Despite frustrations with system, people finding help through ACA

March 06--DURHAM -- With a laugh, Durham resident Darryl Williams said his strategy before was to try not to get sick. As a self-employed musician, he did not have health insurance. But he's getting older and said he's seeing more things happening with his health.

So on a Thursday last month, he was sitting in an office at the Durham County Department of Social Services checking out his options for insurance on the federal online health insurance website. Also called the "exchange," the website launched Oct. 1 as part of the roll-out of the federal health law known as "Obamacare" and officially as the Patient Protection and Affordable Care Act.

This was the second time that Williams said he'd come to try to get enrolled. The first time, he said the federal website was not working properly so he couldn't sign up. He then filed a paper application, but it got lost by the office he sent it to.

Despite the challenges, Williams said he was "very happy" with the outcome of his third experience. He found out that he qualified for a financial assistance through the federal government to help pay for the coverage, and had options for plans that would cost him nothing per month and for another that would cost him as little as $14.79 a month.

"It's actually something that should have been done years ago," Williams said of the federal law that created the online insurance exchanges.

Through the law, most people must have insurance that meets certain standards starting this year or they will have to pay a tax penalty. There are exceptions, including for people whose family income is below the tax-return filing standard, and those who would have to pay more than 8 percent of their income for health insurance, according to The Henry K. Kaiser Family Foundation website kff.org.

For those who do qualify, the penalty this year is either 1 percent of the person's household income, or $95 per person and $47.50 per child up to a total of $285 per family -- whichever is higher. For each month the person is uninsured, a 12th of the total annual penalty is applied. There is also no penalty for going without coverage for less than three months of the year, according to the website healthcare.gov.

The enrollment period ends March 31, but a person must be enrolled by March 15 to have insurance in place by April 1.

With the end of enrollment approaching in March, there were still people in Durham reporting glitches with the federal website. Others had trouble trying to file appeals, and were concerned about an expected 90-day processing window for them.

For Durham insurance broker Michele Smith, working to help people to sign up for health plans through the insurance exchanges meant 12-hour days in November and December. And while she said the website's functionality improved, she's still experiencing frustration.

"It has gotten better, but for example over the weekend (of Feb. 23), I kept getting kicked off and kicked off," she said. "I started working at 10 a.m. Sunday, and finished at 7 o'clock at night with multiple times that I got kicked off, and had to call in to get it pushed through. And it was interesting, long about lunch time, the whole front of the marketplace login changed."

Smith also had concerns that customers would sign up for plans that didn't provide coverage for their current network of doctors. She said she also had clients who signed up for new plans for the exchange and were double-billed both for their old health plans and the new plans. She advised people to go to the National Association of Health Underwriters to find a credentialed agent to work with.

"It's very frustrating to sit there for three hours waiting on hold to help our clients, or to fix one problem...," she said. "A lot of people are waiting until the last minute. No. 1, they don't trust the website, and they're frustrated ... it's still not working properly."

Local enrollment coordinators and others have reported success in getting people signed up so far.

"People are overjoyed that we can help them get coverage," said Brian Toomey, the CEO of Piedmont Health, a Carrboro-based health care provider whose patient population is largely uninsured. Along with Durham-based Lincoln Community Health Center, Piedmont Health won a grant from the U.S. Department of Health and Human Services to help enroll people through the federal online exchanges.

As of early last month, Toomey reported that Piedmont Health's coordinators had enrolled 336 people for health plans through the exchanges, and had come in contact with 1,296. Another 655 had their paperwork in process at that time, he said. Piedmont Health had enrolled 55 people in the Medicaid program, the state-and-federally-funded health program covering low-income parents, the disabled and the elderly.

The Affordable Care Act opened doors for some, Toomey said.

Enrollment coordinators working out of Lincoln Community Health Center, whose patient population is mostly uninsured, helped enroll 356 people through January, according to an email from Ricardo Correa, Lincoln's outreach and enrollment coordinator. That's out of 1,624 people that Correa said coordinators had had come in contact with by phone, email or in person.

"We have had individuals who actually couldn't afford health insurance in the past (who) walked out of here with a very good, satisfied experience ... with the marketplace, and also a health plan they liked a lot," Correa said.

On a Saturday morning at Lincoln Community Health Center last month, arrows on the hallway floors showed the way to the office where coordinators watied at computers to help people sign up for insurance through the online exchange.

Ana Lima and Angel Ortiz had come that morning to get help in signing up for insurance through the exchange. However, the website was down for maintenance.

Speaking through a translator, they said they are legal U.S. residents and wanted to see what they qualified for through the exchange. They had already made a phone call to get help signing up, and had wanted to follow up in-person to see their options. They hadn't been able to make it far enough through the website to see what the plans they qualified for.

Lima said she had coverage through her employer that ended . She was concerned about being able to sign up before open enrollment ends.

"We've only got a small time now," Lima said. "Many, many individuals need this."

Verlissa Mason was one of the certified application counselors working at Lincoln that Saturday. She also had concerns regarding the upcoming end of enrollment.

She said she had encountered a glitch in the website regarding subsidies for lawfully present immigrants. Tax credits are available for legal immigrants who are not otherwise eligible for Medicaid and whose estimated income this year is less than 100 percent of the federal poverty limit. In addition, there are credits for legal immigrants whose incomes are 400 percent of the federal poverty limit or below, according to the website https://www.healthcare.gov/what-do-immigrant-families-need-to-know/.

Mason said she encountered people who should have qualified for credits under those rules, but who were being told they could not on the website. Because of the problem, she said she helped three to four people file appeals. But those appeals had to be filed by paper, and Mason said she was told that it could take up to 90 days to get a response.

___

(c)2014 The Herald-Sun (Durham, N.C.)

Visit The Herald-Sun (Durham, N.C.) at www.heraldsun.com

Distributed by MCT Information Services