As of today, a key milestone in health care reform is 100 days away.
While some help with insurance enrollment under the Affordable Care Act will likely be coming soon to some Augusta providers, even advocates admit that time for getting everything ready by Oct. 1 is tight. How to achieve some key pieces, such as enrolling the young and healthy, remains unclear.
The Government Accountability Office noted last week that the Centers for Medicare and Medicaid Services is behind in some areas in establishing insurance exchanges and subsidies in the 34 states that will not establish their own, which includes the entire Southeast.
Key assistance for the “navigator” program of community groups that will do outreach and education on the exchanges won’t be granted until mid-August.
“Which means then there will be about six weeks for the navigators to go through the training and do everything that they need to do to be ready on Oct. 1 to go out and talk with consumers,” said Cindy Zeldin, the executive director of Georgians for a Healthy Future.
A further complication for navigators in Georgia is a state law passed this year that would require them to be licensed by the state insurance commissioner and have 35 hours of training that includes the state’s Medicaid and PeachCare programs.
The regulations have yet to be finalized, but what Zeldin has seen in draft form has caused her concern.
It “does seem like it would present a very difficult timeline,” she said. The
navigators already have 30 hours of federal training. Zeldin said that while she recognized the need to protect consumers, more provisions might not help.
“There’s a point at which it is interfering with their ability to hit the ground running on Oct. 1, given that they already have a training and a licensing process federally,” Zeldin said.
One thing that should help are federal grants to provide enrollment coordinators at community health centers such as Christ Community Health Services in Augusta. Those grants are supposed to be announced around July 1 and would allow Christ Community to begin preparing earlier, Executive Director Jeff Drake said.
“For us, it’s a big deal because 65 percent of our patients are uninsured,” he said. “Without the enrollment coordinator, we don’t have the extra capacity in our staff to help our patients get into the system. This enrollment coordinator will help us be that much more prepared and be able to give one-on-one time, if necessary.”
Patients might lack computer access to the online exchange or might not be able to even read or write, which the coordinator could help facilitate, Drake said.
The human element is going to be key for the marketplaces to work, said Dr. Keith Mueller, the director of the Rural Policy Research Institute for Rural Health Policy Analysis at the University of Iowa.
“Do not assume that everyone is going to be facile going to some computer portal and working their way through,” he told a recent gathering of the Association of Health Care Journalists.
There might be special challenges in reaching the young, healthy people whom insurance companies need to balance out the risk pool with the many chronically ill, said Dr. David Becker, an associate professor in the University of Alabama at Birmingham’s School of Public Health.
The fine for not having health insurance next year is only $95, he said.
“Does ($95) make me do things I don’t want to do? Not necessarily,” Becker said.
Zeldin pointed to a poll last week from the Kaiser Family Foundation that found more than 70 percent of those ages 18-30 said it was important for them to have health insurance. A special catastrophic health plan for those younger than 30 would appeal to some, she said, and women in that age group could be key.
“Very young and healthy women do typically have ongoing preventive health care needs,” she said.
The poll was welcome news to Anita Maxwell, the director of community relations for Consumers Choice Health Plans, the nonprofit insurance cooperative for South Carolina.
“I would say everyone is trying to reach that group,” she said. Consumers Choice is reaching out through social media, Maxwell said.
“It’s in front of us. It’s digital. It’s 24 hours, nonstop,” she said. “So we have to make sure we are looking at the way people receive their information, and it is different in 2013.”
The group is also reaching out to schools and colleges. It is making plans to be ready Oct. 1, but until that day comes, it is all speculation, Maxwell said.
“That’s the exciting and a little bit crazy part of this whole thing is that we really don’t know, when all of these things come together, what happens,” she said. “I think we are all preparing, hoping for the best, but until it happens we really won’t know.”