By GARRETT NEESE
HOUGHTON - The United States has the best health-care system in the world - if you're rich, said Ray Sharp, community planning and preparedness manager for the Western Upper Peninsula Health Department. For the 50 million people without insurance, it's significantly worse.
"The idea behind health care reform is to try to solve that problem, or at least make it a little better, introduce more equity into the system ... so that everybody can at least get the basics," he said.
Sharp led the hour-and-a-half presentation on changes in the Affordable Care Act for about 60 people at the Houghton High School auditorium recently. The Copper Country League of Women Voters sponsored the event.
The Affordable Care Act will require most Americans to have insurance. Plans can begin by Jan. 1 if people sign up by Dec. 15. People can sign up with no penalty until March 31.
People will get coverage in three main ways. The biggest group - about half of American adults - will get insurance through employers. Another third will get insurance through Medicare or Medicaid. About 10 percent will buy insurance for themselves through the marketplace. However, about 30 million Americans are still anticipated not to have insurance.
Changes through the law include the ability to keep children under 26 on their parents' plan and requirements for things such as free preventative care. The ACA also mandates companies with more than 50 people make insurance available to their employees.
Michigan is one of the states running its own marketplace. Right now, two providers - Blue Cross Blue Shield and Consumers Mutual - are offering 12 plans. Sharp said more insurers are likely to add coverage before the open sign-up period ends.
In states such as Michigan, people making below 138 percent of the federal poverty level can sign up for Medicaid. About 500,000 people in Michigan will be eligible for health care through Medicaid starting April 1, Sharp said.
Some people making above 138 percent may still qualify for tax subsidies, the amount of which varies by family size and income. A single person can qualify for subsidies up to $63,000.
Most people who do not have insurance after March 31 will be subject to tax penalties. In 2014, that will be the greater of $95 for adults or 1 percent of their family income.
Some people are exempted from the individual mandate. They include people who don't make enough to file a tax return ($10,000 for an individual, or $20,000 for family). People who would have to pay more than 8 percent of their income for health insurance after employer contributions or tax credits are also exempted.
People can create accounts for health care plans at healthcare.gov, The main portal for health care information. However, the site has been beset by problems; Sharp had to skip a planned walkthrough of the site Tuesday night because it was down.
"They say they're going to have it fixed by the end of November," he said. "I'm not holding my breath. I hope so, though."
But there are other ways to enroll in the plan. People can complete their application process over the phone at 800-318-2596. The Health Department is also a certified application counselor that can help people complete paper applications.
Sharp showed a slide displaying health care spending as a percentage of gross domestic product. From about 5 percent in 1960, it's now around 16 percent.
"It's unsustainable," Sharp said.
Most economists project the Affordable Care Act will be better able to contain costs by encouraging preventative care, Sharp said.
"It's cheaper to get an immunization to prevent a disease than it is to be hospitalized for that disease," he said.
Blue Cross Blue Shield and Consumers Mutual both list the available prices and policies on its website.
Sharp also fielded a number of questions from audience members. One asked whether they would have to wait to get their tax credit until they received their usual tax refund.
That's not the case, Sharp said.
"Your coverage could start for a marketplace plan as early as Jan. 1, 2014, and the IRS sends a portion of your premium straight to that private company," he said.
Sharp also addressed the letters that have gone out informing people their policies will be cancelled. Those have come about because the original plans fell short of the new requirements under the law. In most cases, he said, people will be able to get new policies that will provide more benefits for a lower or comparable price.
Audrey Erickson of Eagle River said she came to get information on the Affordable Care Act, particularly Blue Cross coverage.
"Very informative," she said. "I was really impressed."
To look at Blue Cross Blue Shield plans, go to bcbsm.com/index/plans/michigan-health-insurance.html. To look at Consumers Mutual plans, go to consumersmutual.org/individual-and-family-insurance-plans.
To find out if you qualify for insurance subsidies, go to kff.org/interactive/subsidy-calculator.