Marketplace ready to go ONLINE [Missoulian (MT)]

The centerpiece of a controversial health care law that requires people to purchase insurance or pay a penalty goes live Tuesday after long years of debate.

Under the Affordable Care Act, also known as Obamacare, virtually all Americans must purchase health insurance or pay a penalty, and the open enrollment period opens Oct. 1. Three

providers - Blue Cross and Blue Shield of Montana, PacificSource and the Montana Health Co-op - will offer four levels of plans at healthcare.gov to Montanans who don't currently have insurance or who are interested in changing plans.

People must purchase health insurance by Dec. 15 for it to become effective Jan. 1 - a date Brooke Barnett is eagerly anticipating. It could be the first time her family has health insurance since she was laid off from her medical writer job with a marketing and communications firm in March and lost health insurance benefits in June.

"Being uninsured is really scary. My eye is twitching," Barnett said Thursday from the Alberton home she shares with her husband and two young children.

"It feels like we're holding out until January," she added.

Fisher, Barnett's 1 1/2-year-old son, didn't wait for January, and the family is struggling to figure out how to pay off a roughly $1,000 bill from a trip to the emergency room for stitches.

Because her husband, Todd Skibbe, works part-time for Alberton, he's not eligible for benefits, and Barnett's freelance writing and photography doesn't bring in enough money to purchase insurance and still pay the mortgage, student loans and other household expenses.

"We're month to month," she said. "There's no padding in the budget."

Insurance through her previous employer wasn't great, she said, but at least it was something in case catastrophe struck.

"It was like I was just throwing money into a black hole," she said, adding she's hopeful the new system will be more about practical, affordable health care than about affordable insurance.

The idea of being able to purchase insurance, made affordable with subsidies and tax credits, is promising, although she would like to see something more like a single-payer system.

However, if an insurance plan costs more than $200 a month, Barnett said she's still not sure how the family will be able to afford the extra cost without skimping on essentials, like the grocery budget.

"I don't know; it just seems like a paradox," she said.

Not having insurance of any kind, though, could have lasting negative impacts, Skibbe said. "It's scary that you can have some sort of medical incident that could have long-lasting financial impacts."

Both Barnett and Skibbe said they have questions about the reality of a new system and that they will reach out to different resources in the community and online to learn more about the insurance exchange and how it could impact their family.

"What's it going to be like to live under this system?" Skibbe asked.

"The raw truth is that I'm totally ignorant about it," Barnett said. "And I think a lot of people out there are."

"This is almost a seismic shift in the way that we as Americans and we as Montanans approach accessing health care and health insurance, and this is an exciting change," said Lindsay Love, communications manager at Planned Parenthood in Missoula.

To help the estimated 22,000 Missoula County residents who need insurance understand the changes and help them work through the online insurance marketplace, several area health care providers are offering resources, like the "navigator" who will be on staff at Planned Parenthood's Missoula office.

Seven navigators will be available statewide through Planned Parenthood to help walk people through the process of purchasing insurance and help them overcome any hurdles or issues with applications. Their positions are being funded through a federal grant.

Outreach educators and outreach organizers are already trusted in area communities and they can help educate people about changes, as well, Love said.

While the navigator will have office hours, "we're also going to kind of take this show on the road," she said, adding that the navigator and outreach specialists will be going to rural communities to help people where they live.

People also can drop by the office at 219 E. Main, or go to plannedparenthood.org.

Support resources won't dry up when the open enrollment period ends. Certified application counselors will be available at Community Medical Center as long as the exchange exists, said Donald Miller, revenue cycle director at the hospital.

Six counselors, including Miller, will be available so that patients can get timely and accurate answers to their questions, he said.

"We can assist them with general questions about the exchange without getting specific information," he said.

Counselors will help people understand basics and intricacies alike.

"You have to know all the elements before you can make an informed decision," Miller said.

Choosing a plan is about more than tax credits and co-pays, he said. "So then, on top of that, you have to determine what you anticipate to be your health needs for the coming year."

Counselors can't steer people toward specific plans, said Merry Hutton, regional manager for ambulatory behavioral health and community benefit at. Providence St. Patrick Hospital.

People must choose the plans that make the most sense for their medical needs and family needs and take into account current medical relationships, she said. "How will you need to use your coverage is a decision point for you to make."

To help answer questions and provide information about the marketplace, Providence is reaching out to the community with free enrollment fairs in both Missoula and Polson.

"It really is just trying to be as supportive of the community as possible," Hutton said.

Even if people think they know where they fall to receive or not receive subsidies or tax credits, they should sit down with a counselor or go online and create an account, she said.

"I just want them to make sure that they know what their options are," she said, adding that 11 counselors will be available between Polson and Missoula on a regular basis.

Three certified application counselors are on staff at Partnership Health Center, thanks to a Health Resources and Services Administration grant. The funding is good for one year, but could be extended.

Anyone, whether they go to Partnership or not, can use the counselors as a resource for answering questions, signing up and getting qualified, said Jeff Seaton, the health center's chief operating officer.

Counselors will not direct people to one plan or another, but will be able to explain terminology and help with the process, Seaton said.

"(Their job is) to present the materials in a way that makes sense to the individual, so that they can make those choices on their own," he said.

As required, counselors have undergone two-tiered training through the Centers for Medicare and Medicaid Services and the state Commissioner of Securities and Insurance office. To talk with a counselor in a private setting, people can call Partnership at 258-4789 or drop by the offices at 401 Railroad St. W.

Regardless of what plan people purchase and what subsidies and tax credits they receive, the plans are not free and people must still pay deductibles and co-pays, Miller said.

Still, "the benefit is to the patient because they have a source of payment for their medical bills," he said.

Theoretically, the new system benefits health care providers, many of which have different systems in place to help people who can't afford medical care.

"But we're going to have to wait and see if that's truly the case," Miller said.

In the meantime, no one knows what kind of demand there will be for counselors and navigators either.

While steady demand for counselors' help seems likely, considering the 7,000 patients each year who come to Partnership without insurance, how busy the counselors will be is unknown until they start helping people this week, Seaton said. "I think it remains to be seen. There's a lot of interest right now."

Getting people to sign up is a matter of education, Hutton said.

"It's hard to know," she said of the demand for face-to-face resources. "I suspect people are still just very curious and don't understand."

As with all new things, there might be glitches, Love said, asking people to be patient. "This is a new landscape for all of us, and it's an exciting time to work in the health care industry. And I think as we look at this first open enrollment period, to a certain extent, we're just going to roll with it as it goes."

Meanwhile, Barnett is hoping she's encountered a glitch herself. After plugging her information into an online calculator last week, she said she was shocked by the price that came up on her computer screen.

"Now I'm feeling incredibly disappointed - and like I'm being squeezed for the benefit of insurance companies," she said.

"I only hope that I have screwed up this rather simple calculator somehow and my numbers aren't right."