Open sign-up for Affordable Care Act coverage starts Saturday, and some observers expect the second year of “Obamacare” will see many more people in Louisiana who put off buying insurance through the online federal marketplace last year decide to give it a try this time around.
Brian Burton, program director for the Southwest Louisiana Area Health Education Center, says there were a couple of major reasons for the reluctance last year.
A lot of people were waiting to see if opponents would succeed in repealing the law, he said, and others wanted to see what happened with people who bought coverage under the act. Did doctors accept the coverage? Did consumers get what they expected from the health plans?
“I think what you’re going to have is a much bigger group of people that are going to be seeking assistance in enrollment this year now that they’ve been able to talk to people within their social networks about it,” Burton said.
The open enrollment period begins Saturday and ends Feb. 15. Consumers have until Dec. 15 to enroll if they want their coverage in place on Jan. 1. Consumers who wait until Feb. 15 won’t see coverage begin until March 1.
Those who are already in the program and do nothing will be re-enrolled in the same plan they have if it is still available. But the federal government is urging consumers to go through the 2015 application because the benefits in their old plans may have changed. Even if a person’s information is the same, he or she may be eligible for lower rates. At the very least, people can compare plan costs and benefits.
In another change this year, penalties for forgoing coverage are increasing. Those eligible for insurance who have none will now face a penalty of $325 for each adult and $162.50 per child, or up to $975 per family; or 2 percent of their income above the federal tax filing threshold. The fines will be paid through deductions from their tax refunds.
In Louisiana, this year’s changes include an additional company, UnitedHealthcare of Louisiana, offering coverage through the federal health insurance marketplace. UnitedHealth will join Blue Cross and Blue Shield of Louisiana, Humana Health Benefit Plan of Louisiana, Louisiana Health Cooperative and Vantage Health Plan on the list of choices.
The Affordable Care Act provides financial assistance to help people pay for health coverage. A single person who makes between $11,670 and $46,680 is eligible for help, while a family of four with an income between $23,850 and $95,400 qualifies.
Close to 102,000 Louisiana residents got coverage through the marketplace during the first enrollment period, according to the federal Centers for Medicare and Medicaid Services.
The impact on the state’s uninsured population — one of the major selling points of the law — is more difficult to measure.
One group, Enroll America, a nonpartisan nonprofit whose goal is to get people health insurance, says the uninsured rate in Louisiana dropped from 21 percent in 2013 to 15 percent in 2014.
Charlotte Parent, director of the city of New Orleans Health Department, said more than 14,000 Orleans Parish residents obtained coverage through the Affordable Care Act the first time around. Parent said she expects more people to sign up this year as more hear about the benefits of doing so.
Last year, Tierney Brinkman, a New Orleans waiter, was able to buy health insurance for the first time in 10 years because of the Affordable Care Act, which eliminated penalties for pre-existing conditions. Brinkman has lumps in her breast and a family history of breast cancer. She plans to re-enroll in the same plan unless there are major changes.
“It’s working great for me. Before, I couldn’t afford it or I wasn’t allowed it,” Brinkman said.
Her premium is now $108 a month. The cheapest policy she could find before was about $230 a month, but it didn’t cover emergencies, hospitalization, mammograms — basically anything that really mattered to her.
Linda Beauvais, executive director of the Capital Area Agency on Aging in Baton Rouge, said she expects the enrollment process will be smoother this time. The communication with the federal government at all levels is much improved, as is the Healthcare.gov website, Beauvais said.
Last year, the marketplace was basically closed for the first six weeks because of technical difficulties. The Obama administration says this year should be different, which will allow navigators to help more people.
The navigators have a year of experience under their belts, which will help them better tailor services to their communities, Beauvais said. For example, the Capital Area Agency expects to help more people one on one this time around and will assign one of its four navigators to that task each day.
“Lots of times, a person just has a question and needs an explanation on how something works,” Beauvais said.
That may take a 10-minute phone call or it could take two or three hours. Either way, someone will be available, she said. If the agency’s navigators are tied up, they can refer callers to other navigators.
That’s because navigator groups, federally qualified health centers, which provide care for uninsured and low-income residents, and providers are working more closely, Burton said.
Because Louisiana doesn’t have a state health insurance exchange, there hasn’t been a central place to get information, Burton said. The Southeast Louisiana Area Health Education Center is taking on that role, helping to coordinate services and resources.
Still, other challenges remain.
Nine out of 10 uninsured people didn’t know when the open enrollment period would begin, according to a Kaiser Family Foundation survey released Oct. 21. And a little more than half of the uninsured didn’t know that financial help is available.
The U.S. Department of Health and Hospitals estimates that between 9 million and 9.9 million people will enroll for 2015 coverage, compared with 7.1 million last time around. Those projections are well below the 13 million the Congressional Budget Office had projected would enroll for 2015.
Another survey, done last month by online financial data aggregator BankRate.com, showed about half of those who enrolled through the marketplace don’t plan to do so again. BankRate found that 43 percent of those surveyed worried that higher prices for health plans will put them out of reach.
Under the Affordable Care Act, the subsidies for coverage rise when the premiums do. This way, consumers spend the same percentage of their income on insurance, as long as their income doesn’t change.
A Kaiser Family Foundation analysis of rates in each state’s largest city found that the second-lowest-priced silver plan, the benchmark used to help determine the financial assistance in the marketplace, will be lower in New Orleans for 2015. In 2014, a New Orleans resident paid $311 per month for the benchmark plan before subsidies. In 2015, the premium will be $296, 4.8 percent less. After the tax credit, the 2014 monthly premium was $209. In 2015, the premium will be $208.
Blue Cross Chief Executive Officer Mike Reitz said the benchmark plan’s cost will be slightly higher statewide.
Meanwhile, B. Ronnell Nolan, president and chief executive officer of the Health Agents for America, said enrolling everyone who now has coverage by Dec. 15 may prove difficult. Consumers will have only 30 days to do what took several months last time.
People will have to consider a number of factors before making a decision in a compressed time frame, she said. Questions to consider: Is their plan still good for them? Does it fit in their budget? Are their doctors and hospital still in the network? Will their prescriptions be covered?
Nolan also has some doubt about the reliability of the marketplace and wonders whether the added traffic will lead to delays or crashes.
Another issue has been the difficulty agents have had finding the answers to their clients’ enrollment questions. In the past, four calls to marketplace representatives about the same topic might generate four different answers, and finding the person who really knows how to help remains an issue, Nolan said.
“Our biggest issue is having someone to call when there’s a problem,” she said.