On the front lines of registering for health care [Mail Tribune, Medford, Ore.]

Oct. 31--Like most people trained to assist Oregonians in enrolling for health care insurance, Aracely Mesta expected her calendar to be jammed this month.

But one delay after another in Cover Oregon's online portal has turned the anticipated digital frenzy into a frustrating paper trail.

"I'm seeing eight people a day and it takes 30 minutes to an hour to fill out their forms," said Mesta, an outreach worker at LaClinica's West Medford Health Center.

"As time goes by, it gets faster, because I'm the one inserting information," Mesta said. "I know what the form looks like, so it depends on how many people are in the household and if they bring in all of their information. Some forget their ID, Social (Security) and income information, so that slows the process."

A month into the greatest transition in health care in the nation's history, not much has really happened. Thousands of paper applications have been forwarded to the state, but Cover Oregon reported no exchange enrollments heading into this week.

While insurance seekers can create an online account, that's as far as the digital experience goes. When Mesta meets clients, they don't see the 20-page application.

"I'm filling it out on the computer, so they don't know how many pages there are until I print it out."

It can take up to 45 days for the paper applications to be processed and for the applicant's eligibility to be confirmed, according to Cover Oregon.

Even so, Mesta said, clients have plenty of questions and anxiety over the unknown.

"They want to see whether they qualify for Medicaid or to receive a tax credit," she said.

The watch words for the outreach workers and insurance agents are patience and endurance.

"It's obviously a challenge," said Dennis Flenner of Protectors Insurance. "Patience will be a virtue. People are anxiously waiting for the system to begin working. You don't have to be a psychic to know there would be a logjam."

Flenner is among the dozens of agents listed on the Cover Oregon website trained to begin working with people signing up for the health insurance exchange this month.

The No. 1 question from clients remains, "How long will this take?" Flenner said. "In the scheme of things, will it take days, weeks or what before we get something cooking? A lot of people are asking why; it's confusing."

While people are excited that economic factors and existing health conditions are no longer barriers to getting health insurance, Scott Bybee, owner of Innovative Investment Services in Medford, said the real worry comes if people can't enroll in the exchanges when Dec. 1 arrives. At present, consumers have until Dec. 15 to acquire insurance via Cover Oregon in order for it to kick in Jan. 1.

"The concern as time passes is that the issue may not be resolved until the end of November," Bybee said. "How do you get people who need coverage signed up in a two-week time period?"

Jeff Caulley, who heads up strategy and business development at Asante Health System, feels like an air-traffic controller during a foggy day after preparing workers to help people sign up at the system's primary care clinics and hospitals.

"We're basically in a holding pattern until the (Cover Oregon) website becomes fully functional," he said. "So it's a lot of 'We'll take your information, we want you to help and get a hold of you once the website is up.'"

About 500 people have come to Asante's community seminars on Cover Oregon.

"Probably 75 percent of who we see are looking to get educated about the exchange," Caulley said.

People who don't care about tax credits or subsidized health care can buy private insurance directly from one of the eight companies offering plans in Jackson County.

"The pre-existing condition portion of enrollment created a ton of paperwork last year," Caulley said. "Now it will take 10 minutes if you know what network you want and are willing to pay the premium."

Terry Hay of Providence Medford Medical Center said his hospital is in a different position, because Providence Health Plans is one of the insurance providers competing in the marketplace.

As a result, Providence's efforts are dealing with Oregon Health Plan families, most of whom received fast-track enrollment forms for the state's expanded Medicaid program.

"The forms we use are two pages with three questions," Hay said. "Are you an Alaska native or member of a federally recognized American Indian tribe? Do you currently have insurance? Who is your primary care provider? After that, you sign it, then fax it or drop it by the DHS (Department of Human Services) office."

The real difficulty, Bybee said, might involve neither low-income users nor those ready to jump into the exchange, but those who find themselves unexpectedly exiting group plans.

"If employers pay for employees' health insurance, but not for their dependents, then the dependents who aren't on the plan are ineligible for Cover Oregon tax credits," Bybee said.

There are also gaps between the start of some group plans and the Cover Oregon calendar.

"That brings up a lot of problems," Bybee said. "How do you deal with it, if your contract year starts Dec. 1, and the employer is trying to help the person, not hurt the person?"

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