On Oct. 1, people needing insurance can sign up to get coverage through the new health insurance online exchanges that have been established as part of the Affordable Care Act.
By Rose Hoban
Aaron White stood behind a table full of pamphlets and handouts at the Searle Center on Duke University’s campus as medical, nursing and physical therapy students swirled around him.
White was at the Community Health Engagement Day, an annual event for Duke’s health-profession students, and he was there to talk to them about getting uninsured patients signed up on the health insurance exchange that starts to enroll North Carolinians in October.
The health insurance marketplace (formerly going by the term “exchanges”) will be a website where people who are uninsured or who want to buy individual insurance can go and comparison-shop for plans.
“They were really open to doing some of the boots-on-the-ground canvassing and phone banking that we’ll be doing,” said White, who spoke to several dozen of the students. “It’s helpful because that’s the kind of outreach we want to spend the time on.
“It was cool for me to see … how receptive and enthusiastic they were.”
Enroll America’s newly hired state director, Sorian Schmidt, said her organization is focusing on talking about the health insurance marketplaces.
“Our research is that 78 percent of the uninsured don’t know what’s coming with health reform and the new marketplaces,” Schmidt said. “They don’t know how they’ll interact with them.”
Schmidt’s organization is part of a national effort to inform people about the changes that are coming associated with implementation of the Affordable Care Act (known as Obamacare) that gets more fully underway this fall.
People can start signing up for coverage on Oct. 1, but the coverage does not go into effect until Jan. 1. The enrollment period closes March 30.
Enroll America is a not-for-profit funded by health insurers, hospitals, doctors, pharmaceutical companies, employers, consumer groups, faith-based organizations, civic organizations and philanthropies. Many of the funders have ties to the White House.
The organization plans a grassroots campaign to find those who need information and talk to them about their options.
Finding the uninsured
People earning between 100 percent and 400 percent of the federal poverty level (see table) will be eligible for financial help in paying for insurance they buy on the online marketplace, with larger subsidies going to people with lower incomes.
According to the liberal advocacy organization Families USA, North Carolina will have as many as 869,000 people who will be eligible for some amount of subsidy in buying insurance through the marketplace.
But the trick will be finding those people.
“There’s no list of who’s uninsured in North Carolina,” Schmidt said. “If you walk out of the door, about one in five people under 65 are uninsured.
“In our lists, we can narrow it down to some of the people, some of the neighborhoods, with a lot of uninsured. So we can mail to them, canvass and call. And when we do those things, there’s a greater likelihood that someone in that house that we contact will be uninsured.”
The group does have some maps. The U. S Census asks people about their insurance and the federal Centers for Medicare and Medicaid Services gives county-level estimates of people who qualify for the food stamp program. Many of those people will likely lack insurance.
Map courtesy of Enroll America; data from the U.S. Census and Centers for Medicare and Medicaid Services.
The data show, for example, that Guilford, Robeson, Gaston and Mecklenburg counties, and several in the far-western part of the state, have high rates of people who need health insurance.
Schmidt said Enroll America employees also will be setting up tables where they think uninsured people will be, like malls and at street festivals.
Enroll America is only one part of the push to enroll people in some of the new insurance offerings. Community health centers and clinics around the state have gotten federal grant money to help people who may be eligible for insurance go through the process of signing up.
Community health centers staff up
Howard Eisenson, chief medical officer at Lincoln Community Health Center in Durham, said his organization will hire six patient certified-application counselors to help people get signed up, three at the clinic, one at the Durham Health Department and two with local not-for-profits.
He said he’s been getting a lot of questions already.
“I tell people, it doesn’t matter what your history is; it’ll be reasonably priced, with decent benefits, and many people will be eligible for subsidies,” Eisenson said. “I keep telling them www.healthcare-dot-gov. But that won’t be as user friendly as sitting down with a local application counselor who can talk them through it.”
Thirty-two community health centers in North Carolina were eligible to apply for federal funds from the Health Services and Resources Administration to hire staff to help enroll patients in insurance plans, but the state DHHS declined to apply for a $220,000 grant to fund application counselors.
The rest of the state’s community health centers received a total of about $4 million to hire and train staff to counsel patients about their options under the law.
“Since the community health center programs started back in the 1960s, they’ve been connecting patients and community members to insurance options,” said Rebecca Whittaker, an outreach coordinator at the North Carolina Association of Community Health Clinics.
“This has really been part of the CHC’s mission since the beginning. So the opportunity to engage in outreach and enrollment through the health clinics is really core to their mission.”
ACA opponents push back
As enrollment efforts ramp up, opponents of the law are taking out ads and ratcheting up the rhetoric against the law.
In Congress, members of the House Energy and Commerce Committee have requested that all organizations receiving federal grants to help with navigators submit paperwork about their plans.
N.C. Rep. Renee Ellmers (R-2nd District), an HEC committee member, released a statement in which she wrote:
“The purpose of this request is to better understand the work these recipients will perform as ‘Navigators’ and the consumer protections that will be in place, as the navigators will be obtaining sensitive medical and financial information from enrollees.
“I am concerned however when I see reports, such as the Kaiser story last week, that quotes an Ohio group saying that ‘We weren’t required to provide position papers, salary ranges, privacy policies or procedures. You don’t do that until you know that you got the award.’ This is startling.”
Ellmers also argues the program is already over budget, citing the Centers for Medicare and Medicaid Services’ original grant offering of $54 million for the navigator program.
But CMS eventually gave a total of $67 million in grants to organizations, mostly in states that opted not to create their own marketplaces, and where political resistance to the bill is strongest.
Some advocates have said that the paperwork for organizations receiving navigator money could gum up their operations.
“It has the potential to become quite a burden for us,” said Patsy Dowling, executive director of Mountain Projects, a not-for-profit community organization located in Waynesville.
She plans to hire five and a half full-time people to do the outreach work in the seven westernmost counties of the state where rates of uninsurance are as high as one in four people.
“We’re dedicated to providing these services, [even] if that means working seven days a week,” Dowling said. “I can do that, or I can give the grant back. But that’s not anything we want to do.”
She said much of the information congressional members asked for is already included in her grant application, which she estimated at between 50 and 75 pages of documents.
“It was job requirements, how many people we’d hire, how we plan to spend the money, budget – things like that,” Dowling said.
We see a lot of people pushed into economic distress because of health-related issues and lack of insurance,” she said. “We wanted to provide those services via our community-based organization. That was our motive.”
Other North Carolina organizations that received a total of just over $3 million in grants include Randolph Hospital, North Carolina Community Care Networks and the Alcohol/Drug Council of North Carolina.
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