Myth-information plagues health-care reform
Molly Armbrister
As the Jan. 1 launch date for the federal Patient Protection and Affordable Care Act approaches, the historic health-care overhaul still is bedeviled by a range of misconceptions.

Among the many false ideas out there, according to Dr. Christy Reimer, an internist and president of the Larimer County Medical Society, is that health care for older Americans will be rationed. That idea is completely untrue, Reimer said, but still is common among her patients.

Other common misconceptions:

Myth: Everyone will be required to get insurance – no exceptions.

Fact: While most Americans will be required to get insurance – either through their employers, by purchasing an individual plan, through the health insurance exchange or through government programs such as Medicare and Medicaid – not everyone will be required to buy insurance. People who are exempt include those whose incomes are so low that they are not required to pay taxes, people with legitimate religious reasons for not believing in insurance, and members of Native American tribes, according to the Georgetown University Health Policy Institute. Three-month gaps in coverage also are allowed.

Other exemptions include people who cannot afford coverage. The law says that health-care premiums cannot cost more than 8 percent of a family's income to be considered "affordable." There is also a "general hardship" exemption that applies to unusual circumstances such as natural disasters.

Myth: All businesses will be required to provide health insurance to their employees.

Fact: Many businesses will have to decide whether to cover employees or face fines. The law says businesses with more than 50 full-time employees that do not offer coverage and who employ at least one person who receives federal subsidies from the health-care exchange must pay a penalty, according to the National Federation of Independent Business. The penalty is $2,000 per employee, after the first 30 employees, which in some cases could prove to be a more affordable option for businesses than providing health insurance.

Businesses with fewer than 50 full-time or full-time equivalent employees are exempt from the mandate, and each 120 hours worked at a business per month counts as one full-time employee. This means that part-time employees' hours are combined to count toward the employee threshold. This is a source of distress for many businesses that are on the cusp of the 50-employee threshold and are trying to decide how to balance hiring needs and health-care costs.

Myth: If you're already insured through your employer, nothing will change.

Fact: For those already covered through an employer, the Affordable Care Act is undoubtedly less confusing and scary than for those who are not, but there are some changes that will impact even those who already are covered.

The law prevents insurers from placing annual or lifetime limits on medical care and requires that insurers provide preventive health care without co-pays. Some changes stemming from the law already have taken place. For example, dependent children under age 26 can be covered on a parent's plan.

The law also imposes the medical loss ratio rule, often called the "80/20" rule, on insurers. The rule is designed to force insurers to spend no more than 20 percent of their revenue on administrative costs, reserving the lion's share, or 80 percent, on health care or improving health care, according to Georgetown's Health Policy Institute.

For companies that sell large-group policies, the percentage must be at least 85 percent. Since this rule went into effect, many have seen reduced premiums, especially those in the individual market, according to a study by The Commonwealth Fund, a New York-based health policy institute.

Myth: The Affordable Care Act will make insurance more expensive.

Fact: While the legislation will make insurance more costly for some, rates will not go up across the board. It is still unclear exactly what rates will do in 2014, but preliminary estimates suggest that rates will decrease for some people age 40 and older while increasing slightly for younger populations, according to The Commonwealth Fund.

However, increased competition from plans offered on the health-insurance exchange could bring costs down. Consumers will have more options, which can lead to lower-priced products.
Health care resources
Kaiser Family Foundation: www.kff.org

Colorado Association of Health Plans: www.colohealthplans.org

America's Health Insurance Plans: www.ahip.org

Connect for Health Colorado (formerly Colorado Health Benefits Exchange): www.connectforhealthco.com