Latest / CareTalk: Healthcare. Unfiltered. / Changes in Obamacare Open Enrollment

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Changes in Obamacare Open Enrollment · CareTalk: Healthcare. Unfiltered.

• 0:00
  Obamacare has been remarkably durable.
• 0:03
  Despite the old repeal and replace rhetoric, it turns out Americans like having affordable health insurance.
• 0:09
  About 18 million people have individual plans, and 80 percent of them receive Obamacare subsidies.
• 0:15
  Open enrollment is here again, and this season is going to be a busy one.
• 0:28
  Welcome to Care Talk, America's home for incisive debate about healthcare business and policy.
• 0:32
  I'm David Williams, President of Health Business Group.
• 0:35
  And I'm John Driscoll, the President of Walgreens Health.
• 0:37
  David, that's a lot of people.
• 0:40
  John, it's a lot of people.
• 0:41
  It's millions and millions of people.
• 0:43
  And, uh, we're going to talk about Obamacare today.
• 0:45
  So, John, you know, what is the latest?
• 0:48
  on Obamacare.
• 0:49
  Well, I think Obamacare is a resounding success.
• 0:54
  If you lay out the problem that the president and his team and Congress were trying to solve, it was how do we keep, get people covered and keep people covered in a system that's got some major.
• 1:07
  I mean, going into 2008, if you recall, in addition to an economic crisis, medical debt was the largest leading reason for bankruptcy in America.
• 1:19
  There were major gaps in the employer insured model.
• 1:24
  Uh, and there was really a breakdown in the marketplace between Medicaid, the program for the poor.
• 1:30
  Medicare, the program for the elderly that people would either be in because of income or age, that, that if we were going to continue to embrace our private sector insurance, which is a uniquely American system, that there needed to be some federal support through Obamacare, uh, to see if we could somehow keep people covered.
• 1:53
  Because when people don't get, are not covered by Obamacare, they still get sick and we still pay for them.
• 1:58
  We just pay for it in extremis.
• 2:00
  And so I think, I think what this.
• 2:02
  Sort of suggests that this many people for this many years and a thriving private Obamacare marketplace that maybe the system's working.
• 2:13
  Yeah.
• 2:13
  It's been a long time since we heard the repeal and replace.
• 2:16
  And of course, most of that was all about repeal and replace was sort of a mishmash with mostly, mostly nonsense.
• 2:23
  And what's, what's interesting is despite the dysfunction in Congress, things are actually looking pretty good for.
• 2:28
  Enrollees, they've, uh, smoothed out some of the...
• 2:30
  What?
• 2:31
  There's dysfunction in Congress?
• 2:33
  You've got to be kidding me, David.
• 2:35
  Come on.
• 2:37
  Well, someone's kidding somebody, John.
• 2:38
  I won't say who that may be.
• 2:42
  So, all right.
• 2:43
  So that's great.
• 2:44
  It's rah rah.
• 2:45
  I mean, but who even qualifies for Obamacare?
• 2:49
  Well, I mean, that, that, that, there's that whole gap group, David, that are...
• 2:54
  You know, more than 400 percent of Medicare.
• 2:58
  I mean, it's, it's the group of people who, you know, it's the group of people who are either don't qualify for employer sponsored health insurance are, are between jobs or between employers.
• 3:11
  And it's actually a pretty big group.
• 3:14
  When you think about how mobile our economy is, uh, the, the, it, and it covers individuals.
• 3:22
  And families, and it's a pretty critical gap coverage when you think of how many people I think there's like 92 million people covered in, in, in, in Medicaid and about 65 million people in Medicare to have, you know, you know, over 10 million people in these exchange plans with a thriving marketplace for people between employer sponsored health plans.
• 3:45
  I mean, it's, it's pretty remarkable.
• 3:47
  I mean, Obamacare has reached the point where I think.
• 3:51
  Now, over 90 percent of Americans are now covered by employer sponsored insurance.
• 3:58
  Well, John, so the, you know, to actually technically qualify for Obamacare, I could argue everybody is covered in a sense because it's affected all aspects of the, of the health care system.
• 4:06
  There's some basic requirements in terms of, uh, you know, being a permanent resident or a citizen, uh, not having Medicare, of course.
• 4:14
  And then, um, anybody can, uh, basically go on an exchange and buy a health insurance.
• 4:20
  Now, people may do it.
• 4:21
  Um, May not do it because they have other choices like their employer sponsors coverage, but those up to 400 percent of the federal poverty level are able to get some subsidies.
• 4:32
  And what's interesting to John is that we've talked a lot this year about the, uh, Medicaid redetermination because of course, during the pandemic, when someone was on Medicaid, they weren't thrown off of it.
• 4:42
  And now there's a process to.
• 4:45
  re evaluate the folks to see who's, who's eligible for Medicaid or not.
• 4:49
  Some of those people losing Medicaid coverage, um, are now going to go on the exchanges.
• 4:54
  And that's one of the reasons why this is going to be a potentially big year, uh, for open enrollment.
• 5:00
  I mean, that Medicaid redetermination, which is the post public health emergency reset, Of the qualifications for Medicaid is, you know, throwing millions of people off of the Medicaid roles.
• 5:14
  In some cases, not them, not even knowing about it.
• 5:17
  So the Obamacare subsidy related health care coverage is really critical.
• 5:24
  And I think what's remarkable about the Obamacare's structure is if you is that the system's kind of working.
• 5:32
  Maybe, David, you could still remind people of our, uh, the metal related categories of Obamacare, so people can understand, like, what does Obamacare cover?
• 5:45
  So, Obamacare basically is comprehensive coverage, and under any of the metal levels, uh, you get the coverage for preventive care, physician care, hospital care.
• 5:57
  Drug.
• 5:57
  So it's, it's comprehensive.
• 5:59
  And then these different levels from, uh, bronze, silver, gold, and, and platinum really, uh, relate to the out of pocket payments.
• 6:06
  So you've got premiums are going to be higher for those, you know, platinum gold plans and lower for the bronze and silver plans in all cases.
• 6:16
  So there's also no, uh, there's no maximum payment.
• 6:19
  If you remember in the battle days, what would happen.
• 6:22
  Uh, that is no maximum coverage, uh, is you might have an expensive disease like cancer, and then your insurance would run out because you'd have either the, uh, annual or lifetime cap.
• 6:32
  So that doesn't happen under, you know, under any of these plans.
• 6:36
  Now the, the bronze plans are the most affordable in a way.
• 6:39
  And if you recall, John, uh, at the dawn of the Affordable Care Act, There were complaints that, that people would, who were against Obamacare would say, Oh yeah, well great, they get coverage, but they can't afford to use it because the deductibles are so high.
• 6:51
  And in fact, of course, insurance is pretty, pretty darn complicated.
• 6:54
  Turns out a lot of people who get subsidies, they could get subsidies for The silver plan, uh, that would actually be a better deal.
• 7:02
  And one of the things that's actually changed this year is that if somebody had had a bronze plan and they were low income and they hadn't actively wanted to renew that plan, uh, then the marketplace will renew them automatically in a silver plan with all the same doctors and hospitals in their network.
• 7:22
  Uh, still going to get a very big subsidy, but they're not going to have so much on the out of pocket, uh, payments.
• 7:29
  So that's kind of how the meta levels relate.
• 7:32
  Well, and you know, and again, this is getting a little wonky, but it's also kind of interesting that the way they're managing Obamacare, that you don't have to hit a particular enrollment period, particularly for those who were affected by the Medicaid redeterminations who may have lost their coverage.
• 7:47
  They, they actually, I believe, have a fairly long period of open enrollment.
• 7:53
  That's right, John.
• 7:54
  So the standard open enrollment period actually varies by state because some states do administer the exchanges.
• 8:00
  But let's say, in general, it's from the beginning of November until mid December.
• 8:05
  If you want coverage that starts January 1st, and then until around mid January, the open enrollment is open.
• 8:11
  But as you say, the people that were under the Medicaid redetermination, or if they've got a special reason, some change of circumstances, but those with Medicaid reenrollment.
• 8:22
  Medicaid redetermination.
• 8:23
  They've had an open enrollment period for a while and it continues until the end of July 2024.
• 8:29
  So there's actually a lot of flexibility that's built in.
• 8:32
  And I think people shouldn't be afraid of Obamacare coverage or looking into it or exchange related coverage because it goes under a bunch of different names.
• 8:41
  Because I think David, you know, 8 out of 10.
• 8:44
  People on, on, on, on, in the Obamacare programs, the exchange related programs are getting some form of subsidy.
• 8:52
  The subsidies, John, are substantial, both in terms of the percentage of people that receive them and, and also how big the subsidies are.
• 9:00
  We're not talking about a 5 percent subsidy here.
• 9:02
  So about 80 percent of the participants.
• 9:05
  Receive subsidies, and typically that means they're paying 10 or less per month compared with the typical silver plan, which for an individual, it depends on the plan and where you live, but something like 475 a month for an individual and higher.
• 9:21
  Uh, for family.
• 9:21
  And so it's, it's, it's very inexpensive if you do get the subsidies, which most people are able to get.
• 9:28
  And David, at the time, Obamacare was sort of equivalently, uh, disliked by the far left who wanted, you know, Medicare for the planet and, and, and the far right that, that, that, that, that, that was, was happy to live with a broken insurance marketplace without coverage for.
• 9:45
  For people or, or, or people who had lost coverage between jobs.
• 9:50
  So how do you, how, you know, how, how should people be thinking about these exchanges and how do they get access to them?
• 9:58
  One of the reasons that there was so much fierce opposition and fear mongering upfront.
• 10:03
  about Obamacare was a realization, uh, by those that opposed it, that, you know, once it's in place and once, uh, you know, people get used to having insurance, they're not going to want to have it taken away.
• 10:16
  And there is a philosophical argument to be had about, you know, what's the overall size of government and the role of government, but for sure it's, it's popular, you know, to have the Obamacare.
• 10:24
  Now, most people who are, if they're already in a marketplace program, in an Obamacare program.
• 10:30
  They'll get a renewal notice.
• 10:32
  They won't have to do anything, you know, a lot of searching out.
• 10:35
  But otherwise, you could just look for Obamacare or health insurance on the web, and you're going to find the marketplace.
• 10:41
  I think you can go to healthcare.
• 10:43
  gov as well to find the federal program or to find your way to your exchange.
• 10:50
  And, uh, and, and you can just navigate from there.
• 10:52
  Now, it turns out there's also in terms of navigation, there are some, uh, people that can help out.
• 10:58
  So the insurance brokers, uh, that, that make a commission from selling insurance and help themselves.
• 11:05
  Yeah, they can get, uh, they can provide advice on, uh, on which plan to get.
• 11:10
  And then there's these, uh, exchange navigators that are actually paid for by the federal government.
• 11:15
  Um, and they will be able to help people to, uh, to figure out how to sort their way.
• 11:19
  Uh, through this, and also, uh, those that are losing coverage under the Medicare redetermination, uh, generally speaking, are going to get information from, uh, the Medicare agency about how to apply, uh, for Obamacare.
• 11:32
  So, it, it, uh, obviously, you know, the, the, the Medicare for all folks are, are disappointed, but you have pretty.
• 11:40
  Solid coverage.
• 11:41
  I mean, the coverage that's provided under these plans is quite competitive with commercial insurance.
• 11:48
  What about the deductibles though, David?
• 11:50
  Wasn't there a fair amount of criticism of the deductibles?
• 11:53
  What do we now know?
• 11:53
  5 years into this program?
• 11:56
  You know, the idea of deductibles is partly to have cost sharing so that, uh.
• 12:03
  People so that the, you know, government pays less or the, you know, whoever is the sponsor, in some cases, employers, they have deductibles, um, as well.
• 12:11
  And also so to share costs and it's also to discourage people from just treating it as though it's free and, and going and, and using, uh, you know, using healthcare as though it were, uh, like water and.
• 12:24
  There are deductibles, but they are limited, um, according to income level.
• 12:29
  And those that are receiving subsidies, you know, they're not paying as much for the deductibles either.
• 12:33
  The specifics vary by plan, but these are not ruinous, uh, these days.
• 12:38
  They are affordable, you know, and I know we call it Obamacare, uh, but it's called the Affordable Care Act.
• 12:43
  And it is affordable for those that are, you know, are receiving, uh, the subsidies.
• 12:48
  So it's nothing particularly to worry about.
• 12:49
  What it does say, though, is when you're shopping and looking at these different plans between...
• 12:54
  You know, bronze, silver, gold and platinum that it's not just the premium to look at.
• 13:00
  It's also to look at what's your complete, uh, complete, complete cost going to be.
• 13:04
  And it's going to be higher with the bronze plans and lower with those in the higher tier.
• 13:10
  David, if your employer offers health insurance, can you still participate in this, in the exchanges and to be able to buy healthcare on the, on the exchange?
• 13:21
  So the answer is it depends, John, which I know you don't like that answer, but here's what it depends on.
• 13:25
  First of all, uh, again, to the point of the insurance supposed to be affordable, uh, if your employer expects you to contribute more than eight and a half percent of your income toward paying for health insurance, then you're actually allowed to go on the exchange.
• 13:42
  It used to be, by the way, 10%, they made it more affordable.
• 13:45
  Now, if you.
• 13:47
  Pay 8.
• 13:48
  5 percent versus 10%, you can go on the, uh, go on the exchange.
• 13:51
  Um, but generally people that have coverage through their employer, if it's good, they'll, you know, they're usually well advised to stay with that.
• 13:58
  What's interesting now, though, is that in some cases, an employer will pay for that employee, but then their dependents, the family members.
• 14:06
  They may not get any subsidy or it might be pretty small and it ends up being affordable for the employee, but not affordable for the whole family.
• 14:13
  It used to be the family could not That's weird.
• 14:15
  Yeah.
• 14:16
  Well, it was like, you know, it was, it was, it was overlooked the first time, but it was, that problem wasn't corrected because there were people that just wanted to see Obamacare fail.
• 14:26
  Now, uh, during the, uh, Inflation Reduction Act, which occurred during you know, It's one of the Biden initiatives.
• 14:33
  They actually made an adjustment here.
• 14:35
  So now what happens is let's say your employer offers you a great deal.
• 14:39
  The employee can do it.
• 14:41
  You got kids, you have a spouse.
• 14:42
  Well, they can go on the exchange.
• 14:44
  So that's, that's new this year.
• 14:45
  And that's another reason why we think that the number of people, uh, enrolling on the exchanges may increase.
• 14:52
  David, there's a lot of subsidy involved in all of these programs.
• 14:57
  I mean, how, I mean, the far right hates that.
• 15:01
  How big are these subsidies?
• 15:03
  And is there a legitimate concern that we're spending too much and getting too little?
• 15:07
  If you just look at the, the subsidies specifically for the Affordable Care Act and the Obamacare exchanges, uh, it's actually You know, it's, it's tens of billions of dollars, but it still doesn't add up to that much, probably something like 70, uh, 70 billion dollars or so.
• 15:22
  The, the Congressional Budget Office, uh, estimates that federal subsidies for health insurance for people under 65, which includes the direct spending, but also.
• 15:34
  You know, tax provisions where it's deductible is about 1 trillion dollars.
• 15:39
  Uh, Medicare itself is also about 1 trillion dollars.
• 15:42
  So I think it all adds up right now to like 1.
• 15:44
  8 trillion.
• 15:45
  Call it 2 trillion dollars.
• 15:47
  Let's set up that 1 trillion before.
• 15:49
  I mean, yeah, almost half of that is.
• 15:52
  His medicaid and the child health program, right?
• 15:54
  That's a little unfair.
• 15:56
  But I, but I think that for that amount of money We're actually keeping people out of bankruptcy.
• 16:00
  We're allowing people to stay employed and we're giving families Options and and they're and it's a market based solution where they're paying out of pocket So why do critics like you constantly carp about obamacare david?
• 16:13
  I think people are moved on to other things john besides obamacare.
• 16:16
  I don't hear too many people Complaining about it.
• 16:19
  It used to be something where I was going to plan.
• 16:23
  Yeah, he's got a plan now.
• 16:24
  Actually, the we asked before about who's eligible for Obamacare and you have to be a US citizen.
• 16:31
  Uh, you have to be not on Medicare.
• 16:35
  Employment income, you know, I know Trump has got I don't know how he pays for taxes.
• 16:38
  Now.
• 16:38
  The 1 of the thing I skipped before.
• 16:40
  Before, but I'll mention now is you, if you're incarcerated, you're not eligible for Obamacare.
• 16:45
  So, uh, Trump is currently eligible perhaps, but, uh, if he were to become incarcerated, uh, he would lose eligibility there.
• 16:53
  So David, what's the best way for people who are interested in Obamacare to actually search and figure it out?
• 17:01
  So I think if you go to healthcare.
• 17:03
  gov, uh, there is, um, a place where you get started and if you actually just put in your, uh, your email address and what state you're in.
• 17:11
  Uh, then it's going to give you, uh, reminders and give you, uh, information specific to your state.
• 17:17
  Some of the states run their own insurance exchanges, the marketplaces, and the federal government runs it for, uh, for others.
• 17:24
  So that's the best way because everyone's going to have their own specific, uh, circumstances.
• 17:28
  But that's, that's what I would recommend, uh, for people to do.
• 17:32
  So, David, what happens if the Republicans win?
• 17:35
  And, uh, and, and do you, do you think there's any real risk to us losing Obamacare?
• 17:43
  John, there's, there's different ways, you know, after the full repeal and replace didn't happen, then it's sort of trying to find a death by a thousand cuts.
• 17:51
  You know, well, we won't, we won't fund the navigators or we'll, you know, turn, we'll make the open enrollment period shorter, or we'll, you know, do, do other sorts of things, uh, from a major.
• 18:01
  It's always possible.
• 18:02
  One of the major things that happened was with this Inflation Reduction Act, the subsidies for the Obamacare exchange continue through 2025.
• 18:14
  So that means we have the coming year and then the year after that, which brings us into the next presidential administration.
• 18:22
  Now, if those subsidies aren't, you know, I already said that it's 500 for an individual to get coverage, but 10 for the subsidy.
• 18:30
  Well, there's a heck of a difference between those two, right?
• 18:32
  So people can afford 10, they can't afford 500.
• 18:36
  If those go away, either in part or in whole, yeah, you're going to see the level of, uh, uninsured rise as it did in the Trump administration, uh, in the first couple of years.
• 18:47
  Um, sure.
• 18:48
  Sure, there's a risk, John.
• 18:49
  Absolutely.
• 18:50
  Can't take this for granted.
• 18:52
  But I, but don't you think given the fact that every time Medicaid expansion has been on the ballot, even in a, in a red state, it's never lost that the political support for Obamacare is, is a, is a, it will protect it?
• 19:08
  You are a believer that the average American wants to see coverage for everybody and, um, I think that, yes, so I know where you stand on that.
• 19:18
  Uh, yeah, I mean, I think for sure the, um, I mean, look, John, if you can't keep the government open, then yeah, there's definitely a chance that the Obamacare.
• 19:26
  Subsidies, uh, will, will fall away and look, healthcare is, uh, it costs too much as we talked about and we get too little for it and this is going to be part of the discussion along with, um, you know, adjustments to Medicare, Medicaid, and absolutely if the, uh, Republicans are ascendant in 2024.
• 19:45
  Uh, then the outlook for government sponsored and subsidized health care goes down.
• 19:51
  But I think the, the, the, the bottom line on Obamacare is like everything else in healthcare.
• 19:56
  It's complicated, but it's helped by providing an extended coverage to folks who are above poverty, but in many cases still working.
• 20:06
  It's really taken a lot of the brutish and nasty parts of our, of the gaps in the healthcare system and filled them.
• 20:12
  It's not perfect.
• 20:14
  But gosh, it seems to be a few years in, one of the most interesting statistics I saw is with extended coverage, um, and all of the value based engineering that's been done in Medicare and Medicaid managed care, you're starting to see a decline in total health care costs for Medicare, particularly in hospitalization and hospital costs and length of stay.
• 20:37
  It's starting to also slow that rate modestly, In the commercial market.
• 20:42
  So it, I think it is a positive knock on effect.
• 20:44
  So critics like you, David, we should, should keep, should, should, should look at the facts, right?
• 20:52
  Well, John, they'll at least look at them and we'll see what happens next.
• 20:54
  I'm a support, support of Obamacare, John.
• 20:56
  And I think Obamacare has become in some ways like Medicare, the people who have it, like it, and maybe there's concerns at the policy level, but, uh, no one wants their Obamacare taken away.
• 21:06
  Well, that's it for yet another episode of care talk.
• 21:09
  We've been talking about.
• 21:10
  Obamacare.
• 21:11
  I'm David Williams, president of Health Business Group.
• 21:14
  And I'm John Driscoll, the president of All Green South.
• 21:17
  If you liked what you heard or you didn't, we'd love you to subscribe on your favorite service.