You probably havent been paying much attention lately to the Affordable Care Act. You may not even realize that Obamacare still exists about 40 percent of people in a recent national survey werent aware that its the law.
By ALAN BAVLEY and DIANE STAFFORD
The Kansas City Star
But the national health care overhaul that was enacted three years ago is alive and might even be well. And starting right now, its going to be a lot harder to ignore.
Sunday marks the final 100 days before Oct. 1, when uninsured people can begin applying for health insurance and premium subsidies through the laws new state and federal marketplaces. Government agencies and insurance companies have been scrambling to get them ready.
If they work as intended, these government websites will make it possible to select a health plan and sign up for coverage in a way similar to how online travel sites let you pick a flight, a hotel and a rental car. Coverage starts Jan. 1, but people can keep enrolling through March 31.
Youll probably start seeing commercials, finding brochures at health fairs, even getting a knock on the door from canvassers with information about applying for insurance. The goal is to reach the estimated 30 million people who qualify for enrollment through the marketplaces. Polls show the vast majority of the uninsured know little or nothing about the marketplaces, formerly referred to as exchanges.
People are confused. Theres a lot of misinformation out there. People are going to need help, said Ryan Barker, vice president for health policy at the Missouri Foundation for Health in St. Louis.
Grass-roots organizing already has started. Two Washington-based advocacy groups with ties to President Barack Obama are spearheading nationwide awareness campaigns. But state organizations like Barkers are leading efforts locally. And health care businesses also are getting involved.
The essential things the advocates want to get across are the benefits the ACA is bringing: Insurers wont be able to deny coverage or charge higher premiums to people with pre-existing medical conditions. Subsidies through tax credits will cover a portion of the premiums for people with incomes from 100 to 400 percent of the federal poverty level. Insurance plans will have to be written in plain English.
Blue Cross and Blue Shield of Kansas City already is running a series of public service advertisements to prepare consumers for the effect of the ACA on its insurance premiums.
Weve armed our broker community with substantial knowledge to help people enroll, said David Gentile, chief executive of the Blue KC organization. But theres no question, we think there will be difficulties navigating the system.
While the timing remains tentative, the federal government is expected to begin rolling out a series of measures key to making Obamacare a reality:
• As early as Sunday, the Department of Health and Human Services may announce a redesign of its HealthCare.gov website that offers more detailed information about insurance enrollment. The site includes an online questionnaire designed to help people determine whether they qualify for coverage through the marketplaces or Medicaid.
• Later this month, Medicare call centers, including one in Lawrence, will be prepared to answer questions about Obamacare. The call centers will be staffed 24/7.
• By July, insurance brokers may start receiving federal training about how to use the marketplace website.
• In August, HHS will announce which organizations and individuals will share in $54 million in grants to help people find and obtain insurance coverage through the marketplaces. These navigators will undergo training and be required to provide consumers with unbiased information. In the Kansas City area, the Mid-America Regional Council has applied on behalf of a coalition of local safety net clinics, mental health centers and other agencies.
• In late August or early September, HHS will disclose which insurance plans will be offered in each state and the rates they will charge. States that chose to operate their own marketplaces already have begun to release this information. Kansas and Missouri are among the majority of states that are letting the federal government be responsible for all or most of their marketplaces duties.
Coinciding with the federal efforts are campaigns by two well-financed advocacy organizations.
Organizing for Action, which grew out of Obamas re-election campaign, announced last week that it is spending at least $1 million to run commercials on cable TV in support of the ACA. The Politico website reported that the organization, which is led by Obama campaign strategist Jon Carson, will focus on California, Texas and Florida, where a third of the nations uninsured live.
A wider campaign is underway by Enroll America. The group officially is nonpartisan, but its president, Anne Filipic, is a former Obama campaigner, and its chairman, Ron Pollack, is executive director of the advocacy group Families USA, which has been a staunch backer of Obamas health care reforms.
Enroll Americas Get Covered America campaign launched last week.
We realize we have a challenge, said Ani Fete, the organizations director of state assistance.
Enroll Americas marketing research has turned up little awareness of the ACA among the uninsured.
We found 78 percent of those who are eligible for coverage in the marketplaces have no idea they have options available, Fete said.
Although it is directing most of its efforts to 10 states not including Kansas and Missouri that have large numbers of uninsured people and high-density populations, Enroll America is actively recruiting volunteers in all 50 states, Fete said.
We want to be present in the community as much as possible. Well be talking to churches, going to schools and going door to door. Well have neighbors talking to neighbors.
On Thursday evening, about 20 people gathered at the Hyde Park home of Kelvin Walls and Sarah Starnes to watch an online strategy session with an Enroll America organizer.
Starnes, a social worker, and Walls, a physician, said that through their work they have witnessed the health consequences of being uninsured.
Its exciting to me that we actually have something now to offer people, Starnes said. Its huge how people are going to benefit.
At least one of the potential volunteers at the meeting is looking forward to those benefits. Knee surgery more than two decades ago has had Katie Allison, 63, locked into an insurance policy that costs her $8,000 per year. Her deductible, the amount of the medical bills she must pay before full coverage kicks in, is nearly $5,000. She has had three surgeries this year, so her health care costs for the year have hit $13,000.
Ill be excited when we can get online in October and see whats available to me, she said.
But many questions remain before Allison and millions of others can start clicking their computer mouse and enrolling in new plans:
• Will the federal government meet its deadline to offer insurance marketplaces by Oct. 1? How smoothly will it go?
In a report last week, the Government Accountability Office pointed out that HHS has a great deal left to do reviewing insurance plans, testing computer systems and not much time left to do it. States that were setting up their own marketplaces had fallen behind schedule. And the government was two months behind its original deadline to award its navigator grants.
Much progress has been made, but much remains to be accomplished within a relatively short amount of time, the GAO said. Whether the marketplaces can open on time cannot yet be determined.
HHS said it is confident that marketplaces will be open and functioning in every state by Oct. 1.
But even if the marketplaces open on time, there could still be computer glitches and miscommunication that will make it frustrating for the first people who try to enroll. Those kinds of problems were encountered during the initial sign-up for the Medicare Part D prescription drug program in 2005.
Twenty-nine percent of callers to the information line received inaccurate, inappropriate or incomplete answers to their questions about Part D, the GAO found. An additional 5 percent didnt get an answer at all, usually because the phone line disconnected.
• How many insurance plans will be offered? How much will they cost?
In California, a variety of insurance companies will be offering an abundance of plans in the marketplace. But that might not be a smart business move in other states with a sparse population or with one or two insurers that dominate the market.
And while we wont know how many insurers will be offering plans in the Kansas and Missouri marketplaces until HHS releases the information later this summer, the number probably will be small.
We think not too many folks have come to the party, said Gentile of Blue Cross and Blue Shield of Kansas City, referring to fellow insurance companies that havent signed up for the marketplaces for Missouri and Kansas.
Scanty participation by insurance companies means less competition to drive down rates and share the risk. So Blue KC is trying to prepare for an influx of previously uninsured, high-risk or sick consumers who will turn to the exchange for coverage they havent been able to get before.
This scenario, here and in other states, has raised fears that insurance premiums for the young and healthy will rise considerably. But a new analysis by the consulting firm Avalere Health found that about two-thirds of people 30 and younger, the group most likely to be hit by rate shock, will qualify for subsidies.
Older people and the chronically ill, who have often been priced out of insurance, will find premiums are lower.
• Who will actually sign up?
With information in short supply and suspicions about Obamacare running high, dont expect a rush to enroll. The tax penalty for not having insurance, as little as $95 for an adult in 2014, isnt very steep, but it rises quickly in the years that follow. The Congressional Budget Office is predicting that about 7 million people will sign up through the marketplaces for coverage in 2014. The number will keep going up each year until it peaks at 27 million in 2018.
In Missouri, about 300,000 uninsured are eligible to enroll through the marketplace and receive subsidies, said Barker of the Missouri Foundation for Health. An additional 50,000 are eligible, but they earn too much for subsidies.
Barker said his organizations goal is to get 200,000 Missourians enrolled by March 31.
Unknown is how many previously insured people will seek coverage through the marketplaces because their employers decided to drop their coverage.
In the smallest market, I think 15 to 20 percent of employers will jettison coverage, Rick Kahle, who leads the Kansas City benefits office of Lockton Companies, said of companies with fewer than 50 employees.
The employers who stop offering health coverage will most likely be those with a preponderance of low-wage employees who will qualify for federal subsidies to purchase insurance on the exchange.
For companies with more highly compensated or white-collar workers, theyll stay in the game, Kahle predicted. Theyll want to stay competitive with employee benefits.