Updated: 2:33 p.m. Friday, Sept. 20, 2013 | Posted: 12:00 a.m. Saturday, Sept. 21, 2013

Special Report: Health Care

Confusion widespread as key deadline nears

Despite stepped-up opposition, law’s crucial phase begins Oct. 1.

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Confusion widespread as key deadline nears photo
Jim Witmer
Ellen Snyder’s job at Dayton Children’s Hospital was eliminated about a month ago, and now she’s faced with the daunting challenge of not only finding another job but securing health insurance on her own. The former clinical care coordinator has heard about the health insurance exchanges established in each state under the Patient Protection and Affordable Care Act, which requires most Americans to buy insurance next year or pay a tax penalty. But like most people, the Oakwood resident is unsure of what her coverage options might be or whether she would qualify for coverage on Ohio’s exchange, which will open for enrollment on Oct. 1 along with exchanges in most other states. She said she’s frustrated that the government hasn’t made more of an effort to educate the public about the exchanges in the three years since the law was passed in 2010. JIM WITMER / STAFF
Infographic: Timeline of health care overhaul photo
Infographic: Timeline of health care overhaul
Infographic: States' ACA marketplaces photo
Infographic: States' ACA marketplaces
Infographic: Ohio health insurance coverage photo
Infographic: Ohio health insurance coverage
Infographic: Where Medicaid is expanding photo
Infographic: Where Medicaid is expanding
Infographic: Average health care spending in Ohio photo
Infographic: Average health care spending in Ohio

By Mary McCarty and Randy Tucker

Staff Writer

Ellen Snyder is the type of person the federal health care law is designed to help.

But the Oakwood resident — whose job at Dayton Children’s Hospital was eliminated about a month ago — is unsure whether she would qualify for coverage through the Health Insurance Marketplace established in each state under the Patient Protection and Affordable Care Act.

It’s a common problem. Many people, even those who stand to benefit, are confused about how to proceed when the marketplaces open for enrollment on Oct. 1, or what their coverage will be.

“It just seems like this is pretty important stuff, and there is not a lot of information out on it yet,” Snyder said. “Until a month ago, this would not have made much difference to me. But at 55, I am not brave enough to be without health insurance.”

Despite all the political maneuvering over the health care law, it has emerged intact and is about to enter a critical phase. People who favor it, oppose it or have no opinion on it will nonetheless need sound information about its various complexities so they can make decisions that affect them and their families.

It wasn’t until Snyder attended a job-seekers’ support group meeting that she learned she may qualify for a federal tax subsidy that could dramatically reduce the $500 a month she currently pays for health coverage under the federal COBRA plan.

“Before I attended the event, I had no idea,” said Snyder, a former clinical care coordinator. “That’s the kind of information that’s very important for me, and anyone else in my position to know. It’s just crazy that more isn’t being done to inform the public.”

That is beginning to change.

Over the past couple of months, the U.S. Department of Health and Human Services has announced funding for education and outreach efforts in Ohio and 33 other states where the federal government will facilitate enrollment in the marketplaces.

Nonelderly adults who are not covered through public programs, such as Medicaid, and those who do not have health insurance through their jobs will be eligible for enrollment on the marketplaces, which are also open to small businesses with fewer than 50 employees.

Ohio received about $6.8 million in federal grant money to help educate and enroll residents.

About $2.9 million went to four organizations across the state to set up a so-called navigator program, which was created by the health care law to hire and train counselors to help Americans navigate the new health exchanges and sign up for insurance. Another $3.9 million went to 36 health centers in Ohio to hire 75 new employees to help people enroll.

Still, most of the organizations that received grant money won’t have their navigator programs up and running until just before or soon after the exchanges open for enrollment in 10 days.

In the meantime, consumers can go to the healthcare.gov website for a general overview about how to enroll, and they can use tools such as the Kaiser Family Foundation’s subsidy calculator to get a rough estimate of how much health insurance may cost in the marketplaces in 2014.

But those tools are only useful if you know about them, and some health policy experts and consumer advocates worry that because the outreach efforts started so late, many consumers may fall through the cracks.

“A large and significant percentage of our own community action clients that are here every day don’t have insurance,” said Deborah Ferguson, director of outreach and social services for the Community Action Partnership of the Greater Dayton Area, which serves Butler, Darke, Greene, Montgomery, Preble and Warren counties. “If they don’t have Internet access at home, and they don’t watch the news or read the paper, they would not be aware of even the basic components of (the health care law) or where to go for help.”

Waiting for answers

Linda Craft of Hamilton is frustrated by her quest for insurance, and frustrated with waiting for answers. She left a job with insurance to start her own business, not realizing she didn’t qualify for COBRA, which allows individuals to continue participating in their employer-sponsored coverage but out of their own pocket and without any premium contributions from their employer. Another insurance carrier denied her coverage because of her height and weight, she said, even though she is never sick.

“I’ve never felt like this in my life,” Craft said. “I’m pretty desperate.”

The Community Action Partnership applied for but did not receive a navigator grant. Still, Ferguson said her organization will refer clients to official navigators in the area, such as Helping Hands Community Outreach Center in Dayton, for information and assistance in applying for insurance on Ohio’s exchange.

“We welcome that kind of cooperation and support,” said Neldra Glasper, Helping Hands’ executive director. “We’re the only organization in Montgomery County that received a navigator grant, and we can’t wait to get the word out and make people aware in the community that insurance will be available to them under the Affordable Care Act.”

A recent survey from the Henry J. Kaiser Family Foundation shows just how critical outreach and education will be to inform the uninsured about their new options.

More than half of Americans need such such assistance, according to a Kaiser Health Tracking Poll in which 51 percent of respondents said last month that they didn’t have enough information about the health care law to understand how it will impact them and their family.

And nearly two thirds (62 percent) of uninsured Americans who are most likely to qualify for coverage on the exchanges were unaware of their coverage options, the survey found.

‘It’s scary’

Teresa Simpson, 62, a truck driver from Huber Heights, lost her insurance in December. Her husband is retired because of medical reasons, and they can’t afford insurance. “We’re not eligible for Medicaid, because we make a little too much,” she said.

She has sought treatment at Dayton’s Reach Out Clinic, where she has encountered many other working families. “It’s scary at my age,” Simpson said. “I’m anxious to see what is going to be offered, and if it’s anything I can afford. We’re surviving from week to week.”

Critics blame President Barack Obama and his administration for not doing a better job of explaining the president’s signature health care law.

Phil Parker, president and chief executive of the Dayton Area Chamber of Commerce, said the lack of information about the exchanges not only affects individuals interested in signing up for health coverage, but employers as well.

“There are going to be employers who have never been able to afford health care before whose employees are going to come to them and say, “Hey, now that we finally have a place where we can go to find insurance, do you know anything about this?”’ Parker said.

He was referring to workers at small firms with fewer than 50 employees that are not required to provide health insurance under the law. But workers at those firms will still be still be required to buy health insurance, and most are expected to seek coverage in the state marketplace.

“Many employers are going to have to try, if they can, to counsel their employees,” Parker said. “But it’s the middle of September, and we’ve yet to get the detailed information about how these exchanges are going to be set up. The federal government has not done its work properly to facilitate this program.”

President Obama too has acknowledged the need for greater communication regarding the health care law and has tapped former President Bill Clinton to help get the word out. But it’s an uphill battle, made more daunting by Republican opposition.

Led by House Speaker John Boehner, R-West Chester Twp., the House on Friday passed legislation that defunds the new health care law but would keep the government running through Dec. 15. The legislation was approved on a party line 230-189 vote, with only 1 Republican voting against it and 2 Democrats supporting it. Passage of the bill sets up a showdown with the Senate, and moves the two sides closer to a possible government shutdown on Oct. 1.

The Republican-led House has voted more than 40 times to repeal or defund all or parts of the law, even though the Supreme Court upheld the law by a 5-to-4 decision in June 2012.

The buzz about repeal has muddied the waters engulfing the health care law. According to the Kaiser poll, more than four in 10 Americans are still confused about the status of the law, with 8 percent thinking the law has been repealed, 5 percent thinking it was overturned by the Supreme Court, and 31 percent unsure whether it remains law.

Not that simple

Even with 100-percent awareness, explaining the law is not that simple, according to Ferguson: “We service thousands of people during the course of the year, almost all of them low-income and with low literacy levels, and we’re particularly concerned that they might not understand how this new regulation affects them.”

Under the health care law, insurers — including more than a dozen companies who plan to sell more than 200 individual and small-business plans through Ohio’s marketplace — will be required to spell out coverage in simple terms.

But they will still use basic insurance terms, such as “deductible, copay, co-insurance and out-of-pocket maximum,” which surveys show few Americans understand.

“This is not a simple piece of information to share,” Ferguson said. “It’s not like telling people you can’t text and drive. This is pretty complicated, and it will take a variety of methods to explain this stuff.”

It will also take a massive outreach effort, and several national groups have stepped in to augment state and local efforts in Ohio. Enroll America — a national nonprofit with ties to the Obama administration — plans to open offices in Cincinnati, Columbus and Cleveland from which volunteers will fan out across the state to educate people about the new health care law.

The Get Covered America campaign, which launched nationwide in June, kicked off in Dayton earlier this month with a series of community forums that discussed the new health law and how volunteers can best prepare to enroll local uninsured residents.

“While we won’t actually be sitting down with folks with a laptop to walk them through the enrollment process, we’ll be more focused on identifying uninsured people out in the community and then connecting them with the resources they need to help them get coverage,” said Trey Daly, state director for Enroll America in Ohio. “We’re really trying to interact with as many uninsured folks as we can. The message we’re trying to send to them is that help is on the way.”

Jean Benton of Springfield hopes that is the case. Her part-time job as a social worker doesn’t offer her health insurance.

“It’s difficult to be uninsured,” said Benton, who has a master’s degree.“People look at you like you’re some kind of alien from outer space.”


Unmatched coverage

Dayton Daily News reporters Randy Tucker and  Mary McCarty are taking a closer look at how the Affordable Care Act affects you. Our series starts today and answers frequently asked questions, as well as look at how the uninsured, self-employed, the health care industry and businesses are impacted by the changes.

COMING NEXT

  • Today, how the new health insurance marketplaces work
  • Monday, how will the marketplace impacts the uninsured in Ohio
  • Tuesday, how it impacts the self-employed
  • Wednesday, how the health-care industry is preparing for the expanded coverage
  • Thursday, the impact on businesses
  • Sunday, a look at who is selling insurance on the marketplace exchanges
  • Oct. 6, Your Guide: The Affordable Care Act is a special section with everything you need to know about the changes and how they will affect you.
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