The Affordable Care Act extends the promise of greater access to healthcare, but it also raises many financial questions, such as who will pay, and how.
The ACA expands Medicaid eligibility to 133% of federal poverty level or $29,726 for a family of four. It also requires states to set up by January 2014 health insurance exchanges where individuals and small businesses can compare and purchase private health insurance plans.
One question states are struggling with as they explore HIEs is whether the program can manage the health needs of a low-income population, especially residents with incomes between 133% and 200% of the FPL or between $29,726 and $44,700 annually for a family of four.
That’s a population that is generally considered to have special coverage needs and is particularly vulnerable to economic shifts that can often leave its members unable to pay for health insurance. There is concern that an HIE, with its broader membership mix, will not be attuned to these special considerations.
The ACA offers a second option, the basic health program, to serve the low-income population. The BHP is not as well-known as the HIE but just like that program, the federal government will provide states with a lump sum payment of 95% of what the feds would have spent on tax credits and subsidies for out-of-pocket healthcare costs for this group.