More than 426,000 people in Pennsylvania and 295,000 in New Jersey signed up for health-care coverage this year through Affordable Care Act marketplaces. Gov. Wolf recently bragged that the uninsured rate in Pennsylvania is lower than it’s ever been, thanks to the law better known as Obamacare. New Jersey is touting similar results.
And in Washington, the latest effort to “repeal and replace” the ACA was defeated without even a vote.
But people such as Antoinette Kraus, whose mission is to help people find health care, are hardly in a mood to celebrate.
“We’re worried folks are going to miss the deadline” to keep their insurance in 2018, said the director of Pennsylvania Health Access Network.
Why the concern?
Despite years of effort, Obamacare’s foes in Congress and the White House haven’t been able to “repeal and replace” a law that has proved popular with most Americans.
Yet the political uproar has left people more fearful and confused than ever about what they must do to get insurance for next year, said Kraus.
Plus, the Trump administration does have the power to nibble around the edges of the law. Under HHS Secretary Tom Price – who recently resigned over his private-plane use — it has been doing so in ways that has people such as Kraus scrambling for ways to help consumers. Specifically, the federal Department of Health and Human Services, which answers to the president, recently announced it is:
- Cutting the open enrollment period in half. This year enrollment is only from Nov. 1 to Dec. 15. In the past, it has continued until Jan. 31.
- Killing most of the dollars used to get out the word about the program.
- Slashing funds to help consumers who know about the ACA, but need assistance with the complicated task of buying insurance.
- Taking down the program’s website, HealthCare.gov, from midnight to noon on most Sundays for maintenance, a move critics say will hurt working families who need that time to research options and sign up.
HHS officials tout the savings they expect, including $90 million in advertising and $25.7 million in funds for navigators who assist consumers. They insist the planned site maintenance times are actually not much different than in the past; they are simply announcing them in advance.
Consumer advocates, meanwhile, are focusing on what happens if people don’t have insurance in 2018.
“I am very concerned. Inevitably it will impact our providing assistance to those with the greatest need for support,” said Christina Miller, a managing director with Public Health Management Corp., which contracts with social service agencies to provide health-care navigators.
State officials too, are worried, especially about the shorter enrollment period. In the past, many people have waited until after the winter holidays to sign up. Now, with the Dec. 15 deadline, that won’t be possible.
“Since the Affordable Care Act was passed, Pennsylvania’s uninsured rate has gone down to 5.4 percent — the commonwealth’s lowest ever,” said Ali Fogarty, a spokeswoman for acting Pennsylvania Insurance Commissioner Jessica Altman.
“The federal government should be encouraging people to enroll in coverage to continue the progress the law has made, and Pennsylvania will do what we can to try to fill this gap and ensure that people know the coverage options that are available.”
She did not explain exactly how Pennsylvania, which is fighting its own budget shortfall, would do that.
Caitlin Oakley, HHS press secretary, defended the cuts, citing rising premiums and the falling number of participating insurers as proof that the law “is not working. The Trump administration is determined to serve the American people instead of trying to sell them a bad deal.”
But local insurance officials say the law is working well.
In New Jersey, just two insurance carriers are providing coverage through the ACA this year, according to the state Department of Banking and Insurance. Still, the number of people insured through the ACA rose by 24 percent in the first quarter of this year, compared with the same period in 2016.
Marshall McKnight, spokesman for the New Jersey insurance department, said three insurance carriers are expected to provide ACA policies next year. What’s more, he said, 80 percent of premiums paid are returned to consumers in health services, as opposed to going toward administrative costs.
In Pennsylvania, five insurance companies provided insurance through the ACA this year, said Tia Whitaker, state director of outreach and enrollment for the Pennsylvania Association of Community Health Centers. The state insurance department confirmed there will be five carriers as well next year.
Another cause for concern: What navigator funds the federal government is giving out will be distributed based on how well agencies met their enrollment goals last year. That’s to “ensure accountability within the navigator program,” according to HHS’s Aug. 31 announcement.
But Whitaker, herself a trained navigator, explained that all kinds of people — even those who have had insurance for years — need help with enrollment. Early retirement, layoffs, and other life changes can mean that people have to seek individual insurance for the first time ever.
Often, she said, people will talk to a navigator but go home and sign up for coverage on their own. These sign-ups don’t count toward the navigators’ quotas — meaning that even effective programs will be penalized by the new HHS policy.
Complicated family situations — divorces, births, adoptions, remarriages — also complicate health insurance needs, and make navigators essential, said Miller of the PHMC.
“It can be very difficult understanding what plan is right for you and your family,” she said. “It’s a lot to digest.”
For 2016-17, PHMC received $392,000 for the health-care navigation work it provided in Eastern Pennsylvania, Miller said. It is facing a 35 percent reduction this year. Whitaker’s association got $948,432 to fund 73 navigators throughout the state last year. This year, the community health centers association also is facing a 35 percent cut, said chief operating officer Cindi Christ.
So with the turmoil and cutbacks, how can consumers who need insurance protect themselves? Here are some expert tips:
- Mark your calendar. The open enrollment period is shorter this year. It goes from Nov. 1 to Dec. 15. There will be new plans and prices available this year. Individuals can sign up at healthcare.gov or call the marketplace at 1-800-318-2596. Free in-person assistance is also available through navigation agencies listed on healthcare.gov. The website is available 24 hours a day, seven days a week but will be taken offline the first five Sundays of the enrollment period from midnight to noon.
- Financial assistance is available. Last year eight in 10 individuals enrolled in the ACA qualified for tax credits to help pay for it, Kraus and Whitaker pointed out. At www.healthcare.gov/see-plans, you can plug in information about family size and wages to see if you may qualify.
- Consider the potential tax penalty — yes that still exists — you might face if you aren’t covered. This year it is $695 per individual, $2,085 for a family or 2.5 percent of your household income — whichever is higher.
- There still are navigators available, but it’s wise to seek their help early. PHMC partners with other organizations to offer navigation services at legislators’ offices, grocery stores, utility payment centers, and other sites. The Philadelphia Free Library will have five locations this year where people can speak to a navigator; go to https://libwww.freelibrary.org/calendar/tag/affordable-care-act for more information. Places to get in-person help are listed at healthcare.gov, or call navigator groups such as PHAN (877-570-3642). In New Jersey, try Family Resource Network at 800-355-0271, www.frnnavigator.org.
- Licensed health insurance agents and brokers also can help you find an ACA plan; their fees are paid by insurers.
- A navigator also can help you find out if you are eligible for other programs like Medicaid and the Children’s Health Insurance Program (CHIP).
- Get prepared. Visit Healthcare.gov and sign up for an account, or if you need to, change your password on your existing account. While you cannot see plans and prices until later this month, make sure you can access your account.
- Consider your current health needs, know your doctors and prescription drugs and think ahead. Whitaker said that navigators talk “about the ‘what ifs,’ ” to help clients pick the right insurance.
- If you already have ACA insurance and want to keep it, still visit Healthcare.gov to make sure your information is up to date. If your plan won’t be offered next year, you may not be automatically reenrolled. Besides, Kraus noted, your family’s needs or your income may have changed, and you need to update all that to be certain you’re getting the best options for you.