Figures indicate turmoil not deterring health insurance applicants

 

By Marilyn Meyer 

 

Today is the final day to sign up to get health insurance in 2017 through the Affordable Care Act's Marketplace.

The Trump administration's vow to repeal and replace the ACA, also known as Obamacare, which Republicans say is expensive, intrusive and hurts the free market system, apparently has not deterred signups for coverage.

"We've had a robust season with signups," said Maryemma Bachelder, director of marketing at Lake Wales Medical Center. "We had a community forum shortly after the enrollment period opened (Nov. 1), and we've had application specialists available throughout the enrollment period to answer questions and to help people sign up."

Most local hospitals — Lake Wales, Heart of Florida, Winter Haven and Bartow – as well as Central Florida Health Care, Polk County Indigent Health Care Division and several private insurance agents offered help to local residents in navigating through the Marketplace's official signup website, healthcare.gov.

Last year, 34,156 health plans were sold to Polk County residents through the Marketplace.

 

If the percentage increase compiled by BayCare Health System's navigator for Winter Haven Hospital, Bartow Regional Medical Center and South Florida Baptist Hospital in Plant City is similar for other entities that have not yet compiled their data, that 34,000 number could jump in spite of the political turmoil surrounding the ACA.

"Enrollment assistance to citizens of Polk County during open enrollment this year increased by 10 percent," said Eva Villas-Boas of BayCare's enrollment efforts.

"Re-enrollments are estimated to be about 65 percent of the consumers assisted and reflect a concentrated effort made to reach out and follow up from past enrollments," she said. "New referrals followed from increased outreach efforts in the community and strong networking."

Nationwide, as of Jan. 14, about 100,000 more people had signed up than at the same time last year through HealthCare.gov — 8.8 million this year in in 32 states including Florida, compared with 8.7 million last year, according to a news release from the Centers for Medicare and Medicaid Services. Twelve states have their own signup platforms.

Florida has accounted for 1,668,180 of those signups as of mid-January.

In past years, there has been a surge of enrollments in the final days before the cutoff deadline.

Local concerns

"We definitely saw brisk interest this year," Bachelder said of counselors helping clients at Lake Wales Medical Center, "and we aided many of our community members in the process. One of the side benefits of this is that we sometimes find people who perhaps were eligible for some other type of coverage and were unaware that they were eligible, and we're able to guide them in obtaining the coverage for which they are eligible."

Margaret E.C. Clardy, an independent insurance agent in Polk County for 29 years, said she got involved in helping people sign up through the ACA several years ago because of her experience providing group insurance plans through employers. She often saw new employees sign up for coverage for themselves but then decide they could not afford coverage for their families.

Through the ACA, everyone who makes between 100 percent and 250 percent of the federal poverty level is eligible for subsidies to help pay their premiums – and the subsidy is determined by how much the families estimate their incomes will be for the year.

For example, sliding-scale subsidies are offered to single people with incomes of $11,800 to $29,500 or for a family of four with incomes between $24,300 to $60,750. On top of those subsidies, they and those who make up to 400 percent of the federal poverty level ($47,200 for a single person or $97,200 for a family of four) are eligible for tax credits.

But even with the subsidies some people cannot afford to pay the premium, said Ermelinda Centeno, the director of enabling services for Central Florida Health Care, a federally qualified community health clinic in 10 communities in Polk, Hardee and Highland counties. The premium prices went up by an average of about 25 percent this year, she said.

The insurers

"We also found there were not as many providers people could choose from. There were some people who said, 'It costs too much and I cannot use it where I want to go so I will not take it,'" Centeno said.

Clardy also said that it has been a struggle finding doctors and clinics that will accept insurance from the only three carriers offering policies in Polk County this year, Molina, Ambetter and Florida Blue.

 

"United and Humana pulled out of Polk County this year, although they are still in some areas of Florida," Clardy said. "We had many happy people with them. Ambetter is in their send year and Molina, their first year. They are great companies but are still building their networks. We are trying to second-guess with doctors and clinics, 'are they going to accept this?' " she said.

"Complicating that, some clinics may accept Florida Blue but not all Florida Blue plans and in some clinics some doctors will accept certain plans but another doctor won't," Clardy said, "From an agent's perspective, it has taken three to five times as long to do a quality job this year."

Although there are affordable plans, getting the clients signed up to the doctors, clinics and hospitals they want has been a problem and "you have to go to the higher-dollar plans. That has been very frustrating this year."

Clardy said that even though there have been problems this year she had not seen before, the traffic volume has been about the same this year as in past years.

 

Who it helps

"The ACA has been wonderful thing for many people. We have saved many lives through affordable health insurance," although there have been bumps along the way, and this year has been especially challenging, Clardy said.

When the ACA was passed by a Democratic-controlled Congress in 2010, 21.3 percent of Floridians had no health insurance. By 2015, the percentage had dropped to 13.3. It has been a target of Republican legislators since its passage, and President Trump pledged to repeal it if elected.

"The cap on out-of-pocket expenses has been wonderful for people who get very sick; people no longer have to worry about going bankrupt because of medical bills," Clardy said. "Medical bills had been the No. 1 reason for personal bankruptcies. This has helped."

And, the ACA has opened coverage to those who have pre-existing medical conditions, she said. "Before the ACA, if you were not healthy, they would not accept you. With the ACA, the sick people could get coverage. The insurance companies were hit hard the first few years with sick people who needed insurance. I guess they did not hit target population to involve younger people who do not have the high medical costs to buy the insurance. But it has been a godsend for sick people."

 

Making it work — or not

Those who do not have health insurance through their employer or other health insurance are required to buy insurance through the Marketplace or pay a tax penalty. Those who were not insured last year are assessed a penalty on their federal income tax: whichever is higher — 2.5 percent of household income or $695 for each adult and $347.50 for each child, up to $2,085 for a family.

Those whose income is too low to have to pay income taxes do not have to pay the penalty. People who do not qualify for an exemption and don't pay the fee will find it is taken out of future tax refunds.

The Democrats' original plan was to cover those who could not afford to pay their premiums by expanding Medicaid coverage. But, Florida and 17 other states refused to do that. As a result, Florida residents ages 19 through 64 who earn less than the poverty level ($11,800 for a single person) and do not qualify for disability remain uninsured. That's an estimated 40,000 people in Polk County.

"We still have barriers," Centeno said. "Many fall into the gap."

"In Polk County, we can offer them some help through the Polk HealthCare Plan through the county's Indigent Health Care Division, (funded through the voter-approved half-cent sales tax for indigent health care)," Centeno said. And for those who do not meet the strict guidelines for that program, "we offer them primary care through the Central Florida Health Care's sliding-fee program. Oftentimes a little health care is better than none."

Clardy said she has heard some in the community express opinions that show huge misconceptions about the Affordable Care Act and what it does, "but we here dealing with it on the ground see what it does and we have a different perspective."

"I think the government could continue to improve the ACA; it certainly has had some bumps along the way," she said. "It reminds me of when Medicare was implemented; there were problems. It took time to streamline it. It takes time for people to get used to change. We try to help them understand how it works. It is complicated."

Her clients "fear the rug is being pulled out," Clardy said. "I have no idea of what they (Congress and the administration) are going to do, but I cannot believe they would leave millions of people high and dry. They will find a solution."

— Marilyn Meyer can be reached at marilyn.meyer@theledger.com or 863-802-7558. Follow her on Twitter @marilyn_ledger.

Central Florida Health Care, Inc. is Federally Qualified Health Center and a Federal Tort Claims Act (FTCA) Deemed Facility. For further information on our FTCA status, please contact the CFHC administrative office at 863-291-5110.

This health center receives HHS funding and has Federal PHS deemed status with respect to certain health or health-related claims, including medical malpractice claims, for itself and its covered individuals.

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Headquarters: 47 5th St N, Winter Haven, FL 33881 863.291.5110

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