Insuring The Uninsured Under Obamacare

Jul 18, 2013

Credit Free Grunge Textures via Flickr

The success of the Affordable Care Act—here in Maryland and elsewhere—in part hinges on a simple result: the number of uninsured people who actually sign up for health insurance.

Starting October 1st, there will be a few different ways to find an insurance plan on Maryland’s online insurance marketplace, or “exchange.” One way is to go online and sign up on your own. Or, you could phone one of several call centers. But as with other complicated choices, there’s no substitute for one-on-one help.

Health care consultant Rosemarie Day was the deputy director for Massachusetts’ online insurance marketplace back when it launched in 2006 and 2007. She says that although there was great enthusiasm, the logistical challenges in signing people up were unavoidable. ”First of all, people don’t walk around necessarily knowing what their annual income is off the top of their heads,” she said, “particularly if they’re, like, putting together several part time jobs or they’re seasonal workers.” She adds that helping people understand “where they fit in” among the various insurance plans and levels of government subsidies is a time-consuming process.  It often requires in-person assistance, and “meeting people where they are.”

In order to meet Marylanders where they are, the state is divided into six regions to enroll individuals and businesses into insurance plans. For individuals, Maryland tapped one “connector entity” in each region—usually a health care non-profit or government agency. Each one will serve as an umbrella group for many more outreach partners and drive enrollment its region.

Of course, in order to do the enrollment work, those “entities” are hiring new employees. One new group, called “navigators,” will go out, find uninsured individuals, and actually sign them up. Another group of new employees, called “assisters,” can sign people up for Medicaid, but not for private insurance plans. A big job for both navigators and assisters will be to educate people on their options. According to Danielle Davis at the Maryland Health Connection (that’s what the state is calling its exchange), two hundred navigators will be hired statewide, and the navigator program will cost $8.6 million state dollars. As for assisters, 250 will be hired as part of $16 million federal grant. Training for both groups is expected to end by mid-September.

Kathleen Westcoat of Health Care Access Maryland, the “connector entity” for Baltimore City and Baltimore and Anne Arundel Counties, says that navigators will really need to understand insurance and subsidies. They also must be good with people, especially because they will interact with many who have never had health insurance. Navigators and assisters will be deployed to health fairs, festivals, homeless shelters—anywhere they think a large number of uninsured people will be. But she also notes that “in the city of Baltimore, you see that the word of mouth is much, much more important than…anything else, any other marketing tactic or venue.”

And that leads to the biggest challenge: overcoming the confusion about Obamacare. A Kaiser Health poll from April found that 4 in 10 Americans were unaware that the Affordable Care Act remained in effect. Davis says they are rolling things out as quickly as possible, but are wary of “putting information out there before something is available and [thus] creating confusion.” Westcoat agrees.”It’s tricky because you don’t want to do too much in advance because then you get a lot of questions and inquiries that you’re really not able to handle.”

So it might be just fine that the public is not too engaged at the moment. A social media campaign launches at the end of July and a paid advertising campaign starts at the end of August. Open enrollment for individuals will begin October 1st and go through March 31st, but changes in family or citizenship status may allow for enrollment after that period. (Coverage starts January 1st). And the enrollment period for Medicaid and Maryland Children’s Health Program (MCHP) never closes. Small business enrollment begins January 1st for coverage that starts on March 1st.

Still, the timeline is tight and the goals are significant. The state projects that 180,000 individuals will find insurance on the exchange by the end of 2014, and an additional 100,000 will enroll in an expanded Medicaid program.

When Massachusetts’ launched its exchange, the open enrollment lasted more than a year. Even with the longer period, getting people insured not easy. “It takes a while for the messaging to sink in for people and for the word of mouth to catch on,” says Day.