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Enrolling uninsured in Obamacare will be a challenge

Statewide coalition prepares to help with health insurance sign-up

By Guy Boulton of the Journal Sentinel

June 15, 2013

Ray Bochas had little reason to learn about the details of the Affordable Care Act before February. That's when the InnoWare paper napkin and plate factory in Menomonee Falls shut down, and he lost his job and his health insurance.
"The loss of insurance really hurt me," said Bochas, who takes seven prescriptions.
He has heard that he's supposed to get health insurance next year but doesn't know what he and his wife will need to do.

"It's so complicated," Bochas said.

The Affordable Care Act's main goal of increasing the number of people with health insurance could hinge on reaching people like Bochas who will be eligible next year for coverage through Medicaid or through subsidized health plans sold on marketplaces known as exchanges.

Yet one recent poll found that two-thirds of those without health insurance were unaware of how the Affordable Care Act would affect them.
It suggests the challenge ahead in reaching the hundreds of thousands of people in Wisconsin who will be eligible for coverage and helping them through the complex process of signing up for Medicaid or a private health plan.
A statewide coalition of more than 70 groups is quietly preparing to take on the challenge.

The Wisconsin Primary Health Care Association, which represents community health centers, and several other groups began working more than a year ago to create the coalition that is calling itself the Wisconsin Access Network.

"It became evident that there might not be anyone else if we didn't take the lead on this," said Lisa Davidson, director of government relations and advocacy for the Wisconsin Primary Health Care Association.

The idea is to build on the existing network of financial counselors at community health centers, hospitals, city health departments and community groups that help people enroll in state health programs.

"We need all hands on deck to make this work," Davidson said.

Money for navigators

The Wisconsin Primary Health Care Association, which represents the clinics that provide primary care to many of the state's low-income residents in urban and rural areas, has applied for the limited federal money available to help people sign up for coverage.
The application is for the $829,000 that the federal government allocated for Wisconsin for so-called navigators who will provide consumer assistance.

Funding for the program will increase in subsequent years, but it is considered woefully inadequate for the first year, given the challenge of helping potentially hundreds of thousands of people as well as small employers understand the new law and their options.

Here's how inadequate: The Wisconsin Primary Health Care Association's proposal calls for hiring six full-time navigators statewide as well as two staffers to oversee coordination. It estimates that the six navigators will be able to sign up a total of only 6,000 of those hundreds of thousands of people statewide who may need help.
That's based on each application taking an hour — an estimate that the association admits is optimistic.
The enrollment period runs from Oct. 1 to March 31.
One of the quirks in the law is that states such as Wisconsin that aren't setting up their own exchanges are getting far less federal money for consumer assistance.

Maryland, a state with a population of 5.9 million, about 200,000 more than Wisconsin, plans to spend a total of $24.6 million for its assistance program, including $8.6 million in state funds in addition to $16 million from the federal government, according to Kaiser Health News. That will pay for an estimated 300 consumer assistance counselors.

In Wisconsin, the community health centers have received a $1.7 million federal grant to help people sign up for coverage. There also will be a federal call line that may be able to help consumers, although details on its role aren't available.
And Gov. Scott Walker requested, and the Joint Finance Committee's proposed budget includes, $10.3 million in state and federal state dollars to hire an additional 88 people to implement the law, including 70 people in Milwaukee County to help people enroll in Medicaid.
Brokers, who can earn commissions on health plans sold through the exchanges, also could have a key role.

'A huge task'

All that will help. But seemingly no one underestimates the challenge.
"It's a huge task," said Bobby Peterson of ABC for Health, a public interest law firm based in Madison. "They are going to have to pull in a lot of people."
He remembers the initial glitches with the introduction of Medicare Part D, the prescription drug benefit.
"This is going to be worse," he said.
Many people will be buying health insurance for the first time. Some may need little help. But some will have limited education or problems with literacy.
People will need to provide financial information to determine if they are eligible for Medicaid or for subsidies for plans sold on the exchange for individuals and families.

Some will not have checking accounts or credit cards, which may prevent them from signing up online. And even with the subsidies, the health plans on the exchange will be costly for many people on limited incomes.

Adding to the challenge is many people without health insurance know little about the law and how it could benefit them.
Bob Berndt, uninsured since losing his job in January 2012, wasn't aware that he could be eligible for coverage next year. "Not at all," he said.
He isn't alone.
"Most people don't have a clue about it," said Steve Ohly, manager of Aurora Walker's Point Community Clinic, which provides care to the uninsured.
Aurora Walker's Point Community Clinic tentatively plans to train a staffer to help people through the process.

Little time to prepare

Encouraging others to do the same is the goal of the Wisconsin Access Network.
Wheaton Franciscan Healthcare and Columbia St. Mary's Health System said they plan to help with enrollment, and other health systems are expected to join the effort.
"We have to take advantage of every group in the state that's doing enrollment," said Sara Eskrich, a health care policy analyst at the Wisconsin Council on Children and Families, one of the groups that took the lead in creating the Wisconsin Access Network.

The hope is to train people as "certified application counselors" who can help people go through the process, answering questions as they fill out an application and help them determine what health plans are available and their cost.

By law, navigators and certified application counselors can't say that one health plan is better than another. But they can show people the information available to help them make a decision.

Navigators and certified application counselors will be required to take 30 hours of training under the federal regulations. They also could be required to have 16 hours of state training under a provision pushed by the Independent Insurance Agents of Wisconsin and now before the Legislature.

The Wisconsin Primary Health Care Association will not find out until August whether its application — perhaps the only one for the state — was accepted. That will give it less than two months to prepare before enrollment begins on Oct. 1.

But the real work will be done by the certified application counselors who work for the groups in the coalition.

"We are doing a lot of behind the scenes work to be prepared," said Joy Tapper, executive director of the Milwaukee Health Care Partnership, which includes the health systems in Milwaukee County, the community health centers and other groups.

"There is a real commitment by this collaborative to do the best job we can," Tapper said.