Deadline looms to sign up for health insurance under Affordable Care Act

As March 31 deadline looms, few residents have signed up for insurance

As the clock ticks steadily toward a March 31 deadline, health care officials and nonprofits nationwide and in Louisiana are scrambling to boost the number of people enrolling for health insurance through the marketplace established by the Affordable Care Act.

The end of the month is the last time until fall that people will be able to sign up through the marketplace established by the Affordable Care Act, also known as Obamacare.

Louisiana has a high percentage of uninsured residents but, so far, has seen a low percentage of residents signing up through the plans offered under the new federal program.

“It’s very, very important we have health care security and make sure the citizens of Louisiana have health insurance,” New Orleans Mayor Mitch Landrieu said at a recent event.

About 45,560 Louisianians signed up for health insurance from October through February, about 9.3 percent of the total number eligible. The federal government set a statewide goal of 75,000 for that time frame.

Louisiana ranks 39th among all states in terms of the percentage of people enrolled.

Of those who did sign up, 17,000 — or more than a third — were in New Orleans and Metairie, which had a goal of enrolling 23,000 residents by March 31. That puts the New Orleans area at roughly 74 percent of its goal, compared with 61 percent for the state as a whole.

More official data won’t be released until next month, although the U.S. Department of Health and Human Services said last week that 5 million people nationwide had signed up for coverage since Oct. 1. That means about 800,000 people enrolled since the beginning of the month.

The program’s original goal was to sign up 7 million people by the end of this month.

The marketplace allows open enrollment until March 31 for coverage that starts April 1. Anyone who does not sign up by that deadline will not be able to sign up through the exchange again until the fall.

Michael Griffin, president and CEO of Daughters of Charity Services of New Orleans, said the city’s network of clinics — like the ones run by his organization — for low-income residents has helped boost enrollment numbers. Daughters of Charity has been in touch with 6,000 people since enrollment started last fall, and in the past week, it spoke with 100 people about enrollment and signed up 33, he said.

Enrollment is particularly important in New Orleans because it has “one of the highest concentrations of uninsured in the country,” Griffin said.

Other groups in New Orleans, including 504Healthnet.org and health care services such as the Musicians Clinic, have also been pushing sign-ups through their regular programs and special enrollment events.

Manning the front lines

The front lines of the health care rollout nationwide have been manned by “navigator” groups funded by the federal government to sign up people and raise awareness of the program. The four such groups operating in Louisiana have received about $1.8 million for those efforts, though some also cover other states.

Many of the people turning to Southern United Neighborhoods, a navigator group for Louisiana, Texas and Arkansas, for help do not have computers at home or are uncomfortable using them and need help being guided through the process, Director Marie Hurt said.

“It’s a little bit daunting for someone who is not used to using a computer every day,” she said.

Many of those the group has helped are older residents who do not yet qualify for Medicare, Hurt said. That’s the age range when people start worrying about health problems, perhaps because they have experienced problems themselves or know others who have, she said.

That experience tracks with the statewide statistics, which show about 51 percent of people enrolling for health care are older than 44.

Another 29 percent of those signing up in Louisiana are in the key age range of 18 to 34, a group that has been particularly targeted for enrollment efforts because younger people are generally healthier and incur fewer health care expenses. As a result, adding them to the pool of those who are insured is expected to drive down premiums for all those with insurance.

Final numbers uncertain

Linda Beauvais, executive director of the Capital Area Agency on Aging, District II, said it will enroll somewhere between 600 and 800 people by March 31.

The nonprofit agency has two full-time navigators. Beauvais said it has taken between 240 and 320 people through various stages of the enrollment process. It has also educated an additional 8,700 people at group events — it makes presentations at six to eight events per week — over the six-month enrollment period.

It’s difficult to say how many enrollments the agency will be credited with in the end, she said. It can walk a person through every step except the final one, payment, but if someone else helps with that step, the agency might not get credit for enrolling that person.

The final numbers will be determined by the Department of Health and Human Services.

Capital Area Agency’s original goal was to enroll 2,000 people in HealthCare.gov, the federal online insurance marketplace, and to help educate a total of 10,000.

However, widely reported problems with the online website rendered it almost unusable for the first two months of the enrollment period. The agency instead helped hundreds of people fill out paper applications during that time. The website didn’t start working well until in December.

“We thought you’d sit down and take somebody through the whole process, and when they left your office, they would have insurance,” Beauvais said. “But it turned out that’s not really how it worked.”

The enrollment process has a lot of different parts. Creating an account, examining different plans with different levels of coverage and benefits, making a choice and talking to an insurance company representative all take time for prospective buyers.

“There were so many steps in the process and so many players involved, it ended up being much more fragmented than we thought it would be,” Beauvais said.

The problems with the online marketplace rollout — and the extensive “bad press” it generated — deterred many from looking at the site when it first launched, Hurt said. Those problems also meant that groups helping to sign up residents often found themselves unable to complete applications.

“Everything negative about the marketplace and Obamacare got out there on the front end,” she said.

Lingering problems

While most of the technical problems have been worked out, lingering traces of those early problems remain.

Baton Rouge resident Penny Smith tried unsuccessfully to enroll Saturday at an event sponsored by state Rep. Regina Barrow, D-Baton Rouge, and Health Agents for America.

Smith, who works part time, tried to enroll earlier on her own but ran into technical issues on HealthCare.gov. On Saturday, she tried again but was locked out of the marketplace because her email addresses and passwords didn’t match.

However, agent George K. Francis Jr. was able to walk Smith through the entire process except for enrolling.

“He showed me some plans, but I haven’t decided on one because I want to look at the vision and dental plans and see what I can afford with all three of them together,” Smith said.

One of the options for Smith would involve out-of-pocket costs of around $100 a month. The remaining two-thirds of the premium would be paid for by a federal subsidy.

Francis said he has helped a number of people find coverage through the marketplace, but he doesn’t know how many actually have coverage.

“You’re not really enrolled until you pay the first premium,” he said.

Website woes

Jason Geslois, special projects coordinator for the Martin Luther King Health Center in Baton Rouge, said the website problems had a huge impact on enrollment.

The center, which treats people without insurance, has helped 205 people complete the enrollment application. Its original goal was 300. However, only 31 have actually purchased health plans, as far as the center knows.

Some of the people didn’t qualify for the subsidies. Some couldn’t afford the coverage. Some said they would just pay the penalty that people without health insurance will be assessed. Some said they wanted to think about it and get back to the center but never did.

A number of applicants didn’t qualify for Medicaid or the subsidies offered under the Affordable Care Act, Geslois said. Those people were looking at monthly premiums of $500 or $600, which would have taken up their entire Social Security or disability check.

Geslois said it was difficult to do follow-up with the people the center helped. Because of security concerns, navigator groups are not allowed to keep the applicants’ data, he said. It’s possible, therefore, that some of those the center helped ended up purchasing coverage without its knowledge.

For example, the center helped 80 people file paper applications. Federal call centers then phoned those applicants to tell them if they were eligible for subsidies, so the Baton Rouge center has no way to check on their status.

Geslois said it probably took two hours to take a person through the process early on, but the time now is closer to 30 to 45 minutes. Most people consider different plans and levels of coverage, and some want to make sure their doctors and medications are covered.

“Many have just never had insurance before and needed insurance just to get by. They were looking at what they could afford; that was their primary goal,” he said.

Rejecting Medicaid expansion

Some officials, however, said the state’s decision not to expand its Medicaid program will leave many people unable to afford private insurance.

The U.S. Supreme Court ruling that the Affordable Care Act was constitutional did strike down one key element: a provision that would have stripped Medicaid money from states that refused to expand that program’s coverage to residents making up to 138 percent of the federal poverty level, or about $32,499.

Without that provision, many states — including Louisiana — with Republican governors or legislatures refused the Medicaid expansion, even though it would be free to state governments in its early years and almost entirely covered by the federal government in later ones.

That left many low-income workers falling in a “gap”: They don’t make enough to qualify for subsidies — which become available for residents making $11,499 or more — but make too much to qualify for traditional Medicaid programs.

In a visit to New Orleans on Thursday, U.S. Health and Human Services Secretary Kathleen Sebelius said Louisiana’s enrollment numbers were typical for states that had not expanded their Medicaid programs.

She urged Gov. Bobby Jindal, who has said the expanded program would be too expensive in the long run, to reconsider. Should that happen, more than 90 percent of the uninsured in the state would be eligible for some sort of federal assistance getting insurance, she said.

“The vast majority of uninsured people in Louisiana qualify for some kind of help,” Sebelius said.