Las Cruses Sun: "Thousands apply for New Mexico Medicaid"

More to be eligible for program Jan. 1

By Brook Stockberger
bstockberger@lcsun-news.com

LAS CRUCES >> About 43,000 New Mexicans have applied for Medicaid since Oct. 1 and as many as 20,000 of those will be eligible to start the program as of Jan. 1.
The Medicaid program in New Mexico will soon be known as Centennial Care and it will expand to take on more people as the Affordable Care Act -- better known as ObamaCare -- kicks in with the start of the new year. Already 550,000 New Mexicans -- about 1 in 4 -- are covered by Medicaid and, as coverage is expanded, the state projects that number to grow through the rest of the decade.
"We've revised the numbers up, and by 2020 as many as 205,000 more people (could be on Medicaid)," said Matt Kennicott, communications director with the state's Human Services Department.
Las Crucen Michael Marrufo said he applied online on Nov. 14 but does not yet know if he will be accepted.
"They shot me an email saying, 'You will receive a final decision from the New Mexico Department of Human Services,' So now I am waiting," he said.
Las Crucen Dave Meade said that he does not currently have health insurance and, with the expansion of Medicaid to include more people, he decided to try and enroll. He applied online last month and is also waiting to hear back.
"If they count our housing costs, which are quite high, I should qualify no problem," Meade said. "If they don't count for housing costs, maybe I won't qualify."

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He said that he has also enrolled for health coverage on the Affordable Care Act's federal website just in case he is not accepted on Medicaid.

Who is eligible?

As of the start of 2014, states that choose to expand Medicaid -- like New Mexico -- can set eligibility levels to 138 percent of the Federal Poverty Line, or about $32,500 for a family of four.
There are other criteria as well. The website yes.state.nm.us offers what it calls a "quick, easy and private way" for people to determine if they are eligible. In addition, people can contact the Income Support Division offices in Las Cruces at 655 Utah Ave., and at 2121 Summit Ct. The phone numbers are 575-524-6500 and 575-524-6568, respectively.

How to apply

Potential enrollees can also use the website yes.state.nm.us to apply or they can also visit the local offices.
"We got outreach to help sign people up at (other) locations as well," Kennicott said.
Both Memorial Medical Center and MountainView Regional Medical Center have pitched in.
"MountainView is helping people get signed up," said MountainView spokesman Kelly Duke, who pointed out that 20 people attended a seminar at the hospital on Friday.
Mandy Leatherwood with Memorial Medical Center said that MMC has six staff members trained as healthcare guides.
"They can help people with signing up for the New Mexico Health Insurance Exchange and the Medicaid expansion," she said.

Problems

Some people have expressed frustration with the sign-up process and even with the state.
Meade said he does not expect to hear back on his eligibility anytime soon based on a phone call he made to the state.
"I tried to get through and it took me a couple of days," he said. "Based on what they told me, it seemed like they hadn't even looked at my application yet. My impression was that it would be sometime in January or February."
Marrufo said the application process was a chore.
"The log-in was a pain," he said. "It took several tries and finally I got an email response from the health insurance marketplace telling me that they knew I was having problems with the site and to try logging in again and complete the registration (so) I did."
Kimmarie Hartley applied on Oct. 6 and received a letter that she was not accepted on Nov. 4. She said that she was denied because she does not have any minor children, but she believes, under the expanded program, that should not matter. She will be covered by Medicare in March, so she has decided not to appeal the process. But her daughter, who also applied, was sent a denial letter too for the same reason. The problem? She has a minor child.
Hartley said her daughter has filed an appeal and was told she'll have to wait a month before she learns more.
Kennicott said people can file appeals with an ISD office.

Brook Stockberger may be reached at 575-541-5457.

Sebelius Announces Three Affordable Care Act Deadline Extensions

Sebelius Announces Three Affordable Care Act Deadline Extensions

Friday, December 13, 2013

On Thursday, HHS Secretary Kathleen Sebelius on Thursday announced that her department is implementing a trio of Affordable Care Act deadline extensions intended to ease the transition to coverage in the law's new insurance marketplaces in 2014, Modern Healthcare reports (Demko, Modern Healthcare, 12/12).

Sebelius said that changes were prompted by the various technical issues that plagued the online marketplaces --particularly the federal health insurance exchange -- when they were launched in October, which caused problems and delays for consumers when they tried to enroll in health plans. As a result, she said many consumers will need more time

to select and pay for the new coverage (Pear, New York Times, 12/12).

Sebelius said HHS has: Officially asked insurers to honor the new Dec. 23 deadline for coverage that begins on Jan. 1 (Kliff, "Wonkblog,"

Washington Post, 12/12); Urged insurers to give consumers more time -- until Dec. 31 -- to make their payments for coverage that begins Jan. 1

and asked them to accept late or partial payments for coverage (New York Times; 12/12); and Extended by one month -- through the end of January 2014 -- the federal Pre-Existing Condition Insurance Plan, which

has been providing coverage to about 100,000 U.S. residents with severe health conditions who were unable to purchase private coverage prior to the ACA (Galewitz, Kaiser Health News, 12/12).

An HHS fact sheet said the department "will consider moving [the Dec. 23] deadline to a later date should exceptional circumstances pose barrier to consumers enrolling on or before" that date (Young, CQ Roll Call, 12/12).

In addition, Sebelius announced that:

HHS has asked insurers to provide "retroactive coverage for people who sign up after Jan. 1," meaning that if a consumer signs up for coverage on Jan. 5, his or her coverage still would be effective on Jan. 1; and

Some consumers who experienced unique problems with signing up for coverage in the federal or state exchanges would be eligible for a "special enrollment period," which will provide them with extra time to complete their enrollment (New York Times, 12/12).

Officials in the Obama administration said that they are encouraging insurers to make additional voluntary accommodations for new enrollees, such as:

Continuing coverage for patients' preferred physicians, even if they are out-of-network under their new coverage plan (Modern Healthcare, 12/12); and12/13/13 Sebelius Announces Three Affordable Care Act Deadline Extensions - California Healthline

Providing temporary coverage for prescription drugs beyond Jan. 1, even if the drugs are not on the plans' list of approved

medications (New York Times, 12/12).

Reactions

In a statement, America's Health Insurance Plans CEO and President Karen Ignagni criticized the new changes, saying that "continued changes to the rules and guidance could exacerbate the challenges associated with helping consumers through the enrollment process." She added, "Health plans will continue to do everything they can to protect consumers from potential coverage disruptions caused by the ongoing technical problems with HealthCare.gov" (CQ Roll Call, 12/12).

Some Republican leaders in Congress also criticized HHS' move. Rory Cooper, a spokesperson for House Majority Leader

Eric Cantor (R-Va.), said, "It's clear that the administration knows Obamacare's problems are only going to get worse, and

patients will be the ones who suffer

Eight Northern Indian Pueblos Council Inc. " Creating a culture of Coverage"

Get Covered this Holiday Season!

WOULD YOU LIKE INFORMATION REGARDING YOUR COVERAGE OPTIONS UNDER THE AFFORDABLE CARE ACT (OBAMACARE)?

You may be eligible for no or low-cost, high quality health insurance coverage.  

If you are a single adult and your income is less than $15,856 a year, you may be eligible for no-cost coverage.  If your income is less than $34,470, you can receive financial assistance to purchase a low cost health plan and may not have to pay any out of pocket expenses (i.e, co-pays, deductibles).

The Eight Northern Indian Pueblos Council, Inc. (ENIPC) is offering confidential, unbiased assistance to help Pueblo members navigate through all of the options available to Native Americans in this process.  

Please note that with Obamacare, if you already have coverage offered by your employer that is "affordable" (amounting to 9.5 % or less of your total household income), you are not eligible to shop in the Exchange Insurance Marketplace.  For those who are eligible, to obtain coverage starting January 1, 2014, the deadline to enroll is December 23, 2013, although Native Americans benefit from an ongoing monthly open enrollment period.  Native Americans are also exempt from requiring insurance coverage, without incurring any penalties. if they decide to opt-out.

A Certified Health Guide/Navigator will be on-site at the Nambe Pueblo Tribal Administration Building every Monday from 1 p.m. to 5 p.m., to assist you with information and application enrollment assistance, both with the Marketplace Insurance Exchange (healthcare.gov) and Medicaid applications.  For preliminary assistance and/or to set up a free in-person appointment, call our toll-free line at 1-855-241-8137, or just drop by!  

Protect yourself and your family from unforeseen medical expenses and get the care that you need.

Community Catalyst Blog Post "States to Decide Medicaid Eligibility for Same-Sex Couples"

http://www.communitycatalyst.org/blog/states-to-decide-medicaid-eligibility-for-same-sex-couples    

States to Decide Medicaid Eligibility for Same-Sex Couples

Posted on: November 25 2013 10:48 am 

The Supreme Court’s decision on the Defense of Marriage Act (DOMA) was met with much elation by advocates pursuing marriage equality. The federal government has been working, since that momentous decision was released, to clarify just how it impacts various types of health insurance coverage. Most recently, the Center for Medicare and Medicaid Services (CMS) released guidance about how states should make most Medicaid eligibility determinations* for same-sex married couples. This guidance lets states choose whether or not to recognize the marriages of same-sex couples in determining adults’ eligibility for Medicaid.

In states already allowing same-sex marriage (regardless if passed by court ruling, legislative action, or popular vote), this should be a non-issue: states will likely recognize all married couples for benefit determination. The real question is whether states that do not allow same-sex marriage will recognize the marriages of couples who live in a state without marriage equality but were wed in a state that allows it.

It’s important to note that no matter what states do about Medicaid eligibility, the IRS will recognize marriages of same-sex couples regardless of where they live (as long as they were married in a state that allows it) when determining eligibility for tax credits in the Marketplaces for private health insurance. The CMS guidance essentially lets states decide whether or not to align their Medicaid eligibility rules with these Marketplace rules.

What’s at stake

Eligibility for Medicaid is based on two factors that could be influenced by whether a person is considered married: household income and household size. So in states that have not chosen to recognize legally-married, same-sex couples, those couples will sometimes be eligible for different insurance options than different-sex couples at the same income level. Also, some same-sex couples will be required to sign up for two different insurance plans rather than being on one plan together.

For example, imagine a legally-married, same-sex couple: John and Jeff. John earns $16,000 a year, or 139 percent of the federal poverty limit (FPL) if John were considered a household of one. Jeff earns $4,000 a year, or about 35 percent FPL for a household of one. They live in Arizona, where same-sex marriage is not legal. But, they were married in Massachusetts, where it is.

If they were a different-sex couple, Arizona would automatically treat them as a household of two with an income of $20,000 (or 129 percent FPL.) At that income, they would both be eligible for Medicaid; they would be able to enroll in a Medicaid plan without any premiums.

But, the CMS regulations allow Arizona to determine how to qualify this family. If Arizona chooses to recognize John and Jeff’s marriage from Massachusetts, they will qualify in the same way a different-sex couple does, and find them Medicaid-eligible. But, if Arizona chooses not to recognize their marriage, only Jeff would qualify for Medicaid (since he earns 35 percent FPL as an individual). John, who earns 139 percent FPL as an individual, earns just a bit too much for Medicaid when he’s considered a household of one. He may qualify for tax credits on the Marketplace, but he will be on a separate plan from his spouse and will likely have to pay premiums for that plan.

Even though in this example, John and Jeff’s marriage recognition resulted in lower costs, and Medicaid eligibility, there may be other circumstances where Jeff and John encounter higher health insurance costs as a married couple. But, this is not different from the various situations any married couple—gay  or straight—regularly  faces. At the end of the day, if we believe that all married couples at the same income level should be eligible for the same financial assistance, and if we believe that same-sex married couples should have the same opportunities as different-sex couples to be on the same plan as their partner, then we need state Medicaid departments to recognize the marriages of legally-wed same-sex partners.

Next steps

All states will have to submit a State Plan Amendment to specify whether or not the state recognizes same-sex marriages for the purposes of Medicaid and CHIP eligibility. Details about the timing of that State Plan Amendment are still forthcoming, but it’s never too soon to check in with your state Medicaid Department to figure out how it plans on handling this decision.

*An important caveat: This guidance only applies to Medicaid applicants whose eligibility is based on Modified Adjusted Gross Income, which is most low-income people applying as parents or childless adults. Guidance governing eligibility determinations for others (such as people who need long-term services and supports, people who qualify based on being blind, disabled or elderly, people in foster care, etc) is forthcoming.

ACA "Obamacare" Outreach Education presentations From NAPPR

Good Afternoon all,

As you may be aware Native American Parent Professional Resources (NAPPR) Inc., in Albuquerque, has been contracted, by NM HIX, as the Umbrella organization to provide outreach, education, and enrollment services to NM Native American Communities.

NAPPR has subcontracted with several Pueblos, Tribes and Consortium agencies to provide those services on their home communities. Part of the contract is to hire Native American Healthcare Guides that perform presentations in communities and provide onsite enrollment into Medicaid and NM HIX.  A Healthcare Guides role is to provide free impartial assistance in enrolling into the appropriate healthcare program, on an individual basis.

To set up an appointment with a Healthcare guide in your Community or from NAPPR call Toll Free 1-855-241-8137, or visit www.bewellnm.com

To schedule an outreach/educational event in your community contact Colinda Vallo 505-933-0079 or CVallo@nappr.org



Navajo Nation individuals for enrollment assistance contact:

Farmington:

Sheri Spencer
Irene Shorthair
Total Behavioral Health Authority
1615 Ojo Ct
Farmington, NM 87401
505-564-4804

Gallup:

Emily Wilson 505-863-6842
Stella Garcia 505-863-7266
Daisy 505-863-7130
College Clinic
2111 College Dr.
Gallup, NM 87301

NM HIX NA Advisory Committee Meeting UPDATED!

The Next NM HIX Native American Advisory Committee meeting will be on December 4th at the Indian Pueblo Cultural Center, starting at 1:00PM ending at 4:00PM

I believe that this is an open meeting.

For more information on NM HIX outreach activities visit www.nmhix.com and view the calender of events.

Feds extend Health Insurance Exchange enrollment by 8 Days

Health Law’s Enrollment Period Is Extended by 8 Days

By MICHAEL D. SHEAR and ROBERT PEAR

WASHINGTON — The Obama administration said Friday that it would give people eight more days, until Dec. 23, to sign up for health insurance coverage that takes effect on Jan. 1 under the new health care law.
Julie Bataille, a spokeswoman for the Centers for Medicare and Medicaid Services, said officials recognized that consumers might need more time to compare and select health insurance plans because of the technical problems that have plagued the online federal insurance marketplace since it opened at the beginning of last month.
The administration also said it would delay the 2015 insurance enrollment period for the Affordable Care Act by a month, pushing it beyond the 2014 midterm elections.
The decision means that people who have not signed up for insurance by the end of March will have to wait until Nov. 15, 2014, to apply again. The second enrollment period was previously scheduled to begin on Oct. 15, 2014.
It also means that insurance companies will have an extra month to set their rates for 2015 after taking into account who has signed up for coverage during the current enrollment period. The companies will now have until the end of May to set their rates for the following year.
“This gives them more time to assess the pool of people who are getting insurance through the marketplaces and make decisions about what rates will look like in the coming year,” said Jay Carney, the White House press secretary.
The decision to move the 2015 open enrollment beyond the midterm elections, which will be held Nov. 4, could help Democratic candidates who have been worried that another debacle involving the health care law’s website, HealthCare.gov, would hurt them just as they are facing voters.
Officials said the reason for the change was to give insurance companies more time to evaluate the success of the new insurance marketplaces, which have been dogged by technical and public relations problems.
The more young and healthy people who sign up during the initial enrollment period, the lower the rates will be the following year. Officials said they expected those customers to wait until the last minute to sign up and wanted to give insurance companies more time to set their premiums.

Fact Sheet on allowing people to keep thier current policies

FACT SHEET: New Administration Proposal To Help Consumers Facing Cancellations

“I've assigned my team to see what can we do to close some of the holes and gaps in the law, because my intention is to lift up and make sure the insurance that people buy is effective, that it's actually going to deliver what they think they're purchasing. Because what we know is, before the law was passed, a lot of these plans people thought they had insurance coverage and then they'd find out that they had huge out-of-pocket expenses or women were being charged more than men. If you had preexisting conditions, you just couldn't get it at all.

“And we are proud of the consumer protections we've put into place. On the other hand, we also want to make sure that nobody is put in a position where their plans have been canceled, they can't afford a better plan even though they'd like to have a better plan. And so we're going to have to work hard to make sure that those folks are taken care of.” – President Barack Obama, November 7, 2013

Today, the majority of Americans have employer-based health insurance that is already providing them quality health care coverage. The Affordable Care Act strengthens employer coverage while creating new protections for people in the individual market – preventing them from being charged more because of a pre-existing condition or getting fewer benefits like mental health services or prescription drugs.

The new Health Insurance Marketplace will help millions of hard-working Americans find affordable health insurance. Premiums are, on average, 16 percent below what was originally projected. Nearly one in four insurers offering health plans through the Marketplace are selling to individuals for the first time. And a recent study found that an estimated 17 million Americans can get discounts on their premiums through the Marketplace, through tax credits.

The law aimed to make Marketplace coverage optional for the less than 5 percent of Americans who have individual market coverage that they want to keep. Health plans that consumers had when the law was passed in 2010 are “grandfathered” in and do not have to adopt most of the new consumer protections. But, in order to provide consumers with better protections and coverage, health insurers in the individual and small group markets have to adopt consumer protections for any new plans purchased after 2010. In some instances, they are adopting those protections by canceling current policies and replacing them with new and sometimes more costly plans.

Many consumers receiving these cancellation letters will be able to find a better deal with financial assistance or better coverage through the Health Insurance Marketplace, but we know a small slice of these consumers may not be eligible for a plan at a more affordable price. Last week President Obama directed his team to explore administrative actions that could be taken to help these consumers who are receiving cancellation letters.

To meet that commitment, today, HHS is using its administrative authority to:

·         Allow insurers to renew their current policies for current enrollees without adopting the 2014 market rule changes. This will give consumers in the individual and small group markets the choice of staying in their plan or joining a new Marketplace plan next year. HHS will consider the impact of this transitional policy in assessing whether to extend it beyond 2014.

·         Require insurers offering such renewals to ensure consumers are informed about their options. Specifically, insurers offering these renewals must inform all consumers who either already have or will receive cancellation letters about the protections their renewed plan will not include and how they can learn about the new options available to them through the Marketplaces which will offer better protections and possible financial assistance.

·         To protect against the potential impacts this change will have on premiums, HHS will adjust the temporary risk corridor program which is designed to stabilize premiums as changes are implemented.

Whether an individual can keep their current plan will also depend on their insurance company and State insurance commissioner – but today’s action means that it will no longer be implementation of the law that is forcing them to buy a new plan. Turnover is high in the individual market, with 50 to 67 percent of enrollees staying for a year or less. This means that the number of people in these bare-bones policies will decrease over time. As such, this action provides a smoother transition in a market that’s generally used as a bridge by most consumers. And, this action will not allow these older plans to be sold to new customers in 2014, which would undermine the Marketplace and drive up premiums for millions of hard-working Americans. In short, this administration solution will give consumers more information and choices, including keeping their old plans. As he has said since he signed the bill into law, the President is willing to work with members of Congress in either party on good-faith, constructive solutions that strengthen the law by pursuing the same goals as this Administrative action and do not seek to undermine or repeal the law as a whole

ABQ Journal Article "Canceled health plans bad idea from the start"

Canceled health plans bad idea from the start

By Winthrop Quigley / Journal Staff Writer | November 12, 2013

 

A nontrivial number of owners of individual health insurance policies will be compelled by the Affordable Care Act to purchase new policies that are more expensive and provide more benefits. The old policies don’t provide what the ACA defines as adequate coverage, and they allow insurance companies to refuse to sell insurance to people with pre-existing medical conditions, a practice Obamacare outlaws.

Some of these customers are angry they will pay more for coverage (though some will pay less), some don’t like a government that dictates to them the coverage they must buy, and some don’t like paying for coverage they don’t expect to need.

Many more are justifiably angry that they were repeatedly and inaccurately assured by the president of the United States that if they liked their insurance they could keep it.

Before we all rush to man the barricades, though, remember these are the same health plans that precipitated a different kind of outrage a few years ago when companies like Blue Cross and Blue Shield of New Mexico and Presbyterian Healthcare Services proposed completely justifiable 20-plus percent premium increases.

I should also point out that owners of these plans periodically call the Journal to complain that they just found out their pregnancies, their cancers or their bum knees are not covered, and they now face horrendous medical bills.

As near as I can tell, individual plans were first offered in New Mexico by Blue Cross and Blue Shield in 2005, to be followed by Presbyterian and Lovelace Health Plan. Together, the companies cover about 54,000 people through individual plans.

A couple of retired industry executives told me a while back that the individual plans were a big mistake. They lose money and customers go ballistic when care is denied and prices are raised.

Unfortunately, to talk about individual insurance requires a detour into some pretty deep weeds.

Insurers need large pools of customers to control risk, by more accurately anticipating the costs they will incur and, therefore, the price they must charge. That’s just basic statistics. Most of us are in such big pools, through our employers, Medicare or Medicaid, or retirement systems.

Pre-ACA individual pools aren’t big or predictable. Individuals drop in and out of the pools all the time. They join when they lose a job or start their own company, and they drop out when they go to work for someone else. They join when they worry about being sick; they drop out when they are healthy. They join when they marry; they drop when they divorce.

The companies tried to mitigate the risk through medical underwriting, which ACA has made illegal. If you had a bum knee, the individual insurance policy you could buy would most likely exclude knee treatment, assuming the company would sell you insurance at all. Nobody covered pregnancy and childbirth, to my knowledge.

Now 54,000 people are enough to create a decent-sized insurance pool, but these folks aren’t in a single pool and won’t be until they are pooled through the Affordable Care Act. They are in dozens of different pools because of what is known as the durational effect.

Over a fairly short period of time, maybe two or three years, a pool of individuals starts consuming more care, medical costs go up, premiums follow, and younger, healthier customers start to drop coverage because they don’t use it and it’s starting to cost too much. With only older and sicker customers in the pool, the costs really start to climb.

The plans then open up new medically underwritten pools to attract what they hope will be less-costly customers. These pools start demanding more care over time, costs rise, premiums rise, younger and healthy people drop coverage, and the cycle begins again.

A Journal reader who complained about losing his individual insurance to the ACA was part of that cycle. He got his first Presbyterian individual plan in 2008 and paid $172 a month for it. It cost $240 in 2010. He dropped his old policy and bought a new one as part of a different pool in 2011. That policy cost him $133. It was up to $142 last year.

As much as some of these customers like their current insurance, even if the ACA allowed them to keep it, the premium inevitably would become unbearable. That is a simple actuarial reality.

The resentment individual plan members have that they now must have coverage they won’t use is a little hard for those of us with group insurance to credit. I have been helping to pay the cost of my colleagues’ medical care for years, and they have been helping to pay for mine.

Owners of individual policies have been paying other people’s bills, too, even if they don’t know it. The pregnant woman delivers her baby, the cancer patient seeks treatment, the heart attack victim is admitted to the hospital whether they have insurance or not.

What they can’t pay out of pocket, the rest of us – even people with individual policies – pay in the form of higher insurance premiums, taxes, a less efficient and more costly health care system, unsuccessful children and a less productive workforce.

Health care always has been a common cost and will be as long as we refuse to let people die in the street.

UpFront is a daily front-page news and opinion column. Comment directly to Winthrop Quigley at 823-3896 or wquigley@abqjournal.com. Go to abqjournal.com/letters/new to submit a letter to the editor.

ABQ Business first Article "Lovelace Health Plan selling to BCBSNM"

Reported by,
Dennis Domrzalski



Lovelace Health Plan, an institution in New Mexico health care, has agreed to sell itself to Blue Cross and Blue Shield of New Mexico in a deal expected to close Dec. 31, Lovelace Health System President Ron Stern told employees Monday.
Lovelace Health System will continue to own its six hospitals and its physician network, Stern said. Additional details on the why and how of the deal continued to trickle out Monday.
In a letter sent to Lovelace Health Plan employees Monday that was obtained by Albuquerque Business First, Stern said the sale was necessitated in part by LHP’s failure earlier this year to win a contract to be one of the state’s Medicaid insurers.
“Earlier this year we learned that LHP was not selected to participate in New Mexico’s Medicaid program, Centennial Care,” Stern wrote. “As a result, we faced the loss of 84,000 Medicaid enrollees or 40 percent of our membership. We chose to work with Molina [Healthcare of New Mexico] to transition our members to their plan, which allowed Medicaid recipients continued access to our hospitals and clinics.
“Since that time we carefully evaluated all options that would allow us to continue serving our health plan members while minimizing the financial impact of not being included in Centennial Care. Without economies created by a larger membership, strategically working with Blue Cross and Blue Shield is the best option for our organization.”
Blue Cross and Lovelace officials have scheduled a 1 p.m. news conference to announce the sale, BCBSNM said in a news advisory. Officials from the two companies declined to comment before the news conference

NY Times "Under Health Care Act, Millions Eligible for Free Policies"

http://www.nytimes.com/2013/11/04/business/under-health-care-act-millions-eligible-for-free-policies.html?pagewanted=1&_r=0&hp

Under Health Care Act, Millions Eligible for Free Policies 11/4/13

Millions of people could qualify for federal subsidies that will pay the
entire monthly cost of some health care plans being offered in the online
marketplaces set up under President Obama’s health care law, a surprising
figure that has not garnered much attention, in part because the
zero-premium plans come with serious trade-offs.
Three independent estimates by Wall Street analysts and a consulting firm
say up to seven million people could qualify for the plans, but federal
officials and insurers are reluctant to push them too hard because they
are concerned about encouraging people to sign up for something that might
ultimately not fit their needs.
The bulk of these plans are so-called bronze policies, the least expensive
available. They require people to pay the most in out-of-pocket costs, for
doctor visits and other benefits like hospital stays.
Supporters of the Affordable Care Act say that the availability of
free-premium plans — as well as inexpensive policies that cover more —
shows that it is achieving its goal of making health insurance widely
available. A large number of those who qualify have incomes that fall just
above the threshold for Medicaid, the government program for the poor,
according to an analysis by the consulting firm McKinsey and Company.
The latest analysis was conducted by McKinsey’s Center for U.S. Health
System Reform, whose independent research has been cited by the federal
government and others.
“The whole point of the law was not only to cover the uninsured, but so
people didn’t have to make choices between food or drugs, or going to the
doctor or dentist,” said Karen Davis, a health policy expert at the Johns
Hopkins Bloomberg School of Public Health. “It’s what it is designed to
do.”
Many insurers tried to price their least expensive plans so they would
become free or nearly free with the addition of subsidies that are set
based on a person’s income and the cost of a midlevel, or silver, plan.
Independence Blue Cross in Philadelphia has four plans that are free to
some customers. But the company, along with other insurers, has been
careful not to publicize its free coverage for fear of alienating
customers who will need to pay more.
“We’re not advertising zero dollar,” said Brian Lobley, a senior vice
president at Independence Blue Cross. But the company is promoting monthly
premiums in the $20 to $30 range, he said.
The Obama administration has also stressed affordability over coverage
with no monthly charge, frequently saying that the cost of coverage will
be less than a monthly cellphone bill for many consumers. Officials at the
Department of Health and Human Services would not comment on the McKinsey
analysis, saying in a statement that the goal of the health law was to
provide a range of options for people with differing needs and budgets.
The analysis found that five million to six million people who are
uninsured will qualify for subsidies that will be greater than the cost of
the cheapest bronze or silver plan. A million more people with individual
insurance could also be eligible, according to McKinsey, although
estimates of the size of the market for private individual insurance vary
widely. None of the people in the analysis qualify for Medicaid.
The availability of zero-premium plans may make the deal especially
enticing to the healthy young people the marketplace needs to succeed,
said Mark V. Pauly, a professor of health care management at the
University of Pennsylvania’s Wharton School. “This is such a good deal
that you’d have to believe you were immortal not to really pick it up,” he
said.
Although they vary in their design, bronze plans generally cover about 60
percent of a person’s medical costs. All plans, including bronze, must
cover standard benefits like prescription drugs, maternity care and mental
health treatment.
The availability of the zero-premium plans varies across the country.
McKinsey found that about 40 percent of the uninsured in Missouri will be
able to select a no-cost bronze plan, for example, compared with 2 percent
of the uninsured in New Jersey.

It is impossible to know who will actually sign up, and whether they will
choose a zero-premium plan.
For many people, paying slightly more for a silver plan may be a much
better option, experts said. Ninety percent of those who will have the
option of buying the no-cost plans make less than 250 percent of the
federal poverty level, which is $28,725 for an individual, and $58,875 for
a family of four. People earning below those thresholds are eligible for
the most generous assistance, but only if they choose a silver plan.
About a million of those who will qualify for free coverage will be able
to buy a silver plan for no monthly cost. McKinsey, which is releasing a
report about the new insurance marketplaces, estimates that the cost of
silver plans for the people who qualify for a zero-premium bronze plan
will range from $40 to $50 a month.
“They may be getting zero premiums, but they’re also leaving a lot of
money on the table if they don’t enroll in a silver-level plan,” said
Sabrina Corlette, a professor at Georgetown University’s Health Policy
Institute.
All plans, including bronze policies, limit annual out-of-pocket costs to
$6,350 for individuals and $12,700 for families. But insurers and
advocates said out-of-pocket costs — even those under that limit — can be
daunting to people with low incomes.
For Mark and Elisabeth Horst, both artists in Albuquerque, the risks of
signing up for a bronze plan were outweighed by the prospect of getting it
free. The Horsts, who make $24,000 a year between them, qualified for $612
in monthly subsidies, but the cost of a bronze plan was $581 a month.
“We’re in good health,” Mr. Horst said.
Besides, he said, they can always switch to a better plan next year. “At
this point, it’s a little bit of a gamble.”
Not everyone selects the cheapest option. Dante Olivia Smith, a lighting
designer from Manhattan, learned that federal subsidies would allow her to
buy a bronze plan for $24 a month.
“It was astounding,” she said. “I almost started crying, and called my mom.”
In the end, however, she went with a silver plan for $91 a month that
included dental and vision coverage. Ms. Smith, who is 30, said she opted
for the more comprehensive plan because of her work, which requires her to
climb ladders and use power tools.
“If I had a different job, for 24 dollars a month I would have been like
‘Woo-hoo!' ” she said. “But the reality is, I know what my risks are in my
life.” Its estimate, based on an analysis of premiums for plans offered in
the marketplaces in all 50 states and the District of Columbia, is in line
with two other estimates, by Credit Suisse and Morgan Stanley.
The McKinsey researchers also found that about half of the people eligible
for zero-premium plans were under 39 and uninsured. The Obama
administration has been emphasizing the affordability of its plans for
young people, a critical group because their participation in the
marketplaces will help keep overall premiums low.
It is impossible to know who will actually sign up, and whether they will
choose a zero-premium plan.
For many people, paying slightly more for a silver plan may be a much
better option, experts said. Ninety percent of those who will have the
option of buying the no-cost plans make less than 250 percent of the
federal poverty level, which is $28,725 for an individual, and $58,875 for
a family of four. People earning below those thresholds are eligible for
the most generous assistance,

Washington Post Article "Healthcare.gov Troubles Don’t Change Public’s View Of Health Law, Poll Finds"

Healthcare.gov Troubles Don’t Change Public’s View Of Health Law, Poll Finds. – WASHINGTON POST. The public has a dim view of how the government has rolled out the health care law so far, but those stumbles have not changed people’s overall opinions of the law itself, a new poll finds.

By Jordan Rau | Kaiser Health News, Published: November 1

The public has a dim view of how the government has rolled out the health care law so far, but those stumbles have not changed people’s overall opinions of the law itself, a new poll finds.
The Kaiser Family Foundation poll found that 48 percent of people think the federal government has done a poor job of implementing the law, and another 32 percent give the government an “only fair” review. (KHN is an editorially independent program of the foundation.)

Only 14 percent gave the federal government good or excellent reviews for the rollout of the law.  The public was slightly less critical about state government management of the law, but even there, 63 percent said their state had done either a poor or “only fair” job.
Republicans were overwhelmingly critical of the federal government efforts, but even a majority of Democrats gave the government bad or middling reviews.
The pollsters did not ask specifically about people’s views on the rollout of the online marketplaces where many people have had trouble enrolling in new plans since they opened at the start of October. More than half of the public was following the technical problems of healthcare.gov closely, but that was fewer than said they were closely following the government shutdown, the economy or efforts to track down Syria’s chemical weapons.
So far, the snags in those marketplaces have not altered the public’s divided view of the law, although the survey was concluded before the deluge of reports on people getting cancellation notices from their insurers. Forty-four percent said they oppose the health care law and 38 expressed support for it, reflecting the same split in previous monthly surveys. Forty-seven percent want to expand it or keep it as is, while 37 percent want to repeal it. The split remains highly partisan, with Democrats backing the law and Republicans opposing it.
The poll found that more people are reporting that they have seen or heard advertisements related to the law, A third of the public said they saw or heard advertisements explaining how people can get insurance, double the number that said they saw or heard that kind of ad in September. About the same percentage say they saw ads supporting the law or criticizing it.
The informational ads are considered an important component of the effort to get people to purchase insurance or to enroll in Medicaid, the joint federal-state health program for low-income people. Despite the increase in attention, 44 percent of people still say they do not have enough information about the law to understand how it will impact them and their families.
The pollsters interviewed 1,513 adults from Oct. 17 through 23. That was after the federal government shutdown had ended but before the Republican-controlled House started holding hearings on malfunctions in the healthcare.gov website. The poll’s margin of error is +/- 3 percentage points.

Article "NM Fighting to Save Behavioral Health"

FOR IMMEDIATE RELEASE – October 31, 2013

Contact: Christi Fields at (505) 604-0221, or Christi_Fields@hotmail.com.
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NEW MEXICANS FIGHTING TO SAVE BEHAVIORAL HEALTH

 

Arizona Firms Lay off New Mexico Behavioral Health Employees

 

The legacy of the shutdown of many of New Mexico’s behavioral health agencies by the State’s Human Services Department (HSD) continues to reap tragic results.  A former therapist with a Valencia County behavioral health agency has reported staff layoffs are causing trauma to mental health clients, at a time when New Mexico leads the nation with the highest rate of mental illness.

 

 Ed Church, who was hired by Valle del Sol, the Arizona firm chosen to take over operations of Valencia Counseling Services last summer, says Valle del Sol has “laid off three counselors, leaving effectively two others to see 380 clients.”

.

Nine layoffs are also reported in Raton and Espanola.  In Roswell, the employee count has diminished from 87 pre-takeover to 39 at present.  Therapists report that diminishing employee numbers statewide have severely impacted client service. 

 

Church says: “There are clients in substance abuse relapse, recently discharged from the hospital and those that will run out of meds on a daily basis who won't be seen for admittance into the services because there are even fewer therapists available to schedule new intakes.”

 

The former therapist says Valle del Sol states the reasons for the layoffs are “revenue shortfalls”.  He questions how this could be, since the NM Human Services Department has committed $18 million dollars to underwrite the transition to the Arizona firms, and is paying Arizona executives up to $300/hour to manage the transition.  He further states: “I thought we were guaranteed three month positions. I also believe Valle del Sol received state monies for a three month transition process.”

 

“This travesty,” says Church, “continues to create trauma and is a slap in the face to mental health clients who won't have any transition or termination interviews. Their appointments, I was told, would simply be cancelled.” 

 

The shutdown of New Mexico’s behavioral health agencies was triggered last summer by a $4 million audit alleging “possible fraud”, yet to be proven.  The action has affected 30,000 clients coping with mental illness, alcoholism and substance abuse. 
 
It is believed by behavioral health advocates that although HSD alleges a 90% rehire rate, the layoffs may be a precursor to similar actions in other agencies since many former employees, like Church, were hired on a 90-day basis.
 
For more information on the shutdown and its effects, go to YouTube/New Mexico Behavioral Health.

Health coverage Mandate CMS: No Penalty for Signup To March 31 Q&A

NM CLP in the News "States see high interest in Medicaid coverage"

States see high interest in Medicaid coverage

By Jennifer Haberkorn

10/28/13 6:05 PM EDT

HealthCare.gov might be limping along to full viability, but Medicaid is flying off the shelves.
New Medicaid enrollment is far outpacing new insurance customers under Obamacare so far, a subtle sign that the program could play a greater role in the law’s coverage expansion than first anticipated. Some people are signing up for the Medicaid expansion created by the president’s health law. Others were already eligible for their state’s current Medicaid program but until this outreach campaign about health coverage they had never signed up.

In Washington state, for instance, the overwhelming number of people signing up for health coverage are eligible for Medicaid, state figures show. Of the 35,528 state residents who had signed up in the first three weeks of enrollment, 55 percent were part of the Medicaid expansion population, and 32 percent were eligible for the state’s existing Medicaid program. Only 13 percent signed up for a new private insurance plan.

In Kentucky, another state running its own exchange, 26,174 people had enrolled in new coverage as of Thursday. Four out of five had enrolled in Medicaid.

So far, only a few states have released enrollment figures. And the federal government doesn’t plan to put out figures for the 36 states where they are running the exchanges until next month. But the figures in a few states could be emblematic of a national trend.

There are several reasons for the spurt of Medicaid coverage, much of which health policy experts had expected.

Health officials were always expecting the massive media attention on Obamacare to spur people who were eligible for Medicaid but not enrolled to sign up — a phenomenon dubbed the “woodwork” effort (as in crawling out of the woodwork), or the friendlier term “welcome mat” effect. For those people, coverage could start as soon as the state approves the application. For expanded Medicaid and the private health insurance plans on the exchange, the start date for coverage is Jan. 1.

New Mexico just put its Medicaid application online as part of the expansion, and that’s made the sign-up process easier for some people.

“The big change for us is that we now have an online application for Medicaid,” said Sovereign Hager, a staff attorney at the New Mexico Center on Law and Poverty. She’s personally helped about five or six people through the sign-up process but hasn’t heard of many people in New Mexico getting through the troubled federal HealthCare.gov.

Medicaid also doesn’t have a premium — and is the only option for people who are eligible. Customers shopping for private plans onHealthCare.gov — if they can get through — likely have multiple plans to choose from. And they have premiums to pay in nearly all cases, even if they get federal subsidies.

“This is not really a surprise, but free is easier to sell than low-cost — and Medicaid enrollment is free,” said Alan Weil, executive director of the National Academy for State Health Policy. “It’s a lot easier to close the deal if at the end of the process, you can offer someone a product without a premium — even if the exchange premium is highly subsidized.”

The Medicaid population — even the Medicaid expansion population — is also a known entity in most states. Many people who will be eligible for the Medicaid expansion are already enrolled in other state safety net programs, or charity-care programs at hospitals. That means their contact information is likely already in a database — and many institutions have already sent information about how to enroll in Medicaid.

Medicaid, while booming in some areas, isn’t without its own enrollment troubles.
The 36 states using the federal insurance exchange won’t begin receiving Medicaid applications on Nov. 1, according to the National Association of Medicaid Directors. After one earlier delay, the exchange was supposed to start sending the data this week, but technical problems forced another indefinite delay.

“The agency is now prepared to start testing this function with any state Medicaid agency that is ready,” the group’s weekly report said, “but did not give a new target date for transfers to begin.”
The delay could further complicate the enrollment process because many states are allowed 45 days to review applications before determining eligibility.

Kyle Cheney contributed to this report.

To view online:
https://www.politicopro.com/go/?id=27311

News Article "Under Bush, Republicans Vigorously Defended Health Care Reform Despite Serious Glitches"

Under Bush, Republicans Vigorously Defended Health Care Reform Despite Serious Glitches

By Igor Volsky on October 24, 2013 at 8:49 am

Millions of Americans try to enroll in health care benefits during the first days of a new government health care program. They rely on indispensable government website that had been “pitched as a high-tech way” to sort through available coverage options. They’re encountering countless glitches and technical errors: the website freezes, displays incorrect plan information and sends insurers erroneous reports.

Administration officials — clearly caught off guard by the surge of technical difficulties — respond to “tens of thousands of complaints” from angry beneficiaries and promise to “fix every problem as quickly possible.”

This sounds like the familiar story of the last few days of the Obama administration’s rollout of the exchanges. But, actually, those quotes, and that scenario, are taken from the Bush administration’s efforts to implement the Medicare prescription drug benefit in 2005 and 2006.

Not only was Bush’s rollout “anything but smooth,” but administration officials had “some trouble getting the [online] tool up and running” and had to delay its debut for weeks. What’s more, computer glitches caused low-income beneficiaries to go without needed medications and sent pharmacies the wrong drug information. Before it was all resolved, Dr. Mark McClellan, Bush’s head of the Center for Medicare & Medicaid Services (CMS), appeared at hearings before the House Committee On Energy And Commerce, laying out the flaws in the law’s implementation and detailing how the administration would address them.

As the House Energy and Commerce Committee holds its first hearing on the implementation of the the Affordable Care Act on Thursday, it’s worth noting that some of the very same Republicans who are lashing out against Obamacare, arguing that the botched rollout is proof that the government cannot implement effectively and should repeal the law entirely, gave the Bush administration a pass and urged Americans not to pre-judge such a complicated process. At least four of the Republicans still on the committee had argued that early implementation hurdles should not taint the entirety of reform:

REP. JOE BARTON (R-TX): “This is a huge undertaking and there are going to be glitches. My goal is the same as yours: Get rid of the glitches. The committee will work closely with yourself and Dr. Mark McClellan at CMS to get problems noticed and solved.” [Barton Statement via Archive.org, 2/15/2006]

REP. TIM MURPHY (R-PA): “Any time something is new, there is going to be some glitches. All of us, when our children were new, well, we knew as parents we didn’t exactly know everything we were doing and we had a foul-up or two, but we persevered and our children turned out well. No matter what one does in life, when it is something new in learning the ropes of it, it is going to take a little adjustment.” [Murphy Floor Speech via Congressional Record, 4/6/2006]

REP. MICHAEL BURGESS (R-TX): “We can’t undo the past, but certainly they can make the argument that we are having this hearing a month late and perhaps we are, but the reality is the prescription drug benefit is 40 years late and seniors who signed up for Medicare those first days back in 1965 when they were 65 years of age are now 106 years of age waiting for that prescription drug benefit, so I hope it doesn’t take us that long to get this right and I don’t believe that it will. And I do believe that fundamentally it is a good plan.” [“Medicare Part D: Implementation of the New Drug Benefit,” 3/1/2006]

REP. PHIL GINGREY (R-GA): “I delivered 5,200 babies, but this may be the best delivery that I have ever been a part of, Mr. Speaker, and that is delivering, as I say, on a promise made by former Congresses and other Presidents over the 45-year history of the Medicare program, which was introduced in 1965 with no prescription drug benefit. And what we have done here is add part D, the ‘D’ for ‘drug’ or, if you want, the ‘delivery’ that we have finally provided to our American seniors.” [Gingrey Floor Speech via Congressional Record, 4/6/06]

Ultimately, the Bush administration fixed the law’s technical glitches, but more than half of the beneficiaries who ended up signing up for insurance didn’t do so until after the first of the year. Significantly, they signed up for coverage despite the Bush administration’s well-publicized initial glitches in extending coverage to low-income beneficiaries. Whereas only 21 percent of seniors had a favorable impression of the law and 66 percent didn’t know what was in it in April of 2005, by November of 2006, “half of the seniors polled said the program was working well or that just minor changes were needed.”

Bridge Project provided research assistance for this post.

Senator Begich Introduces Legislation to Streamline the Definition of Indian in the Affordable Care Act

FOR IMMEDIATE RELEASE

 

Contact: Caitrin Shuy at cshuy@nihb.org or 202-374-9966

 

Senator Begich Introduces Legislation to Streamline the Definition of Indian in the Affordable Care Act

 

 

On October 16, 2013, Senator Mark Begich (D-AK) with Senator Max Baucus (D-MT), Senator Brian Schatz (D-HI), Senator Al Franken (D-MN), and Senator Tom Udall (D-NM) introduced a bill (S.1575) that would streamline the Definition of Indian in the Affordable Care Act.  This is an important first step in ensuring that all American Indians and Alaska Natives (AI/ANs) receive the benefits and protections intended for them in the Affordable Care Act (ACA). 

 

The "Definitions of Indian" in the ACA are not consistent with the definitions already used by the Indian Health Service (IHS), Medicaid and the Children's Health Insurance Plan (CHIP) for services provided to American Indians and Alaska Natives.  The ACA definitions, which currently require that a person is a member of a federally recognized Tribe or an Alaska Native Claims Settlement Act (ANCSA) corporation, are narrower than those used by IHS, Medicaid and CHIP, thereby leaving out a sizeable population of AI/ANs that the ACA was intended to benefit and protect. 

 

National Indian Health Board Chair Cathy Abramson said, "On behalf of the 566 Tribal nations we serve, the National Indian Health Board would like to express the deepest gratitude to Senators Begich and Baucus for introducing this important legislation. This bill will help to create parity in the American Indian and Alaska Native community with respect to provisions contained in the Affordable Care Act.  If enacted, this measure will ensure that everyone is eligible to receive the protections and benefits that are designed to enhance health care access for all American Indians and Alaska Natives."

 

Unless the definition of Indian in the ACA is changed, many AI/ANs will not be eligible for the special protections and benefits intended for them in the law.  These benefits include cost-sharing and monthly enrollment benefits.  This bill will also create statutory language to guarantee that AI/ANs are not subjected to tax penalties for not having insurance, even though they are eligible for Indian health care programs.  

 

###

Free Legal Fair Raymond G Sanchez Community Center in Albuquerque Medicaid/NMHIX enrollment

Free Legal Fair  and Medicaid Enrollment!

Free legal services for low income people and families Divorce/Custody/Support Public Benefits     Probate Guardianships  Bankruptcy and Foreclosure Creditor/Debtor Landlord/Tenant Immigration Worker's Compensation  First-come, first-served basis - Interpreters and bilingual attorneys available* -   *For Vietnamese interpreter services, Please RSVP to New Mexico Asian Family Center (NMAFC) at (505) 717-2877     On site Medicaid enrollment for children and adults    Required documents: Picture ID Birth certificate Proof of income for the most current month Written proof of pregnancy, if applicable Current insurance card, if any      Additionally, consumer-friendly resources on health care reform enrollment and insurance reform will be available.

When

Tuesday  OCT. 22, 2013  From 3pm to 6pm

Where

Raymond G. Sanchez  Community Center  9800 4th Street NW  Albuquerque, NM

Presented by the Second Judicial District Pro Bono Committee Medicaid Enrollment Services and Health Care Reform Materials Provided by Youth Development Inc., Southwest Women's Law Center, and NM Center on Law and Poverty

CQ Health Beat "Enrollment Deadline to Avoid Individual Mandate Fine is Feb. 15"

From the Center on Law and Poverty:

 

 

For all of you engaged in outreach activities, this is an important new deadline for getting enrolled. Maybe this will change as implementation moves forward, but for now it looks like the word. Has anyone heard differently?

 

 

Enrollment Deadline to Avoid Individual Mandate Fine is Feb. 15

By Rebecca Adams, CQ HealthBeat Associate Editor

The Obama administration said Wednesday that consumers need to enroll and pay their exchange coverage premiums by Feb. 15 in order to avoid an income tax penalty for not having insurance.

Health and Human Services Secretary Kathleen Sebelius has repeatedly mentioned Dec. 15 as a key deadline for consumers who want their benefits to start Jan. 1. And she has stressed that the open enrollment period for the new marketplaces is March 31. But she has not emphasized that Feb. 15 is also a key date.

A short timeline on healthcare.gov does not mention February as a key month for implementation of the marketplaces under the law (PL 111-148, PL 111-152).

Since Sebelius has talked about March 31 as the end of open enrollment, many consumers may be under the impression that they would avoid a penalty if they enroll by then. But consumers need to sign up before Feb. 15 if they plan to send in a check by mail so the payment is processed by the deadline.

Even though open enrollment ends March 31, the law says anyone who goes without insurance for three consecutive months during 2014 is subject to a penalty. So someone who signs up for insurance after Feb. 15, wouldn’t have a policy in effect until April 1. That means he or she would then be subject to the fine because they were without insurance in January, February and March.

This detail was first reported by the Associated Press.

The shorter-than-commonly-realized time frame could put pressure on HHS officials to delay enforcement of the penalty for people who do not have coverage in 2014. Already, House Republicans have called for a year delay in the individual mandate, saying that it is only fair since the administration decided this summer to hold off for a year on enforcing the penalties for employers who don’t offer affordable coverage.

Even comedian Jon Stewart hammered Sebelius over the individual penalty when she appeared on The Daily Show this week. “If I’m an individual that doesn’t want it, it would be hard for me to look at big business getting a waiver and not having to do it, and me having to,” said Stewart, adding that opponents would think that individuals don’t get a waiver because they aren’t a strong lobbying force like employers are.

Sebelius never directly answered Stewart’s question.

An administration spokeswoman, who was asked if the administration will start highlighting the Feb. 15 date, pointed out language on the healthcare.gov website. It says: “If you enroll between the 1st and 15th day of the month and pay your premium, your coverage begins the first day of the next month. So if you enroll on February 10, 2014, your coverage begins March 1, 2014. If you enroll between the 16th and the last day of the month and pay your premium, your effective date of coverage will be the first day of the second following month. So if you enroll on February 16, 2014, your coverage starts on April 1, 2014.”

The website does not then clearly state that if someone’s coverage starts on April 1 they will be liable for a penalty.

The penalty that starts in 2014 will be 1 percent of someone’s income or $95, whichever is more. In 2016, the fine increases to 2.5 percent of income or $695 per person, whichever is higher.

The administration is providing a number of exemptions from the fine, including for religious reasons, if the coverage costs more than 8 percent of household income, or people are too poor to file a tax return. People who are illegal immigrants, in prison, or members of Native American Indian tribes also are exempt.

About 2 percent of Americans are expected to pay the penalty in the first year, administration officials have said.

Rebecca Adams can be reached at radams@cq.com.