By Martin Slagter
---- — Anita Cupp waited on the phone inside the Project Access office for a half hour, trying figure out why her application for health insurance through the government's online marketplace wasn’t being processed.
This was the “fourth or fifth” time the Kokomo resident had tried to submit an application through the federal government’s Affordable Care Act website, www.HealthCare.gov. After being turned down for ACA tax credits, Cupp was told to apply for the Healthy Indiana Plan or Medicaid because her income falls below federal poverty level guidelines.
The struggle to find answers on how, exactly, to get access to affordable health care is a familiar one for many in Howard County and beyond. Cupp has been without health insurance since 2009.
“Before Thanksgiving we started this,” Cupp said as she waited on hold. “I didn’t think it was going to be this hard.”
The issue Cupp and many others throughout Indiana are facing with the rollout of the ACA has not been a lack of help, but a lack of resources. Gov. Mike Pence continues negotiating with federal officials to expand Medicaid using the state’s Healthy Indiana Plan —the state’s health care plan for low-income residents — which recently added 3,400 people from its waiting list to its rolls.
There are still about 17,000 spots open for new HIP enrollees, however, changes to the program to meet federal standards eliminated more than 10,000 who were previously covered.
The HIP has become the only option for those in Howard County with incomes below the federal poverty level, which ranges from monthly income of $957 for a single person to $1,962 for a family of four.
Those guidelines have become one of the biggest issues for those applying for coverage.
Employees at Howard County Medical Society’s Project Access, which provides volunteer, comprehensive medical care to uninsured, low-income residents, has seen the struggles of those who are trying to obtain coverage for the first time.
Project Access Director Sherry Rahl estimated out of the more than 100 uninsured people that have been guided through the application process at her office on North Dixon Road, only seven qualified for ACA coverage and tax credits.
“If you’re not going to increase Medicaid, something has to be done for our people,” she said. “These people in the lobby — they have no other choice but us. If they’re above 100 percent of the poverty level, there is nothing right now in the state of Indiana to cover anybody.”
Indiana Health Center Outreach Enrollment Navigator Nemramy D’Agostino said many who enter her office and the Howard County Medical Society’s Project Access program fall below those levels.
“It’s supposed to be for uninsured or underinsured people to make it affordable,” D’Agostino said of the ACA. “Because the Medicaid population is not getting taken care of. Due to a lack of expansion, they’re still uninsured.”
Working through the glitches
Nearly 2.2 million people picked a health insurance plan through the exchanges established by the Affordable Care Act through Dec. 28, according to numbers released this week by the Department of Health and Human Services. That is about 65 percent of the Obama administration’s goal for this period.
In Indiana, 30,443 individuals have selected a private plan — about 52 percent of the third-month target of 58,750. Out of the 126,217 people who have applied for coverage through the marketplace, 42,898 were eligible for Medicaid or the HIP. While lower than hoped for, the figures are a vast improvement from the 3,492 Hoosiers who had selected a marketplace plan through the month of November.
After experiencing a number of glitches in its early stages, the number of ACA applicants is up across the country now that those problems are being fixed.
“It started to work around the middle of November and on,” D’Agostino said of HealthCare.gov. “We’ve had some glitches in verifying identities, but it’s solved itself.
“The marketplace itself has been plagued with delays and not working properly,” she added. “That’s one of the things that has frustrated people. Sometimes they don’t want to come back to it because it takes so long to get their application done.”
D’Agostino, who helps guide applicants through the process at her IHC office and Project Access, said some of the bugs on the ACA website have been worked out. She finds, though, many of those she has helped have returned on multiple occasions to finish their applications or get help determining what their next course of action is — despite having been guided through the process for 1.5 hours per session.
“Lately it’s been working a lot better,” she said. “We’ve been able to get through the application and go all the way to eligibility and even select plans.”
While St. Joseph Hospital hasn’t experienced many issues with the rollout of the ACA in terms of treating new patients, there are some quirks that need to be worked, officials said.
Perhaps the biggest issue is the fact that not everybody who enrolled has received their insurance card, St. Joseph Director of Marketing and Public Relations Sandy Herman said.
“Without that card, patients don't have proof of insurance,” she said. “We will treat patients, regardless of proof of insurance, but it causes worry for the patients about whether their services will be covered. The good news is that St. Joseph has people who are trained to help insured patients obtain proof of insurance so they don't have to worry.”
There are some common misconceptions new patients might have when entering the health insurance marketplace, Herman said, including the assumption that getting insurance through the marketplace means people will be covered no matter where they go for care.
The truth is, each hospital and doctor takes only some products offered through the marketplace, Herman said.
In Howard County, St. Joseph Hospital accepts MDwise marketplace insurance products, but not Anthem. Community Howard Regional Health in Kokomo, however, accepts Anthem marketplace products, but not MDwise, Herman said.
“If patients want to go to a specific hospital or doctor, it is important they choose the plan accepted by their care provider of choice,” she said.
Maybe the biggest misunderstanding applicants have, D’Agostino said, is regarding the penalties that must be paid by those who don’t have health insurance this year.
People who don’t have coverage in 2014 have to pay a penalty of $95 per adult, $47.50 per child, or 1 percent of your income (whichever is higher). The fee increases every year.
It is important to note that those who don’t qualify for coverage through the ACA or HIP can receive an exemption on the penalty, D’Agostino said.
While some in Kokomo and Howard County have struggled to obtain ACA tax credits, there are resources and outreach available to both educate residents about the health insurance marketplace and help guide them through the application process.
St. Joseph Hospital continues to host a series of enrollment sessions where those interested in applying for coverage can get assistance and find out what plan is best for them.
Community Howard Regional Health, the Indiana Health Center, Project Access, Soul Anchor Apostolic Church and the Greentown Lions Club also have hosted enrollment events to help guide residents through the application process.
In addition to navigator assistance, the health care forums often provide extensive information about what one should know before signing up for coverage and question and answer sessions that can provide insight to residents’ most pressing issues.
Kokomo resident Kimberly Watson started her application at Project Access this week and thought the process ran fairly smoothly with the help of a navigator.
Watson, who works at Buffalo Wild Wings, is looking to secure health coverage because she doesn’t work full time. She previously received insurance through the Healthy Indiana Plan and is looking for some basic care and a doctor with whom she can develop a good rapport.
Without the help of a navigator, Watson said, signing up would not have been so easy.
“There are some little glitches, but this has actually run a little more smoothly for me than some of the other people I’ve heard from,” she said. “I have a couple of co-workers that tried it that said it was a mess. I got a lot of help (from the navigator).”
For those who don’t qualify for coverage through the ACA or Healthy Indiana Plan, Project Access remains a viable option, Rahl said.
In 2013, Project Access provided coverage to 783 clients, partnering with providers to donate nearly $1.9 million in medical services and an additional $589,000 in prescriptions.
“If there was a Project Access in every county of America, there would have never needed to be an Affordable Healthcare Act,” Rahl said. “We already do it — we give them a primary care physician and a clinic to go to at little or no cost at all.”
With more local people being denied coverage in the marketplace because they don't have enough income, Project Access is seeing between 30 and 40 new patients per month.
Regardless of how the ACA continues to evolve, D’Agostino said the intent and long-term benefits of the new marketplace will ultimately provide a needed service for many.
“In the long run, people will be healthier,” she said. “A lot of people don’t understand the health benefits that come from this. It might take a generation or two to understand that insurance is important and preventative practices will allow us to be healthier and live longer in the long run.”
Martin Slagter can be reached at 765-454-8570, firstname.lastname@example.org or on Twitter @slagterm.
Help is on the way Those who are still looking to purchase health insurance through the marketplace will have the opportunity to learn more about how to apply for coverage in a series of help sessions hosted at St. Joseph Hospital at 1907 W. Sycamore St. Here is a listing of upcoming seminars available to area residents (please note: St. Joseph Hospital and St. Vincent doctors will be participating only with MDWise/Hoosier Alliance Delivery Plan) 3 to 7 p.m. Jan. 21 10 a.m. to 2 p.m. Jan. 30 3 to 7 p.m. Feb. 4 10 a.m. to 2 p.m. Feb. 13 3 to 7 p.m. Feb. 18 10 a.m. to 2 p.m. Feb. 27 Indiana at a glance: Here is a look at how Hoosiers have utilized the the federal government's Affordable Care Act website, www.HealthCare.gov through Dec. 28, 2013 Total number of completed applications: 79,719 Total individuals applying for coverage in completed applications: 126,217 Eligible to enroll in a marketplace plan with financial assistance: 48,305 Determined or assessed eligible for Medicaid/Healthy Indiana Plan: 42,898 Have selected a marketplace plan: 30,433 Marketplace plan selection by gender: Males 44% Females 56% Marketplace plan selection by age: 0-18: 5% 18-25: 7% 26-34: 14% 35-44: 14% 45-54: 20% 55-64: 39% 65+: 0% Do you qualify? The amount you save on tax credits through the Affordable Care Act depends on your family size and how much money your family earns. If your yearly income falls within the following ranges, you'll qualify to save money on your premiums in 2014. If your income falls below the amounts shown, you may qualify for cover under Medicaid/the Healthy Indiana Plan. However, because Indiana has not expanded Medicaid, you are not eligible for lower costs on marketplace coverage based on your income. Individuals: $11,490 - $45,960 Family of 2: $15,510 to $62,040 Family of 3: $19,530 to $78,120 Family of 4: $23,550 to $94,200 Family of 5: $27,570 to $110,280 Family of 6: $31,590 to $126,360 Family of 7: $35,610 to $142,440 Family of 8: $39,630 to $158,520