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Health

A primer for those eligible for affordable health care next year

For Nevada’s 557,000 uninsured residents under the age of 65, it’s time to breathe a sigh of relief. At least for the next few years. Starting in October 2013, in accordance with the Affordable Care Act, our state will establish a health care exchange, with a goal of making the program self-sustaining by the time the federally funded portion of the four-year contract expires at the end of 2014. (Governor Brian Sandoval has cautioned that the program will most likely be scrapped if that doesn’t happen.)

There are many issues still to be addressed (Will a self-sustaining model really work? Will the Medicaid threshold be expanded?), but in the meantime, we put a few important questions to CJ Bawden, spokesman for the Silver State Health Care Exchange, the independent state body charged with administering the program.

How do I get this insurance?

You can go to a website or a call center, both administered by Xerox State Healthcare, which contracted with the state, or you can go directly to the insurance broker of your choice. In addition, Bawden says “navigators” will help with outreach and education.

How much will this cost me?

It depends on the results of your application. For a family of four, if your income falls between $23,500 and $92,000 a year, you fall between 100 and 400 percent of the federal poverty level (FPL), the range for federal subsidies. There are gold, silver and bronze insurance programs available, and your FPL will determine which program fits you best.

How does the state make money from this?

For each person who gets insured, the insuring company pays the state a monthly fee. In 2014, that fee will be $4.40, rising to $6.20 in 2015. The fees are expected to generate $7.7 million in 2014 and $13.6 million in 2015.

The success or failure of the program will depend upon how many people actually enroll, Bawden says, adding his agency’s estimate of 139,000 enrollees in 2014 and 170,000 in 2015 is neither best nor worst case. “It’s right in the middle.”

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Ken Miller is Las Vegas Weekly's associate editor, having previously served as assistant features editor at the Las Vegas Sun ...

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