“It’s so high with the money they make he wouldn’t bring anything home,” she said outside the Medical Associates Plus at Belle Terrace clinic in south Augusta. She’s heard she will have to have insurance next year but like her cousin Lena Cunningham they are unclear how to get it or again how to pay for it.
“If you don’t have an income then how can I pay the premium?” Cunningham said.
Open enrollment in the new Health Insurance Marketplace in Georgia begins Tuesday as the biggest and most significant piece of the Affordable Care Act. The Department of Health and Human Services said that premiums in the exchanges are actually lower than expected in Georgia and nationally are about 16 percent below what was projected. And many families will qualify for tax credit subsidies.
But even those charged with implementing the enrollment and the new coverage acknowledge the launch is likely to be bumpy. Some expect that it will be similar to the beginning of the last massive federal health benefit program, which was the Medicare Part D prescription drug coverage that began in January 2005. Many people did not have their cards, help lines were jammed and pharmacists were frustrated in the early going.
Medicare Part D had “really significant problems in the early weeks and months,” said Gary Cohen, the deputy administrator and director of the Center for Consumer Information and Insurance Oversight at the Centers for Medicare and Medicaid Services. “The same thing is going to happen with this program.”
IN GEORGIA, many of those who are supposed to be helping with enrollment are scrambling to complete the training required to become a navigator. Only three had actually been licensed by the state as a navigator but nine more were just waiting to clear the background check before they could be licensed and “that could be completed this week,” said Glenn Allen, a spokesman for Georgia Insurance Commissioner Ralph Hudgens. Twenty people have taken the test needed to be licensed under Georgia law – with 16 passing – and another 13 have registered to take the test, he said.
In Augusta, outside of 2.5 positions that will be helping to enroll people through the Community Health Centers of Christ Community Health Services and Medical Associates Plus, there is a great need for volunteers to come forward and help answer questions, said Janice Sherman, the CEO of Medical Associates. The center said there are an estimated 50,000 uninsured in Augusta and 19,000 in Columbia County alone.
“What we really want are some volunteers to help expand the capacity because we really don’t have the capacity based on what the potential demand is,” she said. Sherman hopes retired will come forward to help answer questions.
AND THERE ARE a lot of questions, said Terri Gant, the community outreach manager at Medical Associates and a navigator in training.
As she goes to events to help educate people about what is coming, Gant says she is typically greeted with, “I’ve heard about Obamacare. What is it?”
So she starts “from the beginning, letting them know the correct name is Affordable Care Act. We’re kind of starting from there and going through the whole gamut, letting them know what it is all about, who is eligible, what the enrollment process is going to look like for them. Also teaching them about this is what you need when you come to the table.”
People can enroll online through healthcare.gov, they can contact a call center or they can get the forms and mail it in, Gant said. Going through the Web site allows them to see what subsidies they might be eligible for to help pay premiums. People can go in and record their information and then come back later to enroll if they want to do further research. As they research plans, there will be a link to see what a plan’s provider network looks like, Cohen said. They will be able to look at different copays and deductibles, Sherman said.
“We’ve played around with the information to see if it is really complex and it’s really not,” she said. “I think it’s just more time-consuming and it really has to do with each individual’s ability to grasp that, from a literacy standpoint.” For some people, it may be necessary to explain what some of these insurance concepts mean. Before it begins, it is hard to know where the pitfalls will be, Sherman said.
“The best way to really understand how much more education is needed is just to start enrolling people,” she said. “Because we really aren’t going to know until you get on the site.”
One thing working against them is the low level of penalty for not having health insurance, which Gant said was $95 or 1 percent of income the first year. The penalty increases sharply in subsequent years, she said.
CHRIST COMMUNITY was hiring people last week to help and are hoping they get up to speed soon, said Ron Skenes, the director of communications and development.
“From our perspective, it’s just a matter of getting the people on board, getting them up to speed on the whole process of identifying what’s available and who’s qualified and then what the process is for getting them signed up,” he said.
Probably about half of Medical Associates’ patients will be eligible for coverage, Sherman said. About 60-75 percent of Christ Community’s patients right now are uninsured, Skenes said.
“We want to do what we can to help them understand what their options are and see what’s available that they might be eligible for,” he said.
Though open enrollment starts Tuesday, federal health officials said they don’t expect a rush in the first weeks or months. Judging by enrollment in other programs, people will wait until just before the deadline to do it, which would likely be December if they want coverage in January or just before the open enrollment period ends on March 31, said Julie Bataille, the director of the Office of Communications for CMS.
That’s an important point for patients to remember – it doesn’t have to be done this week, Sherman said.
“There’s time,” she said. “And that’s a good thing.”