Nearly 12,000 in area have beaten Affordable Care Act deadline

Jan. 30--BUTLER COUNTY -- Community health centers and other sign-up locations across Butler and Warren counties have seen a surge of applicants for health plans sold under the Affordable Care Act as Sunday's final deadline for enrollment looms.

Since the three-month enrollment period began in November, 226,421 Ohioans -- including nearly 12,000 in Butler and Warren counties -- have been signed-up or automatically re-enrolled for coverage through the state's online insurance exchange, known as the Health Insurance Marketplace, according to the U.S. Department of Health and Human Services (HHS).

Dora Villegas, a certified application counselor at Primary Health Solutions that has offices in Hamilton and Middletown, said 7,032 have signed up or been re-enrolled in Butler County through Jan. 9. She said 4,796 have done the same in Warren County.

Villegas said this week has been "very busy" at her Hamilton office. She has signed up 10 people this week, she said.

Much of the last-minute rush can be attributed to the federal tax penalty for not having health insurance, which more than doubled this year to a minimum of $695 for an individual who goes without coverage for the full year, up from $325 last year, Villegas said.

She said the penalty is $695 or 2 percent of the person's annual income, whichever is highest.

She also said people typically procrastinate.

"This happens all the time," she said.

Shanise Wade, who was helping residents choose from hundreds of marketplace options at the Corwin Nixon Health Center in Dayton, said when people filed their income taxes this year and got fined for 2015, they saw that the "penalty is real." She encouraged people to pick a plan, even if it's the lowest-cost plan available, because it's better to invest that money in a plan rather than paying it as a penalty,. she said

The health care law requires virtually all Americans to maintain coverage or risk fines, unless they qualify for hardship or other exemptions.

Jennifer Wells, a medical assistant at Corwin who buys her health coverage through the marketplace, said she'll forfeit $150 of her tax refund for 2015 because she let her insurance policy lapse for three months last year -- a self-imposed penalty she doesn't plan to pay again.

Not everyone signing up for coverage is motivated by the potential tax penalty.

"Having insurance is everything," said William "Mike" Coffey, who described the health care law as a Godsend for he and his wife, Nora.

The 68-year-old retiree has Medicare coverage for most of his health needs. But his wife -- who suffers from a variety of serious health conditions, including diabetes and heart disease -- doesn't work and is about a year away from qualifying for the government health plan for seniors when she turns 65. And because of their retirement income, the couple doesn't qualify for Medicaid.

The insurance exchanges, which launched in late 2013, offer subsidized coverage to people with annual incomes between $16,243 and $47,080, or 138-400 percent of the federal poverty level, who don't have access to job-based coverage.

Most people -- about eight out of 10 -- qualify for income-based tax-credit subsidies that help reduce monthly premium costs and even out-of-pocket costs in some cases.

"I'm healthy, but my wife has so many health problems. I'm just trying to keep her alive, and these exchanges are about my only option," a tearful Coffey said as he sat down with an insurance counselor at the East Dayton Health Clinic.

The insurance marketplace, combined with the expansion of Medicaid in many states to most poor people under the health care law, has helped more than 16 million Americans gain coverage.

Increased health coverage has pushed down the national uninsured rate from about 17 percent at the end of in 2013, when enrollment in the marketplaces began, to about 12 percent last year, according to the latest Gallup-Healthways Well-Being Index.

But progress has stalled.

The national uninsured rate was essentially unchanged from the last quarter of 2014 to the end of last year, and about 32 million Americans -- including more than 830,000 Ohioans -- remain uninsured, according to research from the Kaiser Family Foundation.

Experts attribute the sluggish take-up mainly to consumers who are unaware that they qualify for Medicaid or marketplace coverage, and the reluctance of many states to expand Medicaid to most able-bodied adults earning at or below 138 percent of the federal poverty level.

So far, 30 states, plus Washington, D.C., have expanded the government health insurance program for the poor, but states that haven't have left millions of people uncovered.

In Ohio, expansion has added more than 600,000 people to the state's Medicaid rolls, which has been a boon for downtown Dayton-based CareSource -- primarily a Medicaid managed care provider, which also sells commercial health insurance through marketplaces in four states: Ohio, Indiana, Kentucky and West Virginia.

CareSource, which launched its Just4Me commercial health plans in Ohio during the first open-enrollment period, now has more than 130,000 marketplace members across all four markets. While still a small fraction of its more than 1.4 million total members, the numbers for the company's private insurance business continue to grow.

In Ohio, Just4Me membership has ballooned to 80,000 new and existing members through the first two and a half months of current open enrollment -- up 50 percent from the same period a year ago, said Scott Streator, senior vice president of CareSource's marketplace product line.

"We are having a very good open enrollment for the third year," said Streator, who noted CareSource's enrollment represents nearly a third (31 percent) of total marketplace coverage in Ohio.

In addition, enrollment is on pace to meet or exceed projections in every state where the company sells marketplace plans, Streator said, a sign that the insurance markets are still a viable option for insurers and consumers alike, despite reservations expressed by some other health insurers who have threatened to pull out of the marketplace.

Streator attributes much of CareSource's success to pricing: Just4Me plans are the lowest- or second lowest-cost plans in most of the markets where the health plans are sold.

"The No. 1 reason why people across the country want health insurance is financial security," he said. "It stands to reason that the No. 1 reason they're choosing CareSource is financial security because we have one of the lowest out of pocket and total cost of care" programs.

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