Supreme Court upholds Obamacare subsides in all states; ruling has no direct effect on Kentucky, but focuses political debate

By Molly Burchett
Kentucky Health News

The U.S. Supreme Court ruled Thursday that the tax subsidies provided under the Patient Protection and Affordable Care Act are legal in every state.

While the ruling has no effect on Kentucky, and would have had no direct effect if it had gone the other way, it sets the table for continued political debate about health policy in Congress and in Kentucky's race for governor.

"Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them," Chief Justice John Roberts wrote in the 6-3 majority opinion. "If at all possible, we must interpret the Act in a way that is consistent with the former, and avoids the latter."

The law says the federal government can pay subsidies to help people afford insurance bought through “an Exchange established by the State.” The lawsuit argued that Americans in the 34 states using the federal exchanges were not eligible for the subsidies, which are crucial to the law's success, helping to make health insurance more affordable, reducing the number of uninsured Americans. Proponents of the law say not providing subsidies to individuals in those 34 states relying on the federal exchange would have upended the law, notes CNN.

President Obama called on critics to accept the law as permanent, saying after the ruling, "The Affordable Care Act is here to stay."

But Senate Majority Leader Mitch McConnell, R-Ky., called Obamacare “a rolling disaster for the American people,” with a “multitude of broken promises, including the one that resulted in millions of Americans losing the coverage they had and wanted to keep. Today’s ruling won’t change the skyrocketing costs in premiums, deductibles, and co-pays that have hit the middle class so hard over the last few years.”

Maps: Percentage uninsured in 2012, above, and 2014, below

Obama countered, "The setbacks I remember clearly. But as the dust has settled, there can be no doubt that this law is working. It has changed, and in some cases saved, American lives. It set this country on a smarter, stronger course." He added, "The law has helped hold the price of health care to its slowest growth in 50 years" and "Nearly one in three Americans who was uninsured a few years ago is insured today. The uninsured rate in America is the lowest since we began to keep records."

A White House fact sheet noted that the law also expanded "access to preventive care, including immunizations, well-child visits, certain cancer screenings, and contraceptive services, with no additional out-of-pocket costs as well as no more annual caps on essential benefit coverage and new annual limits on out-of-pocket costs."

Since Kentucky established its own exchange, Kynect, for buying subsidized health insurance or signing up for Medicaid, the ruling may seem moot for Kentuckians. However, it establishes some of the facts for a health-care policy debate in the governor's race between Republican Matt Bevin and Democratic Attorney General Jack Conway.

The exchanges and the expansion of the federal-state Medicaid program are choices for the states, and Bevin has said that if elected he would shut down Kynect and end the Medicaid expansion, which has covered about 430,000 Kentuckians. The federal government is paying their entire cost through next year; in 2017 the state would start picking up a small share, rising to the law's limit of 10 percent in 2020.

Conway has acknowledged questions about whether the state can afford to pay its share, but to “say you’re going to kick a half a million people off of health insurance based on what we may or may not be able to afford in 2021 is irresponsible.” A Conway spokesman said he "appreciates the court's careful consideration of this case and agrees with today's decision," reports the Lexington Herald-Leader.

The Herald-Leader's Mary Meehan interviewed officials and experts for a package of questions and answers about the law and Kentucky. It is published at http://www.kentucky.com/2015/06/25/3917832_in-light-of-the-supreme-court.html.

Outgoing Gov. Steve Beshear, a Democrat who expanded Medicaid, said in a statement that the decision “reaffirms that, from the very start, we did the right thing for the more than 500,000 Kentuckians who have qualified for health-care coverage through Kynect since January 1, 2014.”

Susan Zepeda, president and CEO of the Foundation for a Healthy Kentucky, said in a release, "While many have been awaiting this important decision, we must remember that much remains to be done to assure that all Kentuckians – and all Americans – have timely access to safe, effective and affordable quality care." Zepeda said Kentuckians continue to work on ways to improve and protect Kentuckians' health, such as reforming the way we pay for care and making health care cost and pricing more transparent.

"As people who have forgone care too long because of its expense now gain access to care, it will place a larger short-term burden on the health-care system, which approaches like these can help to address," said Zepeda. "The Affordable Care Act permits – and incentivizes – local health care innovation. We can and must shape Kentucky solutions to Kentucky’s health challenges."

Bevin says he will end all Obamacare programs in Ky., including Medicaid expansion that has added more than 400,000 to rolls

Matt Bevin, the Republican nominee for governor, has made clear that if elected he would end the Medicaid expansion that has provided free health coverage for more than 400,000 poor Kentuckians.

During his primary campaign, Bevin never made that quite plain, saying he would close the state's health-insurance exchange, Kynect, because it would cost "hundreds of millions of dollars." Kynect is paid for by insurance companies, so Bevin was alluding to to the state's projected cost of expanding Medicaid, which enrolls through Kynect.

The Washington-based publication Politico reported on June 10, after interviewing Bevin, that he would not only close Kynect but roll back the Medicaid expansion: “You may or may not have access to Medicaid going forward,” he said. “People are not on it for extended periods of time. It’s not meant to be a lifestyle. It really isn’t. The point of it is to provide for those who truly have need.”

Democratic nominee and Attorney General Jack Conway, with Gov.
Steve Beshear; GOP nominee Matt Bevin (AP photos via Politico)

Gov. Steve Beshear "is furious" about Bevin's plan, Politico reported. “I am not going to allow someone to become governor of this state who wants to take us back to the 19th century,” the governor said in a telephone interview. “For a serious candidate for governor to be advocating a simple repeal of the whole program without offering any kind of alternative which will continue health care for these people is irresponsible.”

Beshear expanded the eligibility rules for Medicaid as part of implementing the Patient Protection and Affordable Care Act, raising the income limit to the law's required 138 percent of the federal poverty level, from the state's previous level of 69 percent.

The federal government is paying the entire cost of the newly eligible Medicaid recipients though next year. In 2017, the state would begin to pay 3 percent, rising to the reform law's cap of 10 percent by 2020. A study by Deloitte Consulting and the Urban Institute at the University of Louisville  — "which Republican critics have rejected as spin," Politico says — has said the expansion more than pays for itself through 2020 by expanding health-care jobs and generating tax revenue.

Jobs are growing as projected by the study, according to the Cabinet for Health and Family Services, which handles Medicaid.

Cabinet spokeswomnan Jill Midkiff said the study estimated that 32,000 jobs would be created through 2015 as a result of the expansion. "U of L projected this growth would primarily be in the areas of retail trade, finance and insurance, administrative services, health and social services, accommodations and food services and other services," Midkiff said. "These sectors were estimated to account for more than 28,000 of the 32,000 jobs created." She said the latest Bureau of Labor Statistics figures show that "these sectors have grown by more than 29,000 jobs from 2013 until April 2015. Therefore, the most recent BLS numbers indicate that UofL’s estimates are on target to meet projections."

Politico says a Bevin victory could "blot an Obamacare bright spot," since Kynect has "worked virtually glitch-free." Through April, 106,000 Kentuckians had obtained tax-subsidized, private insurance coverage through Kynect, which is also the portal for enrolling in Medicaid.

Bevin says he would move those people to the federal exchange, which has been marred by technological issues and charges insurance companies much more to use it than Kynect does. But that plan would not work if the U.S. Supreme Court rules this month that the tax subsidies are not legally available through the federal exchange.

"That doesn’t worry Bevin," Politico reports, quoting him: “You’re worrying about a hypothesis. Let’s let the Supreme Court rule.”

And what about the new Medicaid recipients who would lose their benefits if Bevin wins? He "insists that Obamacare is coverage in name only — that Kentuckians still lack access to high-quality health care, partly because Medicaid pays doctors such low rates, partly because he says too many people rely on emergency rooms," Politico reports, quoting him: “Just having health insurance doesn’t mean you’re going to get health care.”

Attorney General Jack Conway, the Democratic nominee, declined Politico's request for an interview. Campaign spokesman Daniel Kemp said, “Jack wants to make sure that the hundreds of thousands of Kentuckians who now have health insurance through Kynect, especially kids, keep their health insurance — not play politics or push an ideology that’s out of touch with Kentucky’s values.”

Politico observes, "Conway is in the tricky spot of embracing Kynect while trying to keep his distance from Obama and Obamacare, a term that still generates ire among Kentucky residents. A September 2014 Marist [College] poll found that 61 percent of registered Kentucky voters had an unfavorable impression of Obamacare. Only 17 percent had negative feelings about Kynect."

Citing costs, Bevin has said he would shut down Kynect; actually, insurance companies pay for it; Medicaid is another matter

By Molly Burchett and Al Cross
Kentucky Health News

The governor's race between Democrat Jack Conway and Republican Matt Bevin will spotlight the Patient Protection and Affordable Care Act, an issue that affects all Kentuckians at least indirectly.

Conway, in his eighth year as attorney general, says he would have voted for the law. Bevin, who was the most conservative candidate in his primary, has said he would shut down the state's health-insurance exchange, Kynect, that was established under the law, because it will cost the state hundreds of millions of dollars.

Actually, Kynect is paid for by insurance companies that sell policies in Kentucky. Bevin appears to be referring to the projected cost of expanding Medicaid, another Obamacare-related move that Democratic Gov. Steve Beshear made at the same time he created Kynect. It raised the program's income limit to 138 percent of the federal poverty level, from 69 percent.

The federal government is paying the entire cost of the Medicaid expansion for the first three years. In 2017, the state will pay 3 percent, gradually rising to the law's cap of 10 percent in 2020. A study for the state projects that the expansion will pay for itself until 2021 by expanding health-care jobs and generating economic activity and tax revenue.

Bevin has scoffed at those projections. Conway has said the state needs to provide health coverage, but only what it can afford.

As Kentuckians, voters, and consumers of health insurance, you may be asking: What's going on with Obamacare in the state? Are we able to afford it? Who and what should we believe? While the cost of Medicaid expansion is debatable, it's becoming clear that Kynect has avoided the problems plaguing other state-run exchanges.

So far, the Centers for Medicare and Medicaid Services has dispensed more than $4.9 billion in grants to help launch state-run exchanges. Kentucky received $253 million for the initial planning and development phases of Kynect. Now its $28 million annual cost is covered by a fee on insurance companies, state officials say.

Despite federal support and their own revenue sources, many of the 17 state-based exchanges are expecting deficits this year and in the future. Many will continue to rely on leftover federal funds to pay for operations this year, report Darius Tahir and Paul Demko of Modern Healthcare. Hawaii announced this week that it would close its exchange and transfer clients to the federal exchange because of continued funding problems.

Kynect officials say it isn't having such problems because the state has ensured that Kynect is self-supporting through fees on insurance plans.

"The governor committed that the exchange would be self-supporting and would not rely on state General Fund dollars," said Jill Midkiff, spokeswoman for the Cabinet for Health and Family Services. "Kentucky’s sustainability plan employs an existing assessment on insurers that was previously used to fund Kentucky Access, the state’s high-risk pool, which was closed [since] individuals previously enrolled are now eligible to purchase a plan through Kynect."

But to transform Kentucky Access into Kynect, Beshear used executive orders that bypassed the General Assembly, where Republicans control the Senate. They have questioned his use of executive powers but generally have not been critical of Kynect.

The fee on insurers is a 1 percent, broad-based assessment on companies offering plans through the exchange. While insurers don't pass this fee directly to consumers, it almost certainly figures into their calculation of premium calculation and thus is indirectly paid by policyholders. The federal exchange is financed in a similar way, but its fee is 3.5 percent, meaning higher costs for insurers and policyholders.

In most cases, premiums for Kynect policies are reduced by a federal income-tax subsidy that is a key part of Obamacare.

"The vast majority of Kentuckians buying health insurance through Kynect are eligible for some kind of payment assistance or subsidy," Beshear said in commenting on most health-insurance companies recent requests for premium increases. "That cost will vary from family to family, so talking about rate changes in a vacuum isn’t a very effective way to gauge how much those rate fluctuations may affect policyholders or those shopping for insurance."

Bevin says he would move Kynect customers to the federal exchange, but the U.S. Supreme Court could rule this month that the tax subsidies are not supposed to be available through the federal exchange. The plaintiffs in the case cite a passage of the law that opponents say was a drafting error and does not make sense when the law is viewed as a whole.

If the court agrees with the plaintiffs, and Congress doesn't change the law, states using the federal exchanges will see spikes in insurance premiums, and millions of people could be at risk of losing their insurance. Bevin has not said what he would do in case of such a ruling.

Independent Drew Curtis is also running for governor.

Most insured through Kynect will pay more in 2016; Kentucky Health Cooperative seeks 25 percent increase

By Molly Burchett
Kentucky Health News

The federal health law requires that insurers planning to significantly increase premiums for policies on a health-insurance exchange to submit their rates by June 1 for review. Many insurance carriers across the country, including four in Kentucky, are requesting double-digit increases in insurance premiums for 2016.

For the individual market, the requested average rates from companies already participating in the Kynect exchange are:

• Anthem Health Plans, 14.6 percent increase;
• CareSource Kentucky, 11.8 percent increase;
• Humana Inc., 5.2 percent increase;
• Kentucky Health Cooperative, 25.1 percent increase;
• WellCare Health Plans, a 9.28 percent decrease.

The rates are not final, but are subject to approval by the state Department of Insurance, "so we don’t yet know what the final numbers will be," Gov. Steve Beshear said. "Changes still may occur. Rates should be finalized sometime in mid-July. We do expect that some plan rates will go down, some will go up and some will stay close to the same as last year."

Consumers will have more choices when enrollment opens, because the exchange is adding three new insurers to its individual market. United Healthcare will be offering coverage statewide, Aetna policies will be available in 10 counties, and Baptist Health Plan, now Bluegrass Family Health, will offer coverage in 79 counties. CareSource will expand its coverage area from 16 to 67 counties.

With these additions, at least three insurers will be offering Kynect coverage in every county, said Ronda Sloan of the Department of Insurance.

"When open enrollment begins this fall, Kentuckians should seek information about their individual plans, not average costs," Beshear said. "System-wide averages don’t give a good picture of what an individual’s out-of-pocket costs may be."

It is also important to keep in mind that premiums cannot be viewed in isolation, and you should look at the individual market dynamics that impact how much consumers pay for their health care coverage.

Why are most rates going up?

For an insurance company to survive, its cost of providing benefits should be less than the premiumums paid for those benefits. Companies now have had more than a full year of claims data to inform pricing structures, and many insurers are finding that people who buy policies on exchanges are considerably older and sicker than anticipated, reports Megan McArdle of Bloomberg News.

As a result, insurers are incurring greater costs of providing benefits than expected. Initially, the U.S. Department of Health and Human Services said that about 40 percent of the exchange policies should be bought by people between 18 and 35, the most healthy age group, to keep the exchanges financially stable. However, according to HHS data, that group accounted for only 28 percent of the policies in 2014 and 2015.

Not only do older people have more complex and more costly health needs, rising premiums in some state-based exchanges are due in part to the uncertainty in the overall health-insurance marketplace. First, there is much uncertainly about the reform law's "risk corridor program," which was designed to have insurers share the financial risk of offering policies on Obamacare exchanges from 2014 through 2016.

The program creates a pool of money to reduce risk for insurers: Those that pay out less in benefits than they collect in premiums pay into the pool; those whose premiums don't cover the cost of providing benefits take money from the pool. However, a recent Standard & Poor's report says the risk corridor will probably not get enough money from insurers with profitable exchange plans, so many insurers must raise premiums to support themselves.

Kentucky Health Cooperative needs shoring up

In another potentially worrisome sign, some insurers had risk-corridor receivables that exceeded half of their reported capital, and Kentucky Health Cooperative had the second-highest level of receivables as a percentage of capital: 117 percent, reports CNBC. That helps explain why it has asked for the largest average increase in premiums this year, 25 percent, and last year, 20 percent. The cooperative is one of several start-ups funded by the reform law to encourage competition in states; it sells most of the 106,000 private policies on Kynect.

Other reasons for the overall premium increases include rising health-care costs, especially for prescription drugs, Larry Levitt, senior vice president of the Kaiser Family Foundation, said on "PBS NewsHour" Wednesday night.

Speaking nationally, Levitt said state regulation means the requested premiums "will come down, in some cases by a lot." He said "Insurers are jockeying for position in these new marketplaces [so] there are some good deals to be had, but consumers really have to look around,"

David Blumenthal, president of The Commonwealth Fund, which researches health and social policy, said exchanges like Kynect "give people the ability to comparison-shop much more easily than before."

As income taxes are filed, half who got Obamacare subsidy will have to pay part of it back; almost as many will get a refund

By Melissa Patrick
Kentucky Health News

This week will go down in history as the first time the Internal Revenue Service enforced the Patient Protection and Affordable Care Act's tax penalty for those who can afford insurance but didn't buy it.

The penalty for those who don't qualify for an exemption is $95 per adult and $47.50 per child, or 1 percent of your income, whichever is larger. The penalty will increase next year to the greater of $325 per adult or 2 percent of household income.

"Ever since its passage, the mandate that every American have health insurance has been at the heart of the controversy over the ACA," Elaine Kamarck writes for the Brookings Institution. It was an issue long before the law passed; in the 2008 presidential primaries, Hillary Clinton favored it and Barack Obama opposed it; as president, he changed his mind.

Tens of thousands of Kentuckians who got subsidies to help pay for their health insurance through the Kynect exchange will probably be surprised to find that they will have to repay some of the subsidy, or that they will get a refund, depending on the difference in their actual income level and the income that was recorded at the time they bought insurance. Most incomes were likely based on an estimated income for the year. Generally, if you overestimated your 2014 income, you will get a refund. If you underestimated it, you will have to repay some or all of the subsidy, which was subtracted from the "sticker price" of insurance to calculate your premium.

Infographic from Kaiser Family Foundation

A study by the Kaiser Family Foundation estimates that 50 percent of Americans who got 2014 tax subsidy will owe some money, and 45 percent will receive a refund. The foundation estimates the average repayment will be $794 and the estimated average refund to be $773.

Some reasons for the income differences are getting a raise, losing a job, and working a different number of hours; and non-job factors such as a change in family size as a result of births, deaths or divorce. These changes should be reported when they occur, so subsidies can be modified, but often aren't, says the Kaiser Family Foundation.

John Ydstie of NPR reports some real examples of policyholders facing these surprises. He tells the story of one person who makes $30,000 a year who decided to take less than her estimated $250-a-month premium subsidy because of her uncertainty about the program, and is getting a $3,900 refund. He notes that most people on Obamacare can't afford to do this.

Ydstie also tells the story of a young woman whose monthly subsidy dropped to $60 from $250 after she married her longtime partner in 2014 and their combined incomes bumped them into a different category. They have to pay back $1,800 but are hoping the amount will be adjusted to $400, to apply only to the months they were married; this has not yet been determined.

As the IRS implements the law, it is faced with budget, staffing, and operational cuts, Kamarck writes: "Given the staff limitations of the IRS and the complexity of reporting and reconciling the government subsidies in the law with people’s income there is likely to be confusion, frustration and, most importantly, a lot of people who find out that their tax refund is a great deal smaller than they anticipated." She suggests that the IRS, in order to survive the first tax season with the ACA, "give taxpayers a break whenever it can."

Kynect opens special enrollment period March 2-April 30 to give people without health insurance a chance to avoid tax penalty

The state health-insurance exchange, Kynect, is reopening enrollment in March and April to allow signups by Kentuckians who discovered that not having health insurance means they have to pay a federal tax penalty.

“We believe that many Kentuckians did not realize those who do not obtain health coverage could face significant penalties when they file their taxes,” Gov. Steve Beshear said in a news release. And given that the personal risks of not having health coverage are even greater than the penalties, we have decided to continue a special enrollment period to allow those individuals more time to sign up.”

The penalty for not having health coverage last year is 1 percent of income, or $95 for each adult in the household and $47.50 for each child, whichever is greater. For 2015, the penalty will be 2 percent or $325 for each adult and $167.50 for each child.

"Individuals taking advantage of this special enrollment period will still owe a fee for any months they were uninsured and did not qualify for an exemption in 2014 and 2015," the news release warns. "This special enrollment period is designed to allow such individuals the opportunity to get covered for the remainder of the year and avoid additional fees for 2015."

If your household income is between 100 and 138 percent of the federal poverty level, which makes you eligible for expanded Medicaid, you will still be charged a penalty if you don't sign up. Medicaid enrollment is open year-round, but the special enrollment for private insurance will end April 30.

Visit https://kynect.ky.gov or call 1-855-4kynect (459-6328) to learn more.

Almost 103,000 Kentuckians now on private health insurance through Kynect, state says

More than 158,000 Kentuckians signed up for private health insurance or Medicaid coverage in the second round of open enrollment under the federal Patient Protection and Affordable Care Act.

The signup total of 158,685 as of Feb. 19 included almost 103,000 Kentuckians who renewed or bought private coverage. The state said the total broke down this way:

• 55,855 enrolled in Medicaid coverage (which is open year-round).
• 75,760 individuals renewed enrollment in private insurance.
• 27,070 individuals newly enrolled in private insurance.
• 6,009 individuals enrolled in dental plans.

“We had a tremendously successful second open enrollment period, with many new individuals signing up or continuing their health coverage through Kynect,” the state's health-insurance marketplace, Gov. Steve Beshear said in a news release. “When people get health insurance, they generally take immediate steps to get healthier, which will help our workforce get even stronger.”

Thousands of Kentuckians face federal tax penalty for not having health insurance

"Thousands of Kentuckians might face a penalty this tax season for failing to sign up for health insurance during 2014," Mary Meehan reports for the Lexington Herald-Leader.

The state estimated that 340,000 Kentuckians would buy private insurance through its Kynect marketplace, but only 80,000 have done so. However, Meehan writes, some of those who did "might have qualified for Medicaid under the state's expanded income guidelines, said Carrie Banahan, who heads Kynect."

Jill Midkiff, spokesman for the state Cabinet for Health and Family Services, told Meehan, "There are too many variables at play here to do simple arithmetic for estimated populations. It would be safe to say that thousands of Kentuckians will likely face a tax penalty this year for not obtaining health insurance."

Banahan said, "A lot of people are going to be very surprised." And that will include some people who were eligible for Medicaid, but didn't enroll in it. Medicaid enrollment is open year-round, but private-insurance enrollment closes Sunday, Feb. 15 and won't reopen until next fall unless someone has a life-changing event "such as a birth, divorce or loss of a job," Meehan notes.

"The penalty for not having insurance during 2014 is $95 for each person in a household or 1 percent of the household income, whichever is higher," Meehan notes. "The bill will come due when 2014 taxes are filed, she said. If a person is due a refund, it will be deducted from the tax refund." Next year, the penalty will be 2 percent, with a minimum of $325 per adult or $162.50 per child, under provisions of the Patient Protection and Affordable Care Act.

Feb. 15 is deadline to get health insurance; those who don't can be penalized up to 2 percent of their annual income

Sunday, Feb. 15 at 11:59 p.m. is the deadline to buy private, subsidized health insurance through Kynect, the state-run marketplace created under federal health reform.

If your annual income is above the federal poverty level and you don't buy a policy or enroll in Medicaid, and don't qualify for one of several narrow exceptions, you will be subject to a tax penalty from the Internal Revenue Service. (You may qualify for Medicaid if your income is less than 138 percent of the poverty level; Medicaid enrollment is open year-round.)

The penalty is $325 per person or 2 percent of household income, whichever is greater. "In many cases, this penalty could exceed the annual cost of insurance," the release said, giving these examples using "bronze" plans (the cheapest alternative, which has high deductibles):

• A 30-year-old in Lexington making $20,000 would qualify for a subsidy and pay $37.44 for a full year of bronze coverage, or pay a $400 penalty and remain uninsured
• A 25-year-old in Louisville making $40,000 would qualify for a subsidy and pay $604.08 for a full year of bronze coverage, or pay an $800 penalty and remain uninsured.

“Not only is insurance important for your physical health, it also makes financial sense,” Kynect Executive Director Carrie Banahan said in the release. “Why risk the possibility of being uninsured and facing a costly medical procedure and a tax penalty, especially when you may qualify for financial assistance to defray some of your premium cost? Don’t wait. Visit Kynect and enroll in healthcare coverage today.”

Private insurance on Kynect is subsidized by an advanced premium tax credit. Those who qualified for the credit will receive a 1095-A tax form, which provides information to help fill out Form 8962 as part of their federal tax returns. Individuals with questions about their Form 1095-A can call a special Kynect hotline at 1-844-373-2417. More information is available at kynect.ky.gov.

People on Medicaid, Medicare, the Kentucky Children's Health Insurance Program, catastrophic health insurance or insurance through an employer or other agency do not need Form 1095-A to file their federal taxes.

Kynect private-insurance enrollment runs through Feb. 15; exchange works to get taxpayers information to prove coverage

With the close of open enrollment coming Feb. 15, state officials are making a final push to get Kentuckians to enroll in Medicaid or buy private, subsidized health insurance on the state's health benefits exchange, Kynect.

The federal health reform law requires most people to have health insurance or pay a penalty, and Kynect says it is working to help Kentuckians get the information they need to prove coverage when they file their tax returns.

Outreach events continue at several campuses in the Kentucky Community and Technical College System. Events are open to the general public and will feature "Kynectors" who answer questions and help people find a plan that fits their needs and budgets. Tthe remaining events will be at:

• Bluegrass Community and Technical College, Leestown and Newtown campuses, 10 a.m.–2 p.m., Feb. 2 and 3.
• Jefferson Community and Technical College, downtown Louisville campus, 10 a.m.–2 p.m., Feb. 4 and 5.
• Gateway Community and Technical College, Covington campus (Two Rivers Building), 10 a.m.–2 p.m., Feb. 9 and 10.
• Gateway Community and Technical College, Boone County campus, 10 a.m.–2 p.m., Feb. 11 and 12.

As of 3:30 p.m. Jan. 29, 50,754 new applications for coverage had been submitted to Kynect; 43,181 people had been newly enrolled in Medicaid; 75,760 people had renewed their private insurance; 18,533 had newly enrolled in a private plan; and 4,914 individuals had enrolled in dental plans.

Kynect Director Carrie Banahan said, “If you or anyone you know remains without health insurance the time to enroll in coverage through Kynect is now. Please don’t delay. Enroll as soon as possible.”

Those who need health insurance are encouraged to log on to www.Kynect.ky.gov, call 1-855-4kynect (459-6328), or contact an insurance agent or Kynector before the Feb. 15 deadline. Medicaid enrollment is open year-round.

Taxpayers, take note

Individuals who qualified for an advanced premium tax credit, or subsidy, through Kynect will receive a 1095-A tax form in the mail. The form provides information for individuals and families who received payment assistance to help them fill out IRS Form 8962 as part of their federal return.

"Kynect has instituted a robust training and information program to help individuals, Kynectors, insurance agents and tax preparers understand the requirements," a state press release said. "Individuals with questions about their Form 1095-A may also call a special Kynect hotline at 1-844-373-2417.

Individuals with Medicaid, KCHIP, Medicare, catastrophic health insurance or insurance through an employer or other agency do not need Form 1095-A to file their federal income taxes. 

Penalty for those without health insurance in 2015 will be significantly higher than for 2014; Feb. 15 is deadline to sign up

Wall Street Journal photo illustration

One aspect of the Patient Protection and Affordable Care Act supporters don't spend much time talking about is the part of the law that imposes a penalty on those who don't have insurance, but the time has come for the uninsured to pay up.

This is the first year taxpayers are required to report to the Internal Revenue Service whether they have health insurance, and charged a fine if they don't, as required by the federal health care law.

This year's fine is $95 per adult or 1 percent of the household income, whichever is greater. This fine will increase significantly in 2015 to $325 per adult or 2 percent of household income, whichever is greater. And will increase again in 2016 to $695 per adult or 2.5 percent of income, whichever is greater.

Dayna Dayson of Phoenix, Ariz., estimates that she’ll have to pay $290 in fines this year when she files her federal return, Ricardo Alonso-Zaldivar reports for The Associated Press. Dayson, who’s in her early 30s and works in marketing, said she would like to have health insurance, as required by the law, but can't afford it.

“It’s touted as this amazing thing, but right now, for me, it doesn't fit into my budget,” she told AP.

It is too late to avoid this year's penalty, unless you qualify for one of about 30 exemptions, most of which are related to financial hardships, Alonso-Zaldivar notes, but you can avoid a penalty next year if you sign up for health coverage by Feb. 15, the last day of open enrollment.

Kentuckians can sign up for health insurance through Kynect, the state's health insurance exchange. Jan. 15 is the deadline to get covered by Feb. 1 and those who sign up by Feb. 15, the final enrollment deadline for 2015, will get coverage beginning March 1. Medicaid enrollment is open year-round.

"Roughly 4 million uninsured people will pay penalties and 26 million will qualify for exemptions from the list of more than 30 waivers," H&R Block says in a congressional analysis, Alonso-Zaldivar reports.

One reason many of the uninsured will end up paying a 2015 fine is that they don't know about the larger fine or the sign-up deadline to avoid this penalty.

Only 3 percent of uninsured people know what the fine for 2015 will be, according to a recent poll by the Kaiser Family Foundation. And just 5 percent of uninsured people know the correct deadline, according to a Kaiser poll, Alonso-Zaldivar reports.

“We could be looking at a real train wreck after Feb. 15,” Stan Dorn, a health policy expert at the nonpartisan Urban Institute, told AP. “People will file their tax returns and learn they are subject to a much larger penalty for 2015, and they can do absolutely nothing to avoid that.”

Alonso-Zaldivar suggests one reason people don't know about the penalties could be because they are the "most unpopular part of the health care law" and supporters have "played down the penalties in their sign-up campaigns" to avoid "political backlash."

If you are interested in estimating your potential fine or seeing if you qualify for an exemption, Alonso-Zaldivar suggest going online and using the Tax Policy Center’s Affordable Care Act penalty calculator or using a free online tool called “Exemption Check" created by TurboTax.

While many, like Dayson, find paying for health insurance "doesn't fit into the budget," one way to save money when choosing a plan is to make sure you choose a plan with the best deductible option for your family, Michelle Andrews reports for Kaiser Health News.

Typical plans have a single out-of-pocket deductible that must be met for the entire family before insurance will start paying. But some plans offer both a total family deductible and a separate deductible for each family member. For example, a $3,000 deductible family plan might have separate $1,000 deductibles for each family member, Andrews reports.

This type of plan is a good option if one family member requires more medical care than the others over the course of the year, Sabrina Corlette, project director at Georgetown University's Center on Health Insurance Reforms, told Andrews.

This plan allows the insurance company to start paying for all of this one family member's medical bills after their embedded-individual-deductible is met, even if the family has not reached its total out-of pocket payment, Andrews writes.

You might have to call the plan directly to see if it offers this type of deductible, Corlette said.

Only 1/4 of estimated number eligible for subsidized, private health insurance through Kynect have signed up for it

While 85,000 people are covered by private health plans through Kynect, that's only one-fourth of the 340,000 that state officials estimated would be able to buy subsidized coverage through the state insurance exchange. That "underscores some of the challenges" of the federal health-reform law, Abby Goodnough reports for The New York Times, in the latest of series of stories using Kentucky as a bellwether for Obamacare.

"People earning between 138 and 400 percent of the poverty level — between about $16,000 and $47,000 for a single person — can get subsidies to help with the cost," Goodnough explains. "Even with that incentive, only about 76,000 Kentuckians signed up for these plans in 2014 and have renewed the coverage for next year. Since the enrollment period for 2015 began on Nov. 15, an additional 9,000 people have selected exchange plans."

2015 is the first year taxpayers will have to report on tax returns whether they had health insurance in the prior year. Unless they qualify for one of about 30 exemptions, mostly involving financial hardships, the health-reform law requires them to pay a penalty: $95 per adult and $47.50 per child, or 1 percent of the family’s modified adjusted gross income that is over the threshold the requires it to file a tax return. The penalties will increase next year, but for most people will remain below the cost of insurance, so many are expected to pay a penalty.

Kentucky is considered one of 13 states where people in the individual insurance market are better off under Obamacare than they were before, and compares well with other states, so why are so few getting coverage? "National polls have found that many people simply consider the exchange plans unaffordable, even with subsidies," Goodnough notes. Several thousand Kentuckians signed up for coverage but didn't pay the premiums.

David Elson gets dialysis. (NYT photo by William DeShazer)

One was David Elson, who "decided he could not afford the $350 monthly premium for a plan that included his doctors," Goodnough reports. "His poor health got worse, and in October, he landed in the hospital with end-stage kidney disease."

That enabled him to get special Medicare coverage for dialysis. But Elson, 61, of Louisville, told Goodnough, “The president gets up there and says, ‘We’ve got to get affordable health care for our people. It’s not.”

While Kentucky's private-plan enrollment is probably more modest than most states because it has more people living in near-poverty, the unwillingness of the near-poor to spend money on health insurance — something many of them have never or rarely done — may be the greatest long-term challenge to the new health-insurance system.

"Supporters say the private insurance exchanges will need robust business, including young and healthy customers that help balance the cost of sicker ones, to thrive," Goodnough notes. But her story also looks at people like Amanda Mayhew, 38, of Louisville, whose income is low enough for her to get free Medicaid coverage: "She has been to the dentist five times to begin salvaging her neglected teeth, has had a dermatologist remove a mole and has gotten medication for her depression."

Kentuckians with health insurance are more likely to have heard about Kynect than those without insurance, poll finds

The 10 percent of Kentuckians who remain without health insurance are less likely to have heard much about Kynect, the state health-insurance exchange created under the federal health-reform law, than those who have insurance.

But overall, the uninsured are only a little less likely than all Kentucky adults to have heard anything about the online marketplace, according to the latest Kentucky Health Issues Poll. The survey, taken Oct. 8 through Nov. 6, found that 77 percent of Kentucky adults said they had heard about Kynect. Among the uninsured, the figure was 70 percent.

However, the uninsured were much less likely to say they had heard "a lot" or "some" about Kynect, and more likely to say they had heard "only a little." And only 17 percent of the uninsured said they had tried to get more information about Kynect, suggesting that efforts to reach the uninsured to get them to sign up for coverage have not reached a substantial part of the population the exchange was designed to serve.

Kynect can be used to sign up for private health insurance or the federal-state Medicaid program, which the state has expanded to include people in households with annual incomes up to 138 percent of the federal poverty level, which in 2013 was $32,500 for a family of four. Among Kentucky adults with such incomes, 19 percent said they had sought more information about Kynect.

The poll was conducted by the Institute for Policy Research at the University of Cincinnati for the Foundation for a Healthy Kentucky and Interact for Health, formerly the Health Foundation of Greater Cincinnati. It interviewed 1,597 adults throughout Kentucky, 1,086 by landline telephone and 511 by cellphone. In 95 of 100 cases, the statewide estimates will be accurate to ± 2.5 percent. The error margin for smaller samples is larger. For details about the poll, go to www.interactforhealth.org/kentucky-health-issues-poll.

Dec. 15 is deadline for Jan. 1 Kynect coverage; final deadline in second open enrollment is Feb. 15

Kentuckians can sign up for coverage under the Patient Protection and Affordable Care Act through Kynect, Kentucky's health insurance exchange, through Feb. 15. But to be covered on Jan. 1, you must sign up by Dec. 15.

Coverage for those who miss the Dec. 15 deadline and sign up between Dec. 16 and Jan. 15, will begin on Feb. 1. Those who enroll between Jan. 15 and the Feb. 15 deadline will have a March 1 effective date.

Nearly 18,000 new applications have been filed since open enrollment began Nov. 15, with more expected to sign up in the coming days, state officials told Chris Kenning of The Courier-Journal. It has not yet been determined how many of these applicants were for Medicaid and how many were for private plans.

This year, the penalty for not having coverage in 2015 will rise from $95 per adult, or 1 percent of household income, to $325 per adult or 2 percent of household income, whichever is greater.

And if you are one of the 80,000 Kentuckians who purchased private plans last year that will be automatically re-enrolled, changes in subsidies and premium amounts may cause an increase in your plan cost so it is important for this group to re-evaluate their plans this year, Kenning writes.

 "You could get a bigger subsidy, a lower monthly cost, or more network options if you shop again,"  Carrie Banahan, executive director of Kynect, told Kenning.

Officials estimate 290,000 Kentuckians are potentially eligible for subsidies with the Affordable Care Act, Kenning reports. Subsides are based on income, but are capped at $46,680 for individuals and $95,400 for a family of four.

He offers these examples of how subsidies might work: a 35-year-old single parent of two who earns $35,000 per year could get a monthly subsidy of $240; or a retired couple with $50,000 in income could get a $526 monthly subsidy.

To examine Kynect options, visit https://kynect.ky.gov or call 1-855-4kynect (459-6328)

If you have a Kynect policy, or are buying one, shop around to get the best deal; prices and tax credits change each year

Obamacare customers in Kentucky probably need to shop around the Kynect health insurance marketplace if they want to get a better deal this year.

"More than 70 percent of people currently enrolled in Affordable Care Act health-insurance-marketplace insurance can find a 2015 health plan offering the same level of coverage at a cheaper premium," reports Jason Millman of The Washington Post, citing a report from the federal Department of Health and Human Services. The report says 80 percent of current enrollees could likely "find a health plan with a monthly premium lower than $100 after tax credits are applied."

The reason, according to the department, is that premiums for the benchmark "silver" plan, the second-lowest cost plan in each area, are increasing an average of 2 percent this year. The benchmark plan is used to calculate how much a tax credit a consumer can receive on any plan, and it may have changed in each area, causing a change in the tax credit in 2015.

Most people generally stick with their health insurance, even if it means passing up a better deal, and the Obama administration "is begging" people to shop around to make sure they have the best plan available to them, Milliman reports.

Shoppers have until Feb. 15 to pick a health plan, but they only have until Dec. 15 to choose a plan for coverage starting Jan 1.

The health-reform law is working well, but “One fundamental challenge remains: If Obamacare is to succeed in holding down premiums over the long run, it needs consumers to shop around," rather than treating health insurance like finance or a utility, and falling victim to "consumer inertia," James Surowiecki writes for The New Yorker magazine.

"Consumer inertia" in health care
New Yorker illustration by Christoph Niemann

"People have no difficulty comparison-shopping and changing allegiance when it comes to, say, automobiles or consumer electronics. Companies in those markets face huge pressure to keep quality high and prices low," Surowiecki writes. "But there are also markets where consumers tend to stick with the same choice forever, even though switching could save them quite a bit of money. Energy bills are a classic example. We’ve long been told we can save money by leaving incumbent providers for newer upstarts, but the vast majority of us haven’t. Economists call it consumer inertia, and you can see it in many fields, including banking, credit cards, and health insurance."

Surowiecki elaborates on several factors that cause this inertia: the complicated and confusing nature of health insurance, which often offers complex and multiple options; the time and energy it takes to do enough research to make an informed switch; the added complexity of factoring in subsidies and taxes that comes with Obamacare; and the greatest one, the very real fear of changing doctors if you change insurance.

This inertia benefits insurance companies, making it easy for them to raise prices, Surowiecki writes. He offers this example: If you have a storage unit, you may well have been lured by an attractive monthly rate, only to find that it soon started rising by significant increments. (What are you going to do? Move all your stuff?) "Similarly, even though there are lots of affordable new Obamacare plans this year, many of last year’s are raising premiums substantially," he writes.

Surowiecki says Obamacare both limits and encourages this inertia. It limits through the influx of new customers who pay attention to price, pressuring insurance companies to keep premiums reasonable. He also suggests that people with lower incomes, as many using the law are, will scrutinize the price of their insurance. But the automatic renewals of insurance built into the law, for those who don't change plans, encourages the inertia.

One study found that “fully informed” consumers saved a couple of thousand dollars compared with those who were less well informed, as long as they are confronted with the information, Surowiecki reports.

Kynect policyholders get premium notices, are urged to check website to see if a better deal is available

The 80,000-plus Kentuckians who bought private health insurance during the first open enrollment period under the federal health-reform law are getting letters notifying them of their new premium and subsidy amounts. Most policies will cost more, and the overall average increase is expected to be 4.6 percent.

Policyholders will be automatically enrolled in the same plans as last year, but should check the state's Kynect website to see if a better plan is avaialble. The second enrollment under the law is open through Feb. 15.

Kentuckians are showing "brisk interest" in Kynect coverage, according to a news release from Gov. Steve Beshear's office. It said that as of 11 a.m. Friday:
• 72,335 unique visitors to the site had viewed 2.1 million web pages;
• 45,412 people had conducted preliminary screenings;
• 4,180 new accounts had been created;
• 6,471 new applications had been submitted;
• 8,727 people had made changes to existing applications; and
• 3,199 people renewed their enrollment in a private health-insurance plan.
• 908 people newly enrolled in a private plan.

The release said more than 1,800 people had visited the new, federally funded Kynect store at Fayette Mall in Lexington, and 522 of them had completed applications for new coverage.

“We made tremendous headway last year, but we still have thousands of Kentuckians who need insurance for themselves and for their families,” said Carrie Banahan, executive director of Kynect. “Not only do we encourage first-time insurance buyers to check out Kynect online, by phone or in person with an insurance agent or Kynector, we are also strongly encouraging those who enrolled last year to check out the plans available for 2015. You could get a bigger subsidy, a lower monthly cost, or more network options if you shop again.”

Carrie Banahan, director of Kynect, is named one of Governing magazine's nine Public Officials of the Year

Carrie Banahan, executive director of the Kentucky Health Benefit Exchange, has been selected by Governing magazine as one of nine 2014 Public Officials of the Year.

The magazine, for state and local government officials, has presented the awards since 1994 to recognize excellence in state and local government.

The magazine said it chose Banahan "for her tireless work overseeing the creation, development and promotion of Kynect," the brand for the insurance exchange created under the federal health-reform law. Her profile will be featured in the December issue of the publication.

“Lots of things had to go right before Kentucky became the nation’s gold standard for health-care implementation, and the first thing we did right was to name Carrie Banahan as kynect’s executive director,” Gov. Steve Beshear said in a release from his office. “Carrie not only had the perfect mix of experience and technical know-how to direct Kynect, she had the passion for the job."

Over her more than three decades of public service, Banahan has served as deputy commissioner of the Department of Insurance, deputy commissioner of the Department for Medicaid Services and executive director of the Office of Health Policy in the Cabinet for Health and Family Services.

“Carrie was truly the perfect person for this job. It is as if her whole career has been training her for this very opportunity,” Cabinet Secretary Audrey Haynes said in the release. "She is certainly deserving of this prestigious honor.”

Kynect has enrolled more than 521,000 Kentuckians in health care coverage, with three out of every four enrollees reporting they did not have health insurance prior to signing up, says the release. The Gallup Organization found that the percentage of Kentuckians without health insurance fell from 20.4 percent in 2013 to 11.9 percent midway through 2014, second only to Arkansas, the other Southern state that expanded Medicaid.

Kynect enrollment for private, subsidized insurance reopens; previous enrollees should check website and re-enroll

By Molly Burchett
Kentucky Health News

The Patient Protection and Affordable Care Act's second annual open enrollment period has started and brings with it many changes.

Kentuckians can use Kynect, the state’s health insurance exchange, to purchase their plans. They can also use Kynect to sign up for Medicaid, if they qualify. During the first open enrollment period under the 2010 federal law, more than 521,000 people obtained coverage through Kynect.

About 85,000 of them purchased private insurance plans, and most of those received a federal subsidy. The rest were added to Medicaid, the government health insurance program for the poor and disabled.

People who have been added to Medicaid do not need to sign up again, but should report income changes to the managed-care organization that handles their coverage. They can change their MCO until Dec. 12.

Even those who purchased plans through Kynect last year should re-enroll and consider purchasing a different plan this year because plans have changed, new plans are being offered and there have been changes in the factors used to calculate premiums and subsidies. 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 be more of sting than this year's $95-or-1 percent penalty.

Health plans will send a new tax document, IRS Form 1095-B, to policyholders to document 2014 coverage. While some exemptions are available for a short lapse of coverage up to 3 months, most taxpayers without coverage must pay the 2014 penalty and will get a taste of the higher penalties to come.

Plans on Kynect still vary widely. In addition to comparing premiums, it is important to consider deductibles, co-payments and other plan details. Kynect offers four basic types, labeled bronze, silver, gold and platinum. Bronze plans have the lowest premiums but have the highest deductible. As you move up the plan spectrum to platinum, your premiums increase and your deductibles decrease. The exchange also offers people under 30 a plan that provides only catastrophic coverage with a very high deductible and no subsidy.

Expect premium and plan changes

Premium increases in 2015 are likely for most Kentuckians, but some premiums could decline slightly. Rate filings indicate plans with Kentucky Health Cooperative could increase an average of 20 percent, while plans with Humana could increase an average of 12.8 percent. The tax-credit subsidy available to people with incomes between 100 and 400 percent of the federal poverty level ($11,670 to $46,680 for an individual) reduced the effect of premium increases.

Buyers should be watch for changes in plans because subsidies are based on the second-lowest-cost plan, silver, and many of these plans have changed in 2015. When that happens, people may face substantial premium increases unless they take the time to shop and make sure they’re still in a low-cost plan.

Fortunately, this year the actual cost of health insurance this year will be displayed on Kynect, giving insurance-browsers both the basic premium cost and the subsidy before completing an application. Enrollees can also complete a preliminary eligibility determination to see if they qualify for Medicaid or a subsidy.

Check premium and subsidy estimates

Two types of subsidies are available. The premium tax credit can be taken in two ways: You can apply it to monthly payments, or take it when you file your tax return. The other type of subsidy, cost-sharing, is designed to minimize enrollees’ out-of-pocket costs when they go to the doctor or have a hospital stay.df

INCOME LIMITS FOR TAX-CREDIT SUBSIDIES

Lower-income families get the most help. You may qualify for payment assistance if your employer does not offer health insurance, you do not receive Medicare, or your family does not make more than the yearly income listed in the chart to the right. Click here for more information.

Let's consider the coverage eligibility of a man we will call John Smith to see how plans coverage differ from his options for 2014 plans. The individual market in Floyd County was limited to two companies in 2014, Anthem Blue Cross and the non-profit Kentucky Health Cooperative; Humana wasn't (and still isn't) offering individual coverage there. John could chose varying levels of plans, and based on the plan type, his premiums ranged from $182 (bronze) to $421 (platinum), with deductibles ranging from $6,300 (bronze) to $500 (platinum).

In 2015, John can still only chose between Anthem and the co-op. His premium options range from $204 (KHC-bronze) to $426 (Anthem-gold), with deductibles ranging from $5,750 (Anthem-bronze) to $1,000 (KHC and Anthem-platinum). However, be careful to watch out for high out-of-pocket costs, which for most bronze and silver plans, are $6,600 per person in 2015.

The estimated monthly premiums in the chart are the full price before any payment assistance. the total premium for the plan John wanted was estimated to be $415.48, but his income qualified him for a 47 percent subsidy. Using Kynect's Health Plan Savings Calculator, John's estimated actual cost is $220.80. The Kynect website will provide estimates of premiums and assistance, but the actual amount can't be determined until you complete a full application.

Important dates to remember

There are several key dates for you to keep in mind during this enrollment period, which is shorter than the first one:

• Nov. 15: second open enrollment period began 
• Dec. 15: Consumers must select a plan for coverage to begin by Jan. 1. Currently enrolled consumers must renew coverage and application for financial system. If they fail to do so, current coverage and tax credits may be automatically renewed. (See below.)
• Feb. 15: Last say of open enrollment period. Those consumers who select a plan on this date will begin new coverage March 1. Medicaid enrollment is open year-round. 
• April 15: Deadline for filing tax returns, on which taxpayers must indicate coverage in 2014 or face a penalty. Consumers who got tax-credit subsidies in 2014 must file a tax return.

Here is a new and crucial change: If you're already enrolled in a Kynect plan in 2014 and do nothing during open enrollment before December 15, 2014, you will be automatically re-enrolled in an existing plan for next year with your existing premium tax credit.

However, consumer advocates say doing nothing could be costly. If you have experienced changes in income or other circumstances that could affect your tax credit, you risk receiving the wrong amount and may have to pay back next year. Changes in the benchmark silver plans could lead to higher costs for some consumers. Even if the premium of a particular plan may go down, the decrease in the tax credit could be even more, resulting in a net increase, 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.

Those who miss the enrollment deadline may still qualify for special enrollment period if they experience what the law calls "life changing events," such as moving or losing your job.

Additional changes to Kynect include an enhanced website, more call center agents, expanded call-center hours, a Kynect storefront at Fayette Mall in Lexington, and a Kynect app for Apple and Android smartphones that allows users to access their Kynect account, see details of their plan and submit photos of documents for verification.

For more information, call 1-855-459-6328 or go to www.kynect.ky.gov.

Second round of private insurance enrollment under Obamacare starts Nov. 15; rates estimated to rise an average of 4.6%

Enrollment reopens Saturday, Nov. 15, for health insurance under the federal health-reform law and the state insurance exchange, known as Kynect.

In the second year of what is typically called Obamacare, there will be new insurers, new rates, a shorter enrollment period and larger penalties for not having health insurance.

The changes in rates and subsidies will affect people who enrolled in the first round a year ago, because the factors used to calculate them, "such as age, income and the cost of a certain plan used as a benchmark," will change, report Laura Ungar and Chris Kenning of The Courier-Journal.

"PwC, an assurance, tax and consulting firm that collected individual insurance rate filings across the nation, estimated Kentucky's average premium increase on and off the exchange will be 4.6 percent," The C-J reports. (PwC was formerly known as PricewaterhouseCoopers.)

At a news conference Monday, Gov. Steve Beshear noted that premiums in the individual health-insurance market increased 8 percent or more a year before the reform law passed "and there were no subsidies or discounts to help defray costs," Jack Brammer writes for the Lexington Herald-Leader.

"Costs will vary widely," Ungar and Kenning write. "Officials said there are 70,000 premium rates between all the insurers offering various plans on the exchange, and they are still being certified so they cannot yet be made public."

Competition could be keeping rate hikes modest. Two new companies will offering policies on Kynect: CareSource and WellCare, joining five previous insurers.

Kynect provides premium subsidies based on applicants' incomes. "Officials estimate that, in total, around 290,000 Kentuckians are potentially eligible for subsidies with Obamacare plans," The C-J reports. The Kynect website has been changed so users can figure potential premiums and subsidies without actually starting applications.

State officials estimate that about 100,000 people have policies that don't comply with Obamacare rules but were allowed to keep them until 2016. "These could include more than 14,000 customers told in early October by their insurers that their plans are being discontinued," the newspaper reports. "Ronda Sloan, spokeswoman for the Kentucky Department of Insurance, said this is a business decision by insurers."

Kynect is more than doubling its call-center staff and expanding its hours to reduce wait times, which were as long as three hours last year, and is working with 2,800 insurance agents, twice as many as last year, exchange Director Carrie Banahan told the Louisville newspaper. It will also have a federally funded app for Android and Apple smartphones and a "pop-up" store in Lexington. The call center will be open from 8 a.m. to 7 p.m. Monday through Friday and 8 a.m. to 5 p.m. Saturdays.

This year's open enrollment is expected to be less hectic than last year's "because people signing up for Medicaid — who became eligible under the state's expansion of the program and made up the majority of Kynect's sign-ups last year — can enroll at any time," Ungar and Kenning write. They quote Prestonsburg insurance agent Darrell Patton: "There's not as much talk about it this time. It came and it passed, and the sun still came up the next morning."

Still, Patton said some confusion remains, and there is unhappiness with "narrow networks of doctors and hospitals or not being able to get needed services covered," the C-J reporters write.

The penalty for individuals without health coverage in 2015 will be $325 per adult or 2 percent of household income, whichever is higher, up from this year's $95 and 1 percent. The current penalty isn't very effective because taxpayers haven't been required to say on their tax forms whether they had insurance. They will on next year's forms. "Those who went without in some cases can claim an exemption on the form or provide additional documentation if one was previously granted," the writers report.

The second enrollment period will be shorter, closing Feb. 15. Beshear encouraged Kentuckians to shop around, and do it early. Those on Medicaid, form which enrollment is open year-round, do not have to re-enroll unless they want to change their managed-care organization.

Sen. Mitch McConnell faces diverse pressures on the question of repealing the federal health-reform law

Incoming Senate Majority Leader Mitch McConnell says he still wants to get rid of Obamacare, and the Kentuckian is "under rapidly increasing pressure from conservatives to pursue an aggressive path to repealing the landmark health care law," but it won't be easy, Jennifer Haberkorn reports for Politico.

Ardent conservatives are calling for repeated repeal votes under budget reconciliation, which requires only 51 votes, not the 60 usually needed to do significant business in the Senate. But establishment Republicans "barely mentioned Obamacare" the day after the election, Haberkorn notes. McConnell indicated that 60 votes are needed for repeal, and it takes 67 votes to override a presidential veto.

"McConnell has said that he wants to use the Senate appropriations process to starve funding to the law. When asked about his strategy on Wednesday, he said Republicans would be 'addressing that issue in a variety of different ways' and hinted at using reconciliation by saying that 'There are some things we can do with 51 votes'," Haberkorn writes. "Reconciliation is tricky — it would require Congress to pass a budget resolution, which is no easy task, and in the end, even a successful Obamacare repeal bill would just get vetoed anyway. And by the time they’re done, Republicans would have squandered potentially months of their new majority debating health care."

Several Republican sources say that McConnell will all but certainly hold an early, symbolic full repeal vote that is expected to generate support from every Republican and probably no Democrats. It will fail to overcome the 60-vote threshold for a filibuster. Beyond that, the Republican conference will collectively decide the strategy: a full-bore attack on as much of the law as possible, or a selective picking and choosing of the most vulnerable pieces of the law," such as its tax on medical devices and the coming mandate that employers of more than 50 people insure employees who work 30 or more hours a week.

"While Obamacare on the whole remains unpopular, there are pitfalls in any repeal strategy that includes popular parts of the law," Haberkorn notes. "That includes helping people with pre-existing conditions get covered, the subsidies that make insurance more affordable, and the exchanges, which is particularly popular in McConnell’s home state of Kentucky."

Still, "In some quarters, anything other than the full-scale assault is unacceptable," Haberkorn reports. "When McConnell stated on Fox News the other day the simple fact that Republicans couldn’t repeal the whole thing, the backlash was swift. The Senate Conservatives Fund, which backed his Kentucky Tea Party primary opponent, accused him of being insufficiently committed and of 'making excuses for why he won’t deliver on his central campaign promise.' McConnell’s aides had to send out statements restating how much he despised the health law."