RURAL HEALTH: Resources for reporting on health-care reform, and our work in the field

This page provides links to assist in reporting on the massive legislative package, the Patient Protection and Affordable Care Act, passed in March 2010, and describes some of the health-related work of the Institute for Rural Journalism and Community Issues.

Journalists' guide to covering the second open enrollment under the health reform law

The Patient Protection and Affordable Care Act's second annual open enrollment period has started and brings with it many changes. Journalists play a critical role in the process because "Obamacare" remains controversial and there are many nuances that can be obscured, especially because this year's enrollment period is shorter.

If a state doesn’t operate its own exchange for health-care benefits, citizens looking to get covered should visit the federally-run exchange, For the 2015 plan year, 27 states with federally facilitated exchanges, seven states in partnership with the federal goverment and three state-based exchanges will use this site.

The information below pertains to these federally operated exchanges. Click here to check the status of specific states.

Who can enroll and qualify for assistance?

Whether they buy a plan through thefederal marketplace, an exchange in their state, or qualify for Medicaid, everyone must enroll in a plan or pay a penalty. Even those who purchased plans in the marketplace last year must re-enroll and purchase or select another plan this year, because plans have changed and premiums are determined by age and other factors that can change.

Two types of subsidies are available to marketplace enrollees. The premium tax credit reduces enrollees’ monthly payments for insurance coverage. The cost-sharing subsidy, is designed to minimize enrollees’ out-of-pocket costs when they go to the doctor or have a hospital stay. Here is a useful Kaiser Family Foundation brief that explains the subsidies.

People earning between 138 percent and 400 percent of the federal poverty level ($16,105 and $46,680, respectively, for an individual, and up to $94,000 for a family of four) can qualify for premium tax credits. In the 23 states that haven’t expanded Medicaid to households earning up to 138 percent of the poverty level, people with incomes above the federal poverty line ($11,670 for an individual) can also receive subsidies to buy insurance.

Cost-sharing has increased in all exchange plans this year. This means that the limit on total out-of-pocket spending for deductibles, co-payments and co-insurance has gone up. The limit for 2015 will be $6,600 for an individual ($13,200 for a family policy), up from 6,350 and $12,700 in 2014.

People who are eligible to receive a premium tax credit and have household incomes between the poverty line and 250 percent of it are eligible for cost-sharing subsidies, unless they buy the cheapest form of plan, called the bronze plan.

What states expanded Medicaid?

Pennsylvania is the only state that will be expanding Medicaid in 2015. A few other states, such as Utah and Indiana, are openly debating expansion. 

In this Kaiser Family Foundation map, navy states have state-based exchanges and have implemented Medicaid expansion (16 states including D.C.); light blue states have state-based exchanges and have not expanded Medicaid (Idaho); blue states have federally faciliated or partnership marketplaces and have expanded Medicaid expansion (12 states); and orange states have federally facilitated marketplaces and have not expanded Medicaid (22 states). 

What happens if consumers don't enroll?

The penalty for individuals without health coverage in 2015 will be $325 per adult or 2 percent of household income, whichever is greater. That's going to have more of a sting than this year's $95 or 1 percent penalty, which must soon be paid.

Health plans will send taxpayers a new tax-filing form, IRS Form 1095-B, to document their 2014 coverage. Most taxpayers without coverage must pay the 2014 penalty and will get a taste of the higher penalties to come.

Some people who were not covered the entire year will be eligible for an exemption from the penalty. The law provides for exemptions for people who:
  • Cannot afford coverage (defined as those who would pay more than 8 percent of their household income for the lowest cost bronze plan available to them through the federal marketplace) 
  • Are not a U.S. citizen, a U.S. national, or a resident alien lawfully present in the U.S. 
  • Had a gap in coverage for less than three consecutive months during the year 
  • Won’t file a tax return because their income is below the tax filing threshold ($10,150 for individuals and $20,300 for married persons filing jointly) 
  • Can't qualify for Medicaid because their state has chosen not to expand the program
  • Participate in a health-care sharing ministry or are a member of a recognized religious sect with objections to health insurance
  • Are a member of a federally recognized Indian tribe
  • Are incarcerated
Navigators and other in-person assisters can help consumers answer questions and apply for exemptions. Click here for more information on applying for exemptions. Some exemptions can be claimed on the income tax return using the new IRS Form 8965 with their tax return. Those who obtained a Marketplace exemption will need to note the exemption certificate number of Form 8965 and file this with their return.

How much does coverage cost?

Premium increases in 2015 should be modest for most people, and in some cases may decline slightly. The average premium for a 40-year-old non-smoker who makes $30,000 a year will decline by 0.2 percent next year if he buys the second cheapest plan, a silver plan, according to an analysis by the Kaiser Family Foundation.

Journalists can embed the foundation's Health Insurance Marketplace Calculator, found at the bottom of this article. Consumers can use the calculator to get an estimate of eligibility for subsidies and premium amounts, or if their income makes them eligible for free care under Medicaid.

The premium tax credit available to people with incomes between 100 and 400 percent of the federal poverty level minimizes the effect of premium increases on people’s costs. However, consumers should be wary of plan changes because subsidies are tied to the benchmark silver plan. In numerous areas that plan will change in 2015, and as a result, people may face substantial premium increases unless they make sure they’re still in a low-cost plan.

Competitive forces have introduced volatility in the marketplace. So people who chose low-premium plans this year may find that their plan is no longer a low-cost option. Income-related tax credits protect some enrollees from substantial premium increases, but enrollees may need to switch plans to see this benefit.

When dates are important for this enrollment?

There are several key dates for consumers to keep in mind during this enrollment period:
  • Dec. 15: Consumers must select a plan for coverage to begin by Jan. 1. Currently enrolled consumers must renew their coverage and application for financial assistance. If they fail to do so, current coverage and tax credits may be automatically renewed. (See below.)
  • Feb. 15: last day of open enrollment period. Those consumers who select a plan on this date will begin new coverage March 1, 2015. 
  • April 15: All taxpayers must prove they had coverage in 2014 or face a tax penalty. Consumers receiving tax credits in 2014 must file a federal income tax return and reconcile the tax amount.
Consumers who are already enrolled in a federal marketplace plan and who do nothing during open enrollment before Dec. 15 will be automatically re-enrolled in their existing plan for next year with their existing premium tax credit.

New York and Massachusetts will not have automatic re-enrollment, and Maryland is also requiring consumers to reapply for coverage and assistance, so consumers in these states need to make sure to select a new plan. There will also be no automatic renewal for consumers who both didn’t authorize the marketplace to check their most recent tax return, and whose 2013 tax return shows an income level above 500 percent of the federal poverty line.

Consumer advocates say doing nothing before Dec. 15 and automatically re-enrolling in an existing plan with existing premium tax credit could be costly. Not only have benchmark plans changed, if consumers have experienced changes in income, family status or other circumstances that could affect premium tax credits, they risk receiving the wrong amount and may have to pay back next year.

Benchmark plan changes could lead to higher costs for some consumers as well. Even if the premium of a particular plan may go down, the decrease in tax credit may go down even more, so consumers should pay particular attention to these changes.

Before the tax-filing deadline on April 15, consumers must use IRS Form 8962 to reconcile their estimated premium tax credit with the final premium tax credit eligibility. Consumers who overestimated their income may receive a tax refund, but those who underestimated it may have to repay some of all of the difference.

If consumers miss the enrollment deadline, they can qualify for a special enrollment period during the year if they experience certain life events, such as moving or losing your job. Enrollment in Medicaid and the Children’s Health Insurance Program is open year-round.

How do consumers enroll?

The place to start is the website. To start a new application, visit the website's Get Coverage page, select your state, and take the next steps that are outlined. If someone has 2014 coverage, they can log in to update it. Click on this link to find a trained helpers in different communication who can sit down with consumers to answer application questions for insurance, Medicaid or CHIP.

Here is the embeddable Health Insurance Marketplace Calculator of the Kaiser Family Foundation:

Health coverage is major mission for Institute

Most rural areas face challenges in the accessibility and affordability of health care, and many have poor health status. However, rural news outlets often lack the knowledge or motivation to help their readers, listeners and viewers live healthier lives and make better health-care decisions.

Some shy away from looking like crusaders, but the Institute for Rural Journalism and Community Issues argues, “If a news outlet can’t take a stand for good health and better health care, what can it stand for?”

Health topics have been a major focus of the Institute from the start, and are increasingly so.

Its first conference for journalists, “Covering Health and Health Care in Central Appalachia,” led to an Institute presentation, “How Rural Journalism Can Help Rural Health,” at national and state rural-health conventions, and a project that provided a template for rural health coverage.

The Institute obtained funding from the Foundation for a Healthy Kentucky to produce locally oriented stories for special sections on health in weekly newspapers in Appalachian Kentucky. Papers financed the sections by selling advertising, mainly to health-care providers.

At the Institute’s urging, one paper mailed copies to nonsubscribers, who probably need health information more than subscribers. A survey found they would be more likely to subscribe if they knew the paper would have regular features on health. That provided a good argument for papers to do health sections on their own, and several have.

At least one, the Todd County Standard, not only mailed to all homes, but designed its section around a packet of information the Institute sent to every Kentucky paper – the pertinent pages from a county-by-county compilation of health data, including strategies for addressing the main health problems in each county.

The Institute used the report’s data on diabetes to recruit rural journalists to attend the Kentucky Diabetes Solutions Summit in 2008. Journalists came from three of the five counties with the highest diabetes rates, two others in the top 20, and two other counties. All wrote articles about the subject, and one did a four-part series. This suggested that when told their community has a major, specific health problem, rural journalists and their employers will respond.

The Kentucky Institute of Medicine was less successful when it tried to use the county data to get news of certain health problems in print, but it pointed the Institute for Rural Journalism and Community Issues in a direction that may result in more coverage.

With the IRJCI's assistance, an intern for KIOM prepared articles for 16 Kentucky papers about health problems in their regions, but only two published the articles. A rural-journalism institute researcher found that the plurality of articles on health-related behavior in the papers were “advertorials” promoting a health product, service or provider, and that relatively few articles were written by health professionals or newspaper staffers. Results of the study were presented at a national conference.

Under a contract with the Foundation for a Healthy Kentucky, the Institute is conducting research to determine why Kentucky papers run certain health-related articles and not others. Some rural editors have told the Institute that they would like to do more health coverage, but are reluctant to make special efforts for fear of being seen as crusaders.

The findings of the research will guide the Institute as it generates health stories and distributes them to news outlets.

The Institute makes a point to avoid advocating for anything but coverage, commentary and things that facilitate them, in order to maintain its credibility with its clientele, which ranges from very liberal to very conservative. But it partnered with advocates of smoking bans on “Sorting Through the Smoke: Covering Tobacco and Health in Your Community,” a series of seminars and a soon-to-be-developed website, because heavy use of tobacco in Kentucky has such a major impact on the state’s health. The Institute made sure that a leading opponent of smoking bans had time to espouse his libertarian and free-market views and answer journalists’ questions in a give-and-take session with the leading advocate of smoking bans in the state.

The Institute’s health work extends to the national level, with presentations at national conferences and hundreds of items on The Rural Blog. The Institute also helped a talented rural journalist, Tara Kaprowy of The Sentinel-Echo in London, Ky., gain a national Health Coverage Fellowship funded by the Foundation for a Healthy Kentucky. Her reporting since her week in Boston has included a series on obesity, with some follow-up stories. “They were well received and created a lot of positive conversation in the community,” Publisher Willie Sawyers said.