penalties initially will be
small, and folks have until the end of March 2014 to obtain
Individuals and families are going to soon face numerous
decisions that will shape the quality of health care they have
access to in 2014 and beyond.
Brown, like many young men, is in good health. But a recent
spider bite hospitalized him for three days reminding him that he's
not invincible and can suddenly be hit with huge medical bills.
Harper, 22, is already covered by her mother's health insurance
policy thanks to a provision in the Affordable Care Act that
obligated large group health plans to maintain coverage for
dependents up to age 26.
Like many others, the young couple has a vague notion that
something is about to happen that could affect Brown's chances of
obtaining affordable health insurance. But they know few specifics
about the health policies or tax subsidies that will soon be
But twenty-somethings aren't the only individuals who may find
opportunities on the new marketplaces in Missouri, Illinois and
Early retirees, who have not yet reached age 65 when the federal
Medicare program will start paying for most health care costs, may
also find affordable plans and possible tax subsidies on the
exchange or not, depending on their economic circumstances.
Self-employed individuals, and those who work for small
businesses that do not offer health insurance to their employees,
may also find relief. Or, they may find better opportunities on the
open market, depending on an exchange's mix of insurers and
Families with children who've had trouble finding an affordable
health insurance plan may look to the exchange for help. Depending
on their specific circumstances, they may or may not find better
"There's not going to be a bad policy. Everything's covered,"
said Vincent Blair, a Webster Groves-based health insurance broker.
"Now's the time you need to know: What is your financial risk? You
really need to become educated on the out-of-pocket numbers: the
deductibles, the co-insurance and the stop-loss (out-of-pocket
limit) of your policy."
Still, many people at the bottom of the economic ladder may find
themselves out of luck, at least on the western side of the
More specifically, some Missourians who are unemployed or have
low-income, part-time jobs are currently caught in a gap. They are
not enrolled in Medicaid, the joint federal-state health care
program for the poor, yet they earn too little income to receive tax
subsidies on Missouri's federal-run health exchange.
For the most part, individuals who are already covered under
large group health plans will not be lured by policies sold on the
exchange. But individuals who receive health benefits through their
employer and who pay high monthly premiums for coverage of their
spouse or children may look to the exchange for opportunities to
reduce their costs.
The new law was designed in part to help consumers find
reasonably priced health insurance. But as the exchanges open,
insurance brokers as well as consumers and government bureaucrats
seem awash in uncertainty.
The U. …