Officials charged with helping Missourians enroll in the health care exchange are reporting positive results as the nation closes in on the final month of open enrollment in President Obama’s controversial health care law.
Missouri’s relationship with the Patient Protection and Affordable Care Act — more commonly known as Obamacare — has been rocky since it was signed into law in March of 2010. That year, voters approved a ballot measure opposing the creation of a state health care exchange, followed up by a second measure in 2012 that prohibited state and local officials from providing “assistance or resources of any kind” toward establishing or operating a state exchange.
With no state resources available, help for individuals wanting to sign up through the federally-established exchange fell to local and regional community groups, with Pettis County served by individuals from Katy Trail Community Health and the Area Agency on Aging.
Although enrollment in the exchanges, which opened in October, was initially hampered by a series of technical glitches on the healthcare.gov website, those issues were largely resolved in December and enrollment statewide began to pick up, according to Ryan Barker, vice president for health policy with the Missouri Foundation for Health.
“We had a couple rough months with the website through October and November,” Barker said. “However, as of January about 54,000 Missourians have enrolled statewide.”
Of these, Barker said, “83 percent in Missouri have been eligible for financial assistance,” coming in the form of a tax credit to help individuals and families cover premiums and out-of-pocket costs, depending on the size of the household and income levels.
Noting that policy experts and lawmakers believe the sustainability of the exchanges will largely be dependent on the participation of younger Americans, Barker said MFH is “excited about the enthusiasm of younger Missourians looking to get coverage.”
“In Missouri we are doing really well for young people. Of those who have signed up, 27 percent are between 18 and 34,” Barker said.
With open enrollment ending March 31, Barker said MFH and its local allies are ramping up public education efforts.
“The public should understand there are many people eligible for financial assistance, 4 of 5 can get help with premiums,” Barker said.
While a growing number of middle income Missourians have secured health care through the exchange, Barker and others said uninsured low-income Missourians will see little to no relief through ACA after multiple Missouri General Assembly votes opted to forgo expanded Medicaid for those making up to 133 percent of the federal poverty level. Currently the state offers Medicaid to families with dependent children up to 24 percent of poverty level, with zero assistance to non-disabled adults without children.
“It is one of the most difficult parts of the job — coming across people in the gap,” Barker said. “Below 100 percent of poverty, you are not eligible for Medicaid. They can look at the marketplace but they have to pay full price. It is really one of our biggest struggles. Missouri is still having that conversation, so we keep trying to let people know things could still change.”
Though many Pettis Countians may have been wary of Obamacare, Melissa Magaña, an outreach and enrollment specialist with Katy Trail Community Health, told the Democrat that some 500 individuals and families have sought help with enrollment through her office.
“I haven’t had one single person tell me they couldn’t afford the insurance. For the most part people are surprised at what they are being offered,” Magaña said. “At the beginning people say things like ‘I don’t care for Obamacare or this mandate,’ and then once we are done they say ‘wow, this isn’t as bad as I thought.’”
Like Barker, she said Katy Trail has seen a varied sampling of the uninsured population.
“We have seen kids who just turned 19 and are not on Medicaid. We have seen folks that are a year or two from Medicare. We have seen part-time workers with no insurance provioded by their employer,” she said. “We have also seen people paying out of their own pocket and people whose COBRA was ready to run out or COBRA is getting ready to be offered.”
In addition to the poor and younger Americans, ACA was also intended to help people with pre-exisiting conditions that may have made them ineligible for private insurance.
Marilyn Gunter, director of care management for the Area Agency on Aging in Warrensburg, which coordinated ACA “navigators” in 13 central Missouri counties including Johnson and Pettis, said they have assisted a broad spectrum of people.
“We have especially seen a lot of young families and folks where somebody in family has a major illness and couldn’t get coverage before,” Gunter said.
However, both women agreed with Barker that those falling into the Medicaid expansion “gap” have few options, though Magaña stressed those who fill out an enrollment application but aren’t eligible for assistance will be exempt from the mandate for purchase tax penalty.
“That has been hardest part. How do you tell someone that is sick there is no help available?” Magaña said. “When they come in and we fill out the application I tell them I have good news and bad news. I tell them these are your eligibility results. You don’t qualify for assistance, but you also won’t have to pay the penalty. Then I tell them about services through Katy Trail and other free services.”
In an effort to reach out to eligible individuals and families, Katy Trail will host four Saturday enrollment programs in the area, including one from 9 a.m. to 6 p.m. Saturday at Katy Trail Community Health, 821 Westwood Drive.
Magaña said the application process takes about 45 minutes for an individual and one to two hours for families, depending on the size of the household. Those wishing to apply should bring Social Security cards for all members of the household, a 2012 or 2013 federal income tax return, proof of current income, such as a paycheck stub and a photo ID for the person completing the application.
Appointments are preferred, but she said walk-ins on Saturday will be seen if time permits, though Katy Trail representatives can work with individuals to schedule a time that works with their schedule.
For more information, call Magaña at 877-733-5824, ext. 853, or by cell phone at 660-287-7702.