New round of ACA enrollment poses challenges

Getting uninsured Illinois residents to sign up for new options for health insurance under the Affordable Care Act was hardly easy.

The second round of open enrollment, which starts Nov. 15, could prove to be even harder, experts said.

Last year was the first that Americans could enroll in two new options for health insurance under the Affordable Care Act. The law expanded who could apply for Medicaid, which is the state and federal health program for lower-income people, and the law created an online marketplace, where higher-income people could shop for what are supposed to be more affordable health insurance plans with financial aid from the government.

The 2015 open enrollment period for the online marketplace is from Nov. 15 to Feb. 15, though people who would qualify for Medicaid can enroll at any time.

Like last year, so-called navigators or in-person counselors, who are paid by the state or the federal government, will help educate uninsured people about what they qualify for and how they can enroll. Insurance brokers and thousands of enrollment workers at hospitals, clinics and community organizations will also be helping with this.

But they’ll have half the time to do this work; the first open enrollment for the online marketplace lasted six months.

Many navigators also expect to have a harder time persuading the uninsured people to sign up, because they are more likely to be healthier people who don’t think they need insurance or those who have accepted paying a penalty for not having insurance.

This year, the penalty will be 2 percent of income or $325 per person, up from $90 or 1 percent this year. It will continue to increase.

“Last year, when we started open enrollment, we had a lot of folks who were very, very interested in enrolling and would have done whatever it takes no matter how bad the [federal] website was to sit down and enroll and ask all the right questions,” Bill Green, grant manager and in-person counselor for United Way of Metropolitan Chicago, said. “Our challenge this year is reaching the folks who weren’t in that group and are still uninsured.”

Similarly, Mike Claffey, a spokesman for Get Covered Illinois, said, “We know we are going to have to work harder this year to engage people who did not enroll in year one.”

In addition to building on what worked last year, the state plans to target three dates: the beginning and end of open enrollment, as well as the Dec. 15 deadline to get insurance that would kick in Jan. 1, Claffey said.

State navigators will also be paid to work full time, instead of part time as some were last year, as part of an initiative to be more visible in the community and continue educating people. Navigators also expect to deal with people who bought health insurance last year and return to see if they can get better prices this year.

“New insurance companies are being added in, so the pricing is going to be different,” said Richard Larson, program director in the services for the VNA Health Care in Aurora. VNA Health Care met with 115,700 people last year at its nine suburban locations to walk them through their options for insurance.

More than 217,000 people in Illinois had purchased a health insurance plan on the online marketplace as of April 19, the most recent figure available. Another 451,880 Illinoisans have signed up for Medicaid.

Katie Keith, director of research at Trimpa Group, agreed that this year could be more of a challenge than last year. But she also noted that the people who helped enrollees sign up last year have one thing that should help: experience.

“Assisters gained significant experience during the first year by learning how to enroll people, partnering with stakeholders and adopting innovative approaches to reaching the uninsured,” said Keith, former research professor at Georgetown University’s Center on Health Insurance Reforms, where she specialized in state and federal implementation of the Affordable Care Act. “All of these efforts and infrastructure will serve as a critical starting point for year two that could help ease some of the burdens felt during the first year.”

Word of mouth from those people who got health insurance last year — and are happy with the change — could also bring uninsured people to navigators, insurers and other helpers.