Phew, it’s over … or is it?

Medicare Matters


The long-awaited decision by the Supreme Court on the constitutionality of President Obama’s Affordable Care Act was announced this past Thursday.

As anticipated, it was a very close decision and could have been decided in either direction. In the end the vast majority of the provisions were upheld by the highest court in the land. So does that mean the arguments are over? Unfortunately, not quite.

The bill was debated and voted on by the House of Representatives, and the U.S. Senate; it passed both Houses and was signed into law over two years ago. It was then challenged by various groups and states all the way to the Supreme Court, where it was upheld. 

But with this being an election year it has turned into the largest focal point by both parties. The Democrats are rejoicing in its survival and the Republicans are vowing to overturn it if they gain the presidency as well as majorities in both houses.

Most people are in favor of many of the provisions of the act. For instance, we as a country are already reaping the benefits. 

• We have greater prescription drug coverage for folks on Medicare who hit the coverage gap. 

• Individual policies may no longer have a lifetime maximum on benefits paid. 

• Children can be kept on parents’ plans until age 26. Children cannot be denied coverage based upon their health.

• Preventive care is covered without any copays and deductibles.

The main point of contention is what has been called “the individual mandate." 

This is the provision that states that a person will have an additional tax to pay if he or she chooses not to purchase insurance.

Dollars and sense

The Government can’t force you to purchase health insurance, but they can charge you a tax if you fail to do so. So people can still have a choice whether to purchase insurance or not, but they face higher taxes if they choose not to.

The tax in 2014 will be $95 but will increase and could be up to 1 percent of a person’s income by 2016.

That is the global view of the ruling, but let’s takes a closer look at how it will affect people locally. 

Medicare recipients will find few changes at this point. They are already receiving greater preventive screenings as well as enhanced drug coverage.

For people covered under employer coverage, likewise minimal changes. 

Employers with more than 50 employees will have to offer health insurance starting in 2014 or face penalties.

Individuals without health insurance will have a guaranteed right to purchase insurance if they choose. We already have that right in Washington, albeit at a higher premium than standard rates.

Millions of people around the country and potentially thousands here in Clallam County will be eligible for premium assistance through an expansion of the Medicaid program. 

Pros and cons

For local providers the implementation of the Affordable Care Act could be a mixed blessing. Eric Lewis, the CEO of Olympic Medical Center, has stated that it should reduce the amount of unreimbursed care the organization provides but could also reduce the reimbursement rates from Medicare and Medicaid. Hopefully the overall result will be positive.

Greater usage of preventive services and primary care could mean longer wait times for primary service appointments, but shorter wait times in emergency rooms. 

The states will have to create Health Care Exchanges, which are designed to be online shopping sites where people can compare and enroll in plans.


It is anticipated that this will lead to greater competition in Washington as many insurers have avoided the state since the early 1990s. Insurance Commissioner Mike Kriedler has stated that a number of companies have expressed an interest in entering the individual marketplace under the new rules and provisions.

The one thing this bill does not address in any meaningful way is the rising cost of health insurance. Insurance premiums are based upon cost of services provided and as we are all-too-aware, medical expenses continue to increase at rates that are higher than inflation.

It will be interesting to see how everything plays out, but we are now less than 15 months away from, Oct. 1, 2013, when the Health Care Exchanges are to be up and running and accepting applications for January 2014.

When I first started writing about 2014, that date seemed so far away. It now appears to be imminent, so please stay tuned and as things progress I will do my best to explain how it might affect you. 


I will close on a different subject. Lifewise Health Plan of Washington is changing most of its plans that have included a prescription drug benefit.


If you receive any letters from Lifewise, take the time to review and act in a timely manner as any decisions have to be made by July 31. If you require any assistance, feel free to contact those great folks at SHIBA, your existing Lifewise agent, or my office. 

It is not as complicated as it may appear and can easily be explained either in person or over the phone.

Phil Castell is an independent insurance agent in Sequim. He can be reached at 683-9284 or