[ View the story "How the Affordable Care Act affects U.S. territories" on Storify] How the Affordable Care Act affects U.S. territories The Stream investigates why U.S. territories are conspicuously absent from ACA exchange websites.
AJAMStream· Wed, Oct 30 2013 16:06:49
Below is a screenshot of what appears when American Samoa is entered in the health care exchange website.
So the US territories aren't eligible for Obamacare? http://twitter.com/cjpressner/status/395573609432760320/photo/1Chas Pressner
With the exception of Puerto Rico, which has a popular locally funded
health coverage program
, the rate of uninsured in U.S. territories far exceeds the U.S. average.
Many have wondered if the territories were ineligible or left out of the Affordable Care Act. In actuality,
of the Affordable Care Act are devoted to the territories, leaving much of its interpretation up to the Department of Health and Human Services (HHS). The
in how the law applies to states versus territories is that the territories are forced to choose between either implementing an exchange or boosting funding for Medicare. HHS's interpretation of which reforms apply to the territories, however, has made it very difficult for territories to choose to set up exchanges. The Department has interpreted the law to mean that Obamacare's market reforms apply to the territories, but not its individual and employer mandates. This increases the risk of "
," which occurs when not enough healthy people choose to enroll and sends health care premiums skyrocketing unless the exchange is heavily subsidized.
While the law is unclear on which reforms apply to the territories, it does
how much funding each territory would receive for its two options. For many of the territories, the disparity in funding afforded to each option made the choice clear. U.S. Virgin Islands Governor John deJongh Jr.
a task force to look into the feasibility of creating an exchange in the islands. The task force estimated that it would take $251 million to implement and properly subsidize a Virgin Islands exchange over 5 years, while the ACA only offers one-time federal funding of $25 million toward implementation. In contrast, the ACA offers the U.S. Virgin Islands $40 million per year over 7 years in medicare expansion funding, which would extend coverage to an estimated 30,000 U.S. Virgin Islands residents.
Many residents aren't happy with the either-or proposition that is unique to the territories, as it does not provide options to the self-employed.
Without an insurance exchange, individuals who are self-employed are left without the option to buy their own policies as long as they work alone. This is because carriers have never found it cost-effective to offer such policies to such a small population, according to Steven Baker, an insurance buyer for businesses in the Virgin Islands. "An insurance company is not your friend; it's not your buddy," Baker said. "They are here to make money. They have never found that the population, being so small, could support the writing of individual policies."virginislandsdailynews.com
Many of the territories' governments have
that they do not believe exchanges are feasible. However, most have not made an official decision on the matter. Several territories are exploring joining the exchanges of neighboring states. Guam, whose first-year costs of operating an exchange would exceed $104 million,
to be a part of the Hawaii Health Exchange but was denied.
Read the portion of the Affordable Care Act devoted to U.S. Territories here: Should the U.S. territories be treated the same as states under the Affordable Care Act? What do you think? Leave a comment below.