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PCN Enrollees

Utah’s Primary Care Network restricts health care access—forcing families to juggle urgent health care needs
“PCN is a Band-Aid Solution”

Ten years ago, Julie and her husband owned their own successful business and had private health insurance. But it all turned upside-down when Julie’s husband became ill. Now, Julie is the primary provider for her family; she works part-time at the local middle school helping children with special needs. She is not offered health benefits through the school, though her husband receives disability Medicare. Their two children are covered through CHIP and Medicaid. This leaves Julie out in the cold. All she can qualify for is the state’s Primary Care Network (PCN), which only covers basic preventive care.

PCN is “not much comfort” remarks Julie. “It’s really a band-aid, not a fix.” Julie is concerned about what will happen if she becomes seriously ill and needs to be hospitalized or see a specialist—services the PCN doesn’t cover. “What can PCN do for me then? And more importantly, what could I do for my family as the sole provider?” she asks. Julie hopes health reforms will mean coverage is more user friendly, less discriminatory and available to everyone in need, not just those who meet limited qualifications.

However minimal the coverage through PCN is, Julie worries that full time employment would put her over the income limit for any coverage. She feels pressured to keep working part-time just so she can keep the lousy health coverage she has through the PCN.

The Patient Protection and Affordable Care Act is designed to provide protection to families like Julie's:

Julie characterizes her coverage through Utah’s Primary Care Network (PCN) as “a band-aid, not a fix.” The PCN helps individuals earning less than 100% of the federal poverty line (FPL) and parents earning less than 150% of the FPL access primary and wellness care. However, it does not provide adequate coverage for its enrollees.

In specific, the heath reform bill will increase coverage, create state-based exchanges that would offer affordable coverage, and provide subsidies to help pay for that coverage. The new bill will:

  • Expand coverage to 32 million Americans who are currently uninsured.
  • The uninsured and self-employed will be able to purchase insurance through state-based exchanges with subsidies available to individuals and families with income between the 133 percent and 400 percent of poverty level.
  • Separate exchanges will be created for small businesses to purchase coverage -- effective 2014.
  • Funding will be available to states to establish exchanges within one year of enactment and until January 1, 2015.
  • Individuals and families who make between 100 percent - 400 percent of the Federal Poverty Level (FPL) and want to purchase their own health insurance on an exchange are eligible for subsidies. They cannot be eligible for Medicare, Medicaid and cannot be covered by an employer. Eligible buyers receive premium credits and there is a cap for how much they have to contribute to their premiums on a sliding scale. (Federal Poverty Level for family of four is $22,050)