SALEM, Ore. (AP) â€” The federal health care overhaul will affect the way millions of Americans receive and pay for their personal medical coverage, but it won’t be the same in every state. The federal law aims to extend health care coverage to the uninsured, who number more than 600,000 in Oregon.
But this state has gone further, enacting a state-level overhaul for the Oregon Health Plan, Oregon’s version of Medicaid, which is jointly funded by the state and federal governments to provide health coverage for people with low incomes.
The Associated Press tackles some frequently asked questions for Oregon residents:
â€” What is a coordinated care organization, or CCO? How will my medical care be different under a CCO?
They’re new regional organizations that will be responsible for managing the health care of patients in their area. They’ll get paid a specific amount for each patient every month, instead of for every procedure performed.
Most people won’t see much of a change, especially if they’re healthy and don’t spend much time in the doctor’s office.
If you have a chronic condition like diabetes, asthma, heart disease or kidney failure, or if you spend a lot of time in the hospital, the CCO is supposed to ensure that all the doctors you see are working together. If you see a counselor or other mental health professional, that person might start working more closely with your primary doctor. You might be assigned a caseworker to ensure you’re taking your medications and not having any side effects.
The CCOs have quite a bit of flexibility, so it’s impossible to predict exactly what will change for any individual patient. The first CCOs come on line Aug. 1, with others beginning to operate in September, October and November.
â€” I’m on the Oregon Health Plan. Will I still have my coverage? Do I need to join a coordinated care organization?
You will continue to be on the Oregon Health Plan as long as you meet the qualifications, and you don’t need to do anything to keep your coverage. When a coordinated care organization is certified in your area, you’ll automatically be enrolled. You’ll get a letter 30 days before any change happens, and your medical ID card will stay the same. For more information, visit http://bit.ly/QuJORz .
â€” I’m uninsured, but I’m not eligible for the Oregon Health Plan. What happens to me?
That’s a complicated question, and the answer depends on your family’s income and the cost of your health coverage. By the first day of 2014, the Oregon Health Insurance Exchange will have a website and phone number to tell you exactly what you’re eligible for and let you compare various plans and prices. But for now, we’ll try to help you sort it out.
If your family makes less than 133 percent of the federal poverty level â€” that’s $14,856 for an individual, or $30,657 for a family of four â€” you and your family will become eligible for the Oregon Health Plan, if you aren’t already.
If you make between 133 percent and 400 percent of the federal poverty level â€” up to $44,680 for an individual, or $92,200 for a family of four â€” you will get some money from the federal government to offset the cost of buying private insurance. You will buy that coverage through the Health Insurance Exchange. When you call them or go to their website, beginning in 2014, they’ll ask you for information about your income and life situation and determine how much assistance you’re eligible for. If you fall in this category, you won’t have to pay more than 9.5 percent of your income on health coverage, and the percentage is lower for lower-wage earners.
If you make more than that, you can buy coverage through the exchange, but you won’t get a federal subsidy.
â€” What if I get health coverage from my employer?
You’ll probably keep your coverage, but that’s up to your employer. If your company has 50 employees or fewer, the boss might decide to buy your coverage through the Health Insurance Exchange, or she might give you some money and let you buy your own coverage through the exchange. If you have more than 50 co-workers, your employer won’t be eligible for the exchange.
â€” I’m still utterly confused. Where can I find more information?
You’re not alone. Kaiser Health News has a helpful guide at http://bit.ly/N8bmaY . The Obama administration has created www.healthcare.gov to help break down the federal law, and the Oregon Health Authority has created http://health.oregon.gov to help understand the state law.
Jonathan J. Cooper covers Oregon politics and government. Contact or follow him at http://twitter.com/jjcooper