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It's been almost three years to the day since Congress passed the Patient Protection and Affordable Care Act, better known by many as Obamacare. But many of the law's provisions aren't yet in effect.
When the law is finally implemented, the way a lot of us buy health insurance is totally going to change, and it will change in different ways depending on whether you live in D.C., Maryland or Virginia.
One of the biggest is the creation of online health exchanges. Health exchanges will be similar to travel booking websites like Priceline, Hotwire or Expedia. Users will be able to enter in some information, and the exchange website will tell them the prices for several health insurance policies from different insurance companies. An exchange website can also tell if individuals are eligible for any health insurance tax credits.
The idea is to allow users to compare and contrast health insurance policies almost instantly from the comfort of a laptop or home computer. If this law works the way lawmakers intended it to, that easy ability to compare will bring down the price of health insurance -- at least in theory.
"It is certainly true that something of this magnitude has never been done before," says Mila Hofman, director of the D.C. Health Benefit Exchange Authority.
She's one of the people in charge of creating the District's health exchange website. D.C. is going to have its own website, but many other states won't.
The Affordable Care Act allowed states to opt out of creating a health exchange website. If a state decides it doesn't want its own website, for whatever reason, then people in that state would buy their health insurance through an exchange site run by the federal government.
Right now, there are 26 states where the governors and the legislatures have said no, so the people in those states will all use the federal website.
One of those states is Virginia. Republicans there helped lead the charge against the health reform law, and those lawmakers there don't want to participate in it if they don't have to.
In D.C. and Maryland, however, the opposite is true.
"Both Maryland and D.C. made an early decision that we were going to implement the Affordable Care Act fully," Hofman says.
So why does it matter whether a state has its own website or uses the federal site?
The website run by the federal government is going to be one-size-fits-all. The companies that sell policies through that site will have to meet some minimum requirements, but that's it.
If a state creates its own website, it can add extra requirements. For example, D.C. has a much higher rate of people living with HIV and AIDS than most other states. So D.C. could say to the insurance companies, "If you want to sell insurance through our website, you have to cover HIV and AIDS medication at a higher level than what you'd have to do in the federal exchange."
D.C. hasn't actually decided if it's going to do that yet, but that's something it, or Maryland, could do. Virginia can't do that because it's not controlling its own health exchange.
These websites are not meant to be used by everyone. The only people who will need to use them are people who buy health insurance as individuals — people who are self-employed or unemployed, for example, and people who own small businesses and are buying insurance for their employees. Individuals that get insurance through work, won't need to buy insurance through an exchange, although they still can, if they want to.
There is, however, a tiny quirk in the law here that affects our region big time.
Federal workers won't need to use an exchange, but for some reason, the Affordable Care Act says members of Congress and their staffers do. So for example, individuals that work at, say, the Department of Agriculture, won't need to use an exchange website. But those that work for Frank D. Lucas, the Oklahoma Republican who chairs the House Agriculture Committee, they will have to use an exchange.
But ultimately, whether an individual buys insurance through an exchange website or not, they will be affected because it's going to have a huge impact on the health insurance industry as a whole.
For example, Sam Sahouri Ghanem is an insurance broker who's worked for 30 years with businesses in D.C., Maryland and Virginia to help them find the right insurer. If health insurance were like buying a plane ticket, he would be kind of like a travel agent.
And we all know what happened to travel agents after websites like Priceline, Expedia and so on started popping up. They nearly made the whole travel agent profession go extinct. Ghanem is really afraid that's what's going to happen to him.
"I feel like I'm a whipmaker or a carriage maker [and] it's 1901, and I just saw the first car," he says. "I'm a little concerned. Normally for people like me, by this time, by this age, we either look to sell our business or pass it on, and I'm afraid there's not going to be much to pass on... We don't know what the business is going to look like."
Ghanem will have to wait a little bit longer to see how this all plays out. The health exchange websites won't be up and running in their various states until October, and the policies purchased from those exchanges won't go into effect until Jan. 1, 2014.
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