More than a month into the rocky rollout of the Affordable Care Act, one thing is abundantly clear – America is in for some significant changes to our health care system. For the first time we are getting a real look into the controversial health care law signed into law on March 23, 2010, and to the challenges with its implementation.The Legal Aid Society of Palm Beach County is funded by Health and Human Services to employ seven certified Navigators charged with enrolling 3,000 individuals in Palm Beach, Martin, Okeechobee and Hendry Counties in federal Marketplace insurance plans by March 31, 2013.
One month in, we are getting a much better view of the enormity of the project and sweeping changes of this landmark law. It is also clear from the glitchy start to the Marketplace website, this sentiment is being echoed by the federal government.
During October we have done outreach and presentations to hundreds of individuals, including the general public and health care providers. Interest in the Marketplace has been very high. While most individuals are aware of the Affordable Care Act, very few have any real understanding of the details beyond news headlines and broad generalities. Outreach and education is going to be critical to correcting the many misconceptions which remain barriers to enrollment.
But the biggest barrier so far has been the Marketplace itself. In an interview with the South Florida Hospital News I optimistically stated "From what I’ve seen of the program, it should be about as easy as ordering a book off Amazon”. To date, nothing could have been farther from the truth. While interest in the site and in the insurance plans offered has been high, few have been able to complete the process in Florida.
Healthcare.gov has been plagued by software glitches, slow and freezing screens, issues verifying identities, and random errors. The process has proven to be far more time consuming that we anticipated. We have begun registering consumers in stages in order to deal with these issues. The process has been frustrating to both navigators and consumers who have been looking forward to the prospect of affordable insurance for quite some time. Just setting up an account and completing the eligibility determination can take up to two hours, with even fewer getting far enough into the enrollment process to actually view the plans being offered.
The other insight to come out of this process is that very few of our consumers are regular users of the Internet or have internet access at home. The majority of the individuals we have seen so far are living under 400% of the federal poverty guidelines, and dealing with many health and poverty-related issues. They need a great deal of assistance with gathering up the information necessary and navigating the Marketplace website to set up their account. And they will need even more assistance with selecting the best plan for them which takes into account provider preferences, health issues and financial status.
With patience and persistence, I have managed to not only enroll myself in the Marketplace, but I have been able to review the actual plans. There are a staggering 132 different health plans being offered by eight insurance companies in Palm Beach County alone. Premiums for individual (non-catastrophic) plans range from $147 to $748 with a seemingly endless combination of deductibles, co-payments, co-insurance payments, and out-of-pocket maximums. There are HMOs, PPOs, EPOs and HSAs along with in-network, out-of-network and national network plans.
Seeing the plans and the premiums, the results are generally much better than the negative hype. Premiums, for the most part, are affordable – particularly when comparable to current large group rates.
For older individuals who had been purchasing individual policies, the rates are a significant improvement. Many individuals and families with incomes below 400% of the federal poverty guidelines ($94,200 for a family of 4) will be eligible for premium tax credits, further lowering the premiums.
The one element common to all Marketplace polices is an increased element of cost sharing. Cost sharing in the form of deductibles, co-pays, coinsurance, and out-of-pocket maximums can reach $6,350 a year. This is most evident in prescription coverage which often implements coinsurance and deductibles for non-preferred and specialty drugs, as well as for in-patient and out-patient surgical and hospital services. These are, in my opinion, an effort to involve the patient in cost saving measures though a significant financial stake in the cost of care. These cost sharing elements, however, should be reduced for individuals and families with incomes below 250% of the federal poverty guidelines ($58,875 for a family of 4).
With an enrollment deadline of December 15th for coverage to begin on January 1, 2014, the next month will be critical for both Navigators and the Marketplace website. Volume to the website will be very high leading up to that deadline. The next deadline will February 15, 2014, the date where individuals without insurance must be enrolled to avoid the tax penalty which can be as high as 1% of adjusted gross income in 2014.
With all of this, we are moving ahead with enrolment and are hopeful and exited at the prospect of tens of thousands of currently uninsured individuals accessing much needed health care services.
