Focus, Government, and Health Care

First month a headache for Obamacare

ACA enrollment online was lower than Priority Health anticipated.

November 15, 2013
| By Pete Daly |
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ACA troubles
Technical problems during the government’s first month of operating the insurance exchange website may have contributed to fewer enrollees. Courtesy Thinkstock

Priority Health, one of 13 health insurance carriers offering plans on the new Michigan insurance online exchange, reported about 100 enrollees during October, the first full month of enrollment under the Affordable Care Act for insurance starting Jan. 1.

The Grand Rapids-based health insurance company — the second largest carrier in Michigan after Blue Cross Blue Shield of Michigan — is offering a total of 19 plans across the bronze, silver, gold and platinum coverage levels.

Gene Cronin, vice president of marketing and corporate communications at Priority Health, said the average age of those who enrolled in October is 51, compared to 41 as the average for its non-Affordable Care Act plans sold to individuals.

That Priority Health experience was included in a Wall Street Journal article headlined “Young Avoid New Health Plans,” which the publication said raises concerns that cost of coverage under the ACA may be higher than anticipated.

The basic premise of the federal legislation is to get young Americans to buy health insurance if they don’t have any, which will make a larger insured pool and will then help keep premium costs lower for older Americans who are higher insurance risks.

“But it’s early in the process,” Cronin said in early November. “Enrollment is running a little lower than expected, but we think the initial consumers are likely doing some window shopping at this point in time — educating themselves on health care reform and the requirements and options available to them.”

According to healthinsurance.org, coverage mandated by the Affordable Care Act must be purchased by Dec. 15, in order for coverage to begin Jan. 1. The plans can be either individual or family coverage.

“And then, you know, there have been the technical issues with the healthcare.gov website,” added Cronin. “So it’s not surprising that enrollment has been a little lower than we anticipated. It’s also not unexpected that the average age would be a little bit higher because the early adopters are going to be those folks who understand health benefits,” he said, referring to people who had health insurance coverage in the past. “They understand the importance of it.”

Cronin said there are reports involving other insurance carriers that suggest health plans across Michigan are seeing lower than expected enrollment. He said the technical problems with accessing and buying insurance on the health exchange website “have likely kept some folks sitting on the sidelines while they wait for those to be resolved.”

Michigan is separated into several regions for buying ACA-mandated insurance online, and each has a nonprofit “navigator” organization that helps people access the government website. Navigators offer advice — but not purchase recommendations — on the options people face.

Michelle Fitzgerald, lead navigator for Michigan Region 3, operates out of Cherry Street Health Services in Grand Rapids. Region 3 includes 13 counties, from Mason, Lake and Osceola in the north, down through Allegan and Barry in the south.

Although there are 13 or 14 carriers involved statewide, only six are selling plans in Region 3.

The technical problems with buying insurance on healthcare.gov is a major issue in Congress, providing ammunition to the opponents of the Affordable Care Act — “Obamacare” — and generally embarrassing the Obama administration. Fitzgerald said in mid-November, however, that use of the government website “has continuously gotten better.”

“Every week we do see improvement,” she said, adding that people attempting to enroll via the website at the present time “regularly get through the entire application,” although there are still some issues.

One software glitch she has seen while trying to help someone work through the enrollment process is the needless repetition of a relative’s name at multiple places on the application form. Navigators report such glitches to healthcare.gov, she noted.

“We get a sense (among navigators) across the country that these are common things that are happening, and they are things they are working to fix,” said Fitzgerald.

According to Fitzgerald, many people who tried to submit an application on the weekend of Nov. 9 and 10 experienced continuous difficulty, but she said that was due to a combination of planned maintenance on the website and the failure of the IRS “hub” that provides income verification for determining if the applicant qualifies for an insurance subsidy.

She also mentioned — as does the healthcare.gov website — that the site undergoes maintenance each night from 1 a.m. to 5 a.m. and is not accessible.

Fitzgerald noted that last week, the state of Michigan had just submitted its Medicaid expansion proposal to the federal government, which could add some clarity to income levels that may qualify a person for Medicaid. Qualifying for Medicaid would eliminate the need to buy insurance.

As the region navigator, Cherry Street Health Services took calls from 1,337 people seeking information on the Affordable Care Act. There were 316 visits to the Cherry Street office for help in enrolling, and 39 applications successfully completed and submitted with help from the navigation staff. Other applications in the region undoubtedly were successfully completed online with no involvement from Cherry Street.

Fitzgerald said she would estimate that at least 60 percent of the people who came in for help do not have computers at home. Many of those who contacted Cherry Street by phone were people on the computer at their homes who needed guidance.

Application can also be made by phone by calling the federal insurance exchange at (800) 318-2596.

Fitzgerald said many seeking help from the navigator team at Cherry Street primarily were concerned with cost and would choose the less expensive options, but “that’s not necessarily what I would recommend.” She said selection of the cheapest premium ultimately could require the individual to pay more out-of-pocket expense than anticipated, depending on ongoing medical issues.

“We try to help people think through that process,” said Fitzgerald.

Some people who had health insurance in the past are most comfortable going back to that same carrier if it is one of their options on the exchange, said Fitzgerald.

“It’s a key factor,” she said. “People tend to go back to what they are familiar with.”

According to healthinsurance.org, four Michigan organizations received navigator grants to help consumers access and use the marketplace: Michigan Consumers for Healthcare (which funds the Cherry Street navigators), Community Bridges Management Inc., Arab Community Center for Economic & Social Services, and American Indian Health & Family Services of SE Michigan.

The website also states that, according to a report from the U.S. Department of Health and Human Services, the average cost for a bronze plan — the lowest-cost option — in Michigan is $222 a month. The national average for a bronze policy is $249 a month. HHS also said that more than 1.1 million people in Michigan — 14 percent of the population — are uninsured. Nearly 94 percent are likely to qualify for the expanded Medicaid program, or for subsidies to help purchase coverage on the exchange, also known as the marketplace, said healthinsurance.org.

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