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TUESDAY, Oct. 1 (HealthDay News) -- The Affordable Care Act's new health insurance exchanges opened for business Tuesday amid the first federal government shutdown in 17 years and a push by Republicans in the House of Representatives to delay further implementation of "Obamacare."
The rollout of the exchanges, or marketplaces, marks a crucial step in the expansion of health insurance access to millions of uninsured Americans beginning in 2014. Under the law, most people without insurance face the prospect of a fine.
Despite the Capitol Hill clash between Republicans and Democrats, the exchanges will be up and running -- with varying degrees of success -- on Tuesday because the Affordable Care Act doesn't rely exclusively on annual appropriations from Congress.
Some health insurance exchanges were open but not fully functional. Officials in Colorado, Oregon and the District of Columbia announced computer system problems prior to the kickoff of open enrollment, which runs through March 31, 2014.
People in Oregon, for example, can't apply for coverage online for several weeks. Those who want to apply immediately must connect with one of the exchange's licensed agents or community partners.
Jesse Ellis O'Brien, a health-care advocate with the Oregon State Public Interest Research Group Foundation, said he "wouldn't be surprised" if other states found their websites weren't quite ready to go live, either.
"I think the key thing is October 1st is a starting point -- it's not a finish line," he said.
Federal health officials also confirmed last week that small businesses won't be able to apply online for coverage in federally run small business insurance exchanges until November, and that the Spanish-language version of HealthCare.gov, the government's health reform website, won't be ready to enroll people for a few weeks.
Nicole Kaeding, state policy manager for Americans for Prosperity, a conservative advocacy group in Arlington, Va., said she expects these sorts of stories to persist. "Piling thousands of pages of regulation onto an insurance market is an unworkable solution. We're beginning to see just how unworkable it is," she said.
Not even proponents of the health reform law had expected such an immense undertaking to get off the ground without a hitch.
"You know, I think it would be foolish to say that everything is going to go perfectly," Gary Cohen, director of the Center for Consumer Information and Insurance Oversight at the U.S. Centers for Medicare and Medicaid Services, said during a news briefing last week. "On any big IT [information technology] project, there always are going to be things that you can improve on and make better," he said.
The new health exchanges offer one-stop shopping for health insurance coverage. Eligible Americans can compare health plans and prices and choose the coverage that suits them best.
The exchanges will also determine whether people are eligible for public health coverage under Medicaid or the Children's Health Insurance Program.
Some 7 million people are expected to enroll in private health coverage through the exchanges in 2014, according to estimates by the nonpartisan Congressional Budget Office. Another 9 million will enroll in Medicaid and the Children's Health Insurance Program, according to the research outfit's projections.
If you are uninsured, here's how the exchanges are designed to work:
- When you apply for coverage through the health exchanges, you'll find out if you are eligible for federal tax credits to lower your monthly health plan premiums. That help is available to people earning between 100 percent and 400 percent of the federal poverty level, or $11,490 to $45,960 for a single person and $23,550 to $94,200 for a family of four. And depending on your income, you may qualify for cost-sharing subsidies to reduce your out-of-pocket expenses.
- The exchanges also serve as a gateway for people with very modest incomes to enroll in Medicaid. If you live in one of 24 states or the District of Columbia where Medicaid eligibility is expanding in 2014, you can earn up to 138 percent of the federal poverty level -- $15,856 for a single person or $37,384 for a family of four -- and qualify for coverage in the public health program.
How smoothly enrollment goes is likely to vary somewhat by state.
Pennsylvania, for example, is one of 27 states where the federal government is running the state's health insurance exchange.
The U.S. Department of Health and Human Services awarded a little more than $2.5 million in grants -- a third of what some states received -- to train so-called "navigators" to provide in-person assistance to people who need enrollment help, according to Antoinette Kraus, director of the Pennsylvania Health Access Network.
"Our concern is that there will not be nearly enough (navigators) to keep up with the demand," she said. Her organization is encouraging community organizations to get certified to help educate consumers and assist them in applying for coverage.
"We will need an all-hands-on-deck approach to getting the word out," Kraus said.
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