Yes, they are. Under the Affordable Care Act, individual and group plan insurers are required to meet what we consider near term reforms starting in September 2010, as well as the longer-term reforms which will be effective by January 1, 2014.

The near term reforms (Sept. 2010) include: 

1. no lifetime or annual limits on coverage, 
2. prohibition on rescissions , i.e. insurers cannot drop insured individuals because they get sick,
3. insurers must provide coverage for preventive health services, and 
4. extension of coverage of dependent children up to the age of 26. 

The longer term reforms (Jan. 2014) will mean that insurers:

1. will no longer be able to deny coverage for pre-existing conditions or otherwise discriminate against individuals based on health status,
2. must guarantee availability of coverage,
3. must guarantee renewability of coverage,
4. cannot charge discriminatory premium rates, e.g. for women, and
5. must guarantee minimum coverage benefits.

2. What is an Exchange, and will the Virgin Islands establish one here?

The Affordable Care Act provides for the establishment of “Exchanges,” which will be entities where uninsured individuals (who are not eligible for Medicaid) and small businesses can purchase qualified private health insurance plans. Exchanges are intended to expand the availability and accessibility of health insurance by providing “one-stop shopping” that will enable Americans to find a plan that is right for them. The idea behind the Exchanges is to “pool” the purchasing power of those individuals and small employers who are not covered by group plans utilized by big businesses and thereby reduce the cost of health care and increase competition for the business by the insurance companies.

The Virgin Islands will have the option of establishing an Exchange and must make its election by Oct. 1, 2013. If its opts to create an Exchange, the Virgin Islands can receive up to $30 million in federal funds to provide premium and cost-sharing assistance to residents buying insurance through the Exchange. That assistance would help to provide relief to families who have no insurance or otherwise could not afford to buy it.

If we elect not to create an Exchange, we can trade in this allocation for additional Medicaid dollars.

LEARN MORE ABOUT THE PROPOSED HEALTH EXCHANGE›

3. If establishing an Exchange in the Virgin Islands is an option, how will the Government determine if it is feasible to do so?

The Health Care Reform Implementation Task Force will assist the Government in evaluating the feasibility of establishing an Exchange which might require the Virgin Islands to “partner” with another State to take advantage of economies of scale resulting in reasonable premium rates for Virgin Islands families. This is one of the many details that may need to be considered in such an evaluation but have not been determined, and there will undoubtedly be much more information made available in the form of regulations and guidance from the Federal government over the next few years. One factor will be whether federal planning grant funding to be made available to the Virgin Islands will be sufficient to enable the Territory to establish an Exchange.

LEARN MORE ABOUT THE PROPOSED HEALTH EXCHANGE›

4. The Affordable Care Act provides funding which will expand Medicaid program. What does that mean for the Virgin Islands? 

The Virgin Islands is eligible to receive up to $255 million ($285 million if the Territory “trades in” its allocation of federal funds for an Exchange) in additional federal payments for our Medicaid program starting in the last quarter of fiscal year 2011 and the 8 succeeding fiscal years through 2019.

The funding will permit us to expand the Medicaid program as I spoke about earlier. But more specifically, I envision that we will be able to increase enrollment of qualified families through new income eligibility requirements. In addition, we will be able to improve access to affordable prescription drugs and other services for so many of our eligible families, as well as increased Medicaid payment amounts to our primary care providers, so that they can be fairly compensated for their work.

5. What does health care reform mean for a typical Virgin Islands working family with no insurance?

Depending upon their income, they could be eligible for the local Medicaid program or, if we decide to establish an Exchange, they can shop around and buy an affordable health insurance package offering basic coverage (including preventive services) and possibly qualify for premium and cost-sharing assistance.

6. Will Virgin Islanders have to pay a tax penalty of 2.5 percent of their income, if they don’t acquire insurance coverage?

No. Virgin Islanders are exempt from paying the 2.5 percent penalty on income for those individuals who do not have or acquire health insurance.

7. Along with an expected increase in Medicaid enrollment program, what other program enhancements can be expected?

Other program enhancements include an increase in the federal match for the State Children’s Health Insurance Program (91.5% federal match); possibly extending coverage to “newly-eligible” who are childless non-pregnant adults with income up to 133% of the Federal Poverty Guidelines; enhancing computer technology to enroll clients, as well as support a continuum of care process and providing for an electronic health record.

8. Will any jobs be created as a result of Health Care Reform in the Territory?

The additional $285 million in federal funding for the VI provided by the Affordable Care Act will circulate throughout the VI economy, resulting in job creation and enhanced competitiveness. In addition, there are a number of grant opportunities attached to the Health Care Reform provisions. As we are eligible to apply for these grants and receive the grant awards, there will also be jobs created to staff the various initiatives supported by the grants.

9. How is the Government going to address the Small Business Tax Credit issue?

There is still a lot of work to be done in the Virgin Islands regarding the Small Business Tax Credit associated with Health Care Reform. Under our mirror system of taxation, the small employer tax credit will be available to our small businesses beginning this year — just like those on the mainland. However, unlike the States, the cost of the credit will be borne by our local treasury. Moreover, the Virgin Islands and other U.S. Territories with mirror tax codes will not be reimbursed by the federal government. That is one of the changes I will be asking Congress to make in the coming year.