ACA enrollment could be harmed by confusion, lack of information on program, experts say

Navigator Monica Baldwin at Christ Community Health Services helped nearly 180 people enroll in the Affordable Care Act last time and is already fielding calls from concerned patients ahead of the next Open Enrollment period, which begins Nov. 1. TOM CORWIN/STAFF

The calls started coming in September to navigator Monica Baldwin at Christ Community Health Services in Augusta from people concerned about their health insurance under the Affordable Care Act.


“It is the fear of not knowing what is going on,” she said.

With Open Enrollment for that insurance marketplace still two weeks away, there is a lot of confusion and lack of information about what will happen with the program, experts said. With deep cuts to grants for in-person assistance and nearly eliminating the advertising budget by the Trump Administration, it could be more difficult for people to get crucial information about signing up for health care, the experts said.

Only 15 percent of the uninsured and 40 percent of those with an ACA plan knew enrollment for 2018 begins Nov. 1, according to the Kaiser Family Foundation tracking poll. Even worse, 95 percent did not know when it ends, which is Dec. 15 for Georgia and South Carolina, although 11 states that run their own enrollment can extend it and many have. The six week period for the 39 states that use the Web site is half as long as previous years.

Nearly a third of people – 29 percent – didn’t know the individual mandate requiring most people to have health insurance or pay a penalty, was still in effect, said Jennifer Tolbert, director of State Health Reform for the foundation. Yet the Trump administration cut the advertising budget to let people know about enrollment by 90 percent and cut grants to navigators who provide in-person assistance by 41 percent, said Larry Levitt, senior vice president for special initiatives at the foundation.

Those cuts to outreach are “certainly not helping” with the confusion, Tolbert said. “Consumers have to hear this information over and over and over again.”

That’s particularly true for Augusta, Baldwin said.

“There’s still a (need for) a lot of education for people,” she said.

The administration cut the advertising during the last 10 days of enrollment for this year and that may have contributed to slightly lower than expected signups because there was not the late surge at the end that happened in previous years, said Karen Pollitz, senior fellow at the foundation. With the cuts from the administration, it “could be much harder for people to find in-person assistance,” she said.

That may place greater reliance on the Federally Qualified Health Centers that have helped with enrollment in previous years. In Augusta, Medical Associates Plus is planning enrollment events on Nov. 11 and Dec. 15 from 10 a.m. to 4 p.m. but is still finalizing locations, said LaShanda Johnson, community outreach manager. The main concern now is that people will read about premium increases or other cost increases and won’t even try to enroll, which would be a mistake, she said.

“You never really know how much your premium is going to be unless you actually try it,” Johnson said. “The thing is to get people over that fear of what it could be and actually get them to go ahead and enroll and see.” Subsidies tend to rise as premiums increase and 8.7 million of the 10.3 million who get insurance through the ACA marketplaces received premium subsidies, according to the foundation.

Cost concerns were also heightened when Trump announced he would no longer be making cost sharing reduction payments to insurance companies to compensate them for reducing things like deductibles and co-pays for low-income consumers.

“We’ve always had the issue of people fearing affordability but now it is even more grave than it has been in the past, especially with the cost reduction subsidies being cut,” Johnson said.

Baldwin hears those same fears from the consumers she works with.

“I can feel and I can touch the fear of people” worried about being priced out of their insurance, she said. Christ Community will do what it can to help enroll but is trying to concentrate on helping its current patients get enrolled, said Ron Skenes, director of communications and development. But if someone comes seeking help “we’re not going to turn them away,” he said. Last time, Baldwin said she enrolled nearly 180 but saw and educated 500 more who for various reasons were not able to enroll.

While there was a bipartisan deal announced this week by U.S. Sens. Lamar Alexander and Patty Murray to restore cost sharing reduction payments, its chances of passing either the Senate or the House is very uncertain, Levitt said. Those payments make a real difference for those who get them, which was about two-thirds of the people who got an ACA plan this year, Levitt said. While the average deductible for a Silver plan was $3,609, with cost-sharing it was $255 for those whose income was up to 150 percent of the federal poverty level, or $18,090 a year for an individual.

While Pollitz was reluctant to make a prediction, taken altogether the changes “suggest there could be a drop in enrollment as a result of this,” she said.

Reach Tom Corwin at (706) 823-3213 or