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Health exchange signups begin Oct. 1

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About 17 percent of Nelson Countians are without insurance

By Randy Patrick

Kentucky’s 640,000 people who are uninsured will be able to purchase private insurance through the state’s new health care exchange beginning this week.

That number includes 6,316 Nelson Countians who are uninsured, or approximately 17 percent of the county’s population, according to state figures available as of Sept. 10.

Open enrollment begins Oct. 1 under KyNect, the exchange established by the state under the federal Patient Protection and Affordable Care Act of 2010. It ends March 31 of next year. Those who must purchase individual insurance must sign up by then or pay a tax penalty of 1 percent of their annual income or $95, whichever is highest.

The penalty will increase annually to 2.5 percent of income or $695 by 2016.

The individual mandate, which is part of the Affordable Care Act, or “Obamacare,” is intended to reduce health care costs by reducing the number of uninsured, although there is considerable debate about whether it will actually do so.

The exchange allows Kentuckians to find their own insurance on the state’s website, www.kynect.ky.gov, where they can also learn more about the program and watch a short video about it. They can also call 1-855-459-6328 to have someone answer questions between the hours of 8 a.m. and 7 p.m.

Coverage under the companies offering insurance through the exchange could take effect as early as next January.

Individuals must take responsibility for making their own purchasing decisions. Different levels of insurance coverage are available. Some have lower premiums, but higher out-of-pocket deductibles. Others have low deductibles but higher premiums. Prices also vary based on lifestyle choices. Smokers, for example, might be charged more for their coverage.

“We all want to make sure they understand what they’re looking at because insurance is very complex,” said Linda Sims, director of the Lincoln Trail Health District, which includes Nelson County.

“Moving into this new area of health care is scary for many providers and patients,” Sims said, “but our hope is that we will see better coverage and care, and more healthy habits develop.”

Sims said she’s excited about the possibility for more people having health insurance.

Jan Tronzo, director of the Nelson County Community Health Clinic, which provides health care for the uninsured working poor, said the number of patients the clinic sees could decrease as a result of the health care reform law, and its insurance expansion next year.

“That would be what I would hope,” she said, but added that she still thinks there will be a segment of the population that won’t purchase health insurance because they won’t be able to afford it.

“You can’t get blood out of a turnip,” she said.

Workers who will continue to receive health insurance through their employer’s plans won’t need to sign up for individual coverage through the exchange.

Nor will those who are on Medicaid, the state-federal insurance program for the poor.

Under the new health law, those who are below 138 percent of the federal poverty level will be eligible for Medicaid coverage under an expansion of the program in which the federal government will cover most of the additional costs.

The current poverty level for a family of four is $23,550, meaning a family making up to $32,499 will qualify for Medicaid. An individual over 18 who earns $15,856 or less will also qualify.

A family of four earning under $94,200 or an individual earning under $45,960 would qualify for payment assistance that they can use toward a private insurance premium.

Small businesses with 25 or fewer employees will also be able to get tax credits for health insurance; however, they will not be required to provide insurance.

The employer mandate, which would have required businesses with 50 or more employees to provide insurance or pay a penalty, has been delayed until 2015.

Under the new federal law, insurance coverage cannot be denied or canceled by a company even if an individual has a pre-existing condition, such as cancer or diabetes.

In Nelson County, which has a population of 43,974, based on U.S. Census numbers, it is estimated that about 17 percent of the population is uninsured.