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Much Smoother ACA Enrollment Period, Says Health Exchange Worker

Alex Smith
Samuel U Rodgers marketplace counselor Joe Torres says this year's ACA open enrollment is going much better than last year's.

Only six people were able to sign up for private health insurance plans on the first day of open enrollment last year, due to widespread computer problems with the online insurance marketplaces. So enrollment helpers breathed a big sigh of relief earlier this month when the second round of enrollment launched with few glitches.

To find out more about how the second enrollment period is going, Heartland Health Monitor’s Alex Smith talked to Jim Torres, lead health insurance marketplace counselor for Samuel U. Rodgers Health Center in Kansas City. As of Friday, their enrollment center had helped about 100 people sign up.

So far, how does this year’s open enrollment compare with last year’s?

It’s going very well. It’s much smoother than last year. Everybody knows about all the problems with the website last year. And it was the first year. We were learning, but this year, we’ve got some experience. Website’s working very well, and we’ve having a lot of enrollments.

There were a few reports of website glitches. Have you seen many of those here?

There are the occasional glitches that still come up from time to time, and we can usually work around them. But overall, the website is working very well most all the time.

Do you see a big difference in the understanding that people have about the health exchange or are there a lot of the same misunderstandings?

Well, it depends. People that enrolled last year have an idea of what to expect if they did an application and got enrolled. But there are a lot of people who didn’t apply last year or didn’t get enrolled, didn’t complete the process, so we’re still having to go talk to them and help them apply and see if they’re eligible to get enrolled.

What kinds of misunderstanding do you most often hear?

I think people don’t really know how the financial assistance that they might be eligible for works. The way I explain it is: the financial assistance is through the taxes they pay if they file a federal tax return. If they’re eligible, the assistance works just like cash, but it doesn’t go to the individual, it goes to the health insurance company, pays down the cost of whatever plan they chose. And the consumer only pays the difference between the total cost and what the financial assistance covers.

What kinds of new insurance options are available in this area? I mean, do you see more low-end plans or more of the premium plans?

We see a little bit of everything. Last year, there were only two major insurers competing in the marketplace in Kansas City: Coventry Health Care and Blue Cross Blue Shield of Kansas City. This year, we have both those plans back, as well as Humana offering plans in the marketplace. So, all told, there’s over 20 plans, I believe, offered among the three insurers.

Have you seen a lot of people who are already insured coming in to check out some of those new options that are available?

Yes, if they enrolled last year, they’re going to get a letter from their insurance company letting them know if their plan is going to be offered again this year. And they’ll also get a letter from the marketplace reminding them to come back and update their information, especially the income and household information and be sure and check out the plans, do their research, make sure that they still like the plan that they chose last year. If they don’t like it, they can switch now. Check the premiums, copays and deductibles. Make sure their drugs are still covered by their plan, and most importantly, make sure their doctor is still covered as an in-network provider in whatever plan they happen to be looking at.

Missouri has not expanded Medicaid as prescribed by the Affordable Care Act. How does that affect enrollment here?

Well, it leaves a big gap in the health care law. There are anywhere between 250 and 300,000 Missourians who could be covered by the state’s Medicaid program if the state would only expand Medicaid and accept the federal funds to do that. These folks have low income. They don’t qualify for Medicaid under its current, very restrictive rules. You’ve got to be very, very low-income. And you’ve got to be a low-income parent of a young child in order to be eligible.

How many people have you ended up turning away because they fall in that enrollment gap?

The coverage gap, we meet people every single day who fall into that gap. And it’s very sad to tell them that they actually earn too little money to get help getting insurance. If they’re above the poverty level, they might be eligible for financial assistance to purchase private insurance, but if they’re below the poverty level, the health care law tries to provide them with Medicaid coverage, but the state has to cooperate.

So when do you expect the big rush for enrollment to come? Or are you in the middle of that right now?

We are. We are. Our phones are ringing. We’re very busy. We’re getting a lot of people calling, requesting appointments, asking questions.

And how many people do you expect will enroll with the help of Samuel Rodgers?

Last year, we helped enroll about 1,400 people to get covered, either through private health plans or Medicaid or Children’s Health Insurance plans through the state. We hope to do at least that many this year. Maybe we can do better, but we really don’t have a specific number in mind.

As a health care reporter, I aim to empower my audience to take steps to improve health care and make informed decisions as consumers and voters. I tell human stories augmented with research and data to explain how our health care system works and sometimes fails us. Email me at alexs@kcur.org.
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