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Advocates call ACA ‘biggest civil rights law’

Thu, Mar 20, 2014

Big push to meet March 31 deadline for Insurance Marketplace

March 31 is the deadline under the Affordable Care Act (ACA) for all Americans to have health insurance, and the West Side Health Authority has been working to enroll people since October 1 of last year. Its health insurance “navigators” have signed up about 900 people at food pantries, the Salvation Army, parole offices, the Illinois Department of Corrections and through walk-in traffic at its own four offices.

ObamaThe average age of West Side Health Authority’s newly insured is about 40, but some are as young as 20, according to Percy Giles, director of the Affordable Care Act for West Side Health Authority, which serves Austin, Garfield and Lawndale. For the most part, many of these people have never had insurance before. Some of them have health conditions and are looking forward to getting coverage so that they can get medicine; until the ACA, preexisting health conditions could mean that an insurance company could reject them as a client.

During the signups, “some people had diabetes, a lot of people had substance or alcohol abuse who wanted help. Some could barely stay awake to answer the questions – they were on something — but they wanted help,” Giles said. “We think that in the years to come we’re going to see a decrease in disparities in the death rate of African Americans compared to others” because of the ACA.

Most of West Side Health Authority’s new enrollments have been for Medicaid, which under the ACA has been expanded to cover single people. In the past, they would have been eligible only if they were disabled or were caretakers of children. Now, people who earn up to 138 percent of the poverty level ($15,856 for an individual and $32,500 for a family of four) are eligible for a restructured Medicaid at little or no cost to them.

There is no end date for Medicaid enrollment. Since West Side Health Authority’s contract with the State of Illinois ends June 30, “as the weather gets warmer we’re hoping for another couple thousand signups,” Giles said.

Medicaid expansion because of the ACA accounts for the enrollment of 182,000 people in Illinois as of February 23, according to Mike Claffey, spokesman for the Illinois Department of Healthcare and Family Services, which runs Medicaid. The Department expects 200,000 people to sign up for Medicaid this year, Claffey said.

“We’re also working with Cook County Sheriff Tom Dart and the Department of Corrections to help people getting out of prison or jail to enroll in Medicaid, to get back on the right path, to be in position to get all basic health care services.”

These newly insured people will be enrolled in care coordination networks so that they can be treated in a holistic way, he said. They will have a “medical home,” where they can go on a regular basis to make sure all their needs are met in terms of medical or mental health, substance abuse treatment or prescription drugs.

Besides those covered under Medicaid, another 88,000 Illinoisans have purchased coverage through the Illinois Health Insurance Marketplace, Claffey said. This marketplace includes plans by commercial insurers and is operated by the State of Illinois in partnership with the federal government.

Marketplace coverage is for people whose incomes are between 139 percent and 400 percent of the federal poverty level (up to $45,960 for individuals and $94,000 for a family of four). These people are also eligible for a tax credit based on a sliding scale according to income, which will help them pay their premiums.

Before signups began October 1, there were roughly 506,340 uninsured Chicagoans age 19 to 64, according to Enroll Chicago! A Profile of the City’s Uninsured published by the Chicago Department of Public Health along with Health and Disabilities Advocates. The expanded Medicaid was supposed to cover about 235,000 of these low-income individuals; another 220,000 middle-income people would be able to buy insurance in the marketplace. Still another 50,569 people whose income exceeded 400 percent above the poverty level could buy insurance in the marketplace, but they would be ineligible for tax credits.

Stephani Becker, senior policy specialist at the Sargent Shriver National Center on Poverty Law, agrees with West Side Health Authority’s Giles about the scope of the ACA. “This is the biggest civil rights legislation and obviously health care expansion in my lifetime and many of our lifetimes. It protects a lot of people’s rights as consumers and also does go a long way toward equalizing some of these ethnic and racial disparities in health.”

Heartland Health Centers

Vivian Ezeji, left, a certified applications counselor, or “navigator” with Heartland Health Centers, looks through Illinois Health Insurance Marketplace plans with Lorena Acosta at Truman College (Suzanne Hanney photo).

There were 44 million people in the U.S. without health insurance before the ACA began (including 1.7 million in Illinois). Since October 1, 3.3 million people have signed up for marketplace coverage across the nation, according to the latest enrollment report from the U.S. Department of Health and Human Services (HHS).
Although the numbers might seem to be lagging, Becker is nevertheless enthusiastic about the momentum. Between October and December 31, cumulative marketplace signups were 2,153,400; January added 1,146,100 more, a 53 percent increase. Moreover, the total number of enrolled young adults (age 18-34) also increased proportionately faster in January; their numbers rose from 489,460 to 807,515, a 65 percent increase.

“I am really optimistic about Medicaid applications for sure,” Becker said. “They can apply all year long. I believe after March 31 there will be redoubled efforts to reach out to Medicaid-eligible. Now the specialists are concentrating on the Marketplace-eligible.”

Yes, glitches in the Marketplace rollout were one reason for the lagging numbers. But historically people also procrastinate until the deadline, as was seen when Massachusetts began its all-state coverage, she said.

“People are starting to get the message and starting to hear positive things about the law,” she said. “If you heard only negative messages – ‘it’s going to be repealed’ – but now we’re hearing positive stories of people who have gotten the insurance and used it and gotten these tax credits.”

Graham Bowman is an Equal Justice Works fellow at the Chicago Coalition for the Homeless who has met with about 50 homeless unaccompanied youth and helped to enroll 30 or 35 in Medicaid since November. Many of these youths had medical cards until they were 19 or they received health care services at school. “However, now that they are in their early 20s, many youth have a variety of different health issues that are going untreated, such as mental health issues, diabetes, or epilepsy.”

EnrollChicago812013-6

Source: Enroll Chicago!

Some youth experiencing homelessness need to show the Department of Human Services that they are living on their own and should be allowed to apply for Medicaid and food stamps without a parent or other adult. They can use shelters such as La Casa Norte, Teen Living Program and Broadway Youth Center to receive important mail attached to their new health care.

“The reason why access to health care is so important for this population is that there is a stereotype of homelessness being the chronically ill person with mental health issues on the street,” Bowman said. “That person did not end up in that situation overnight. They became that way after decades of unmet needs that weren’t being treated. Now young people experiencing homelessness are able to receive preventative health care for the first time. That’s the inspiration for my work, that we can avoid long term adult homelessness by helping people access preventative services when they are younger.”

Bowman explained Medicaid expansion under the ACA to a group of homeless youth at a Feb. 15 signup session featuring free pizza at Willow Creek Ministry Center downtown. Co-sponsoring was the Young Invincibles, an interest group focused on improved employment, higher education affordability and access to health care for young people age 18-34.

“Medicaid is a government program that pays medical bills. Starting January 1, everything changed. Unless you are an undocumented immigrant, you are eligible. County Care and Medicaid are the same thing; they don’t care if you are healthy or unhealthy, if you have got a job or you are homeless. You will get a medical card, so don’t go to the Emergency Room; you will get a doctor to see before you start having seizures.”

Bowman explained the 10 essential services covered under both Medicaid and the marketplace: yearly wellness doctor visits and mammograms, blood pressure checks, cholesterol and glucose screenings; emergency room visits; maternity and newborn care; pediatric; outpatient services; prescription drugs; rehabilitative and habilitative services; inpatient hospitalization; lab tests; substance abuse or mental health services such as for bipolar disorder.

The mention of bipolar caused an approving murmur among the youths. However, the word “Obamacare” prompted nearly as loud a cry about implantation of “RFID chips.” The falsehood about Radio Frequency Identification chips stemmed from a satire on National Report.net based over proposed but unenacted ACA measures that would have started a post-market registry of people with pacemakers or hip replacements, according to MSN.com.

Source: Enroll Chicago!

Source: Enroll Chicago!

“They are not putting a chip in you,” Bowman said.

Medicaid could help the youths stop incurring large medical bills so that they could get the credit to become housed, he said. “The Emergency Room is one of the most expensive places in the world. You never want to be in an emergency room without a medical card.” In addition, Medicaid would retroactively pay medical bills backward three months from the time they enrolled.

Isaiah Offord, 22, was among the youths who then checked out Medicaid with the help of insurance navigators. Offord said he was in foster care from age 13 to 18; he has also been on disability since age 13 for ADHD and bipolar disorder. His mother is incarcerated. He took medication when he was young and he said he needs to sign up for it again because without it he becomes really angry. Just the same, he said he finished school on the honor roll and had a job cleaning at school. He would like to be a construction carpenter and to have his own business.

Federal statistics do not tell whether signups are penetrating heavily uninsured neighborhoods but Becker said anecdotal evidence says that is the case. In addition, the State of Illinois allocated $27 million in federal money to 44 community-based organizations for 1,500 navigators across the state who could help people choose between Medicaid and the marketplace.

“We know a lot of resources are being poured into highly uninsured areas,” Becker said. “That’s how the state decided where to put these navigator grants in. We know that was on the state’s mind and it was very strategic.”

Alimatu Sadia Issaka Ayinga, left, ponders health insurance coverage with Dalia Galvan Morales, an in-person counselor with Heartland Health Centers, during free help session at Truman College. (Suzanne Hanney photo)

Alimatu Sadia Issaka Ayinga, left, ponders health insurance coverage with Dalia Galvan Morales, an in-person counselor with Heartland Health Centers, during free help session at Truman College. (Suzanne Hanney photo)

The February HHS report also shows more interest in health coverage than the 3.3 million enrollment figure would indicate. Between Oct. 1, 2013 and Feb. 1, there have been nearly 64 million visits to marketplace websites and 16 million phone calls to marketplace information lines.

“We’ve heard it takes up to 17 times for someone to hear the message, whether they are looking at it themselves or hearing it at work,” Becker said. “They are shopping, looking at healthcare.gov and talking to their spouse, being confused. Sure it takes a lot of time to purchase. It’s a big purchase for a lot of people.”

Across the US, 62 percent of people enrolling in the marketplace have chosen a Silver Plan. The reason, Becker said, is that if your income is under 250 percent of the federal poverty level or, $28,000 for a single person, you are eligible for a “cost sharing reduction.” “You get lower copay, lower deductible and any time you go to the doctor it is cheaper. The only way to get cost sharing is in a Silver plan. It is a good plan, it covers a lot of services and your out of pocket cost is less.”

Felicia Fredricks is a navigator, in fact the lead certified application counselor with Heartland Health Centers doing signups in Uptown, Rogers Park, Edgewater, Albany Park and other northwest Chicago communities. Fredricks had a client who made just over $18,000 as a substitute teacher and who qualified for both a Marketplace tax credit and a cost sharing reduction that brought her Blue Cross/Blue Shield premium down to zero. However, the plan’s deductible was $6,000. A plan with a $35 monthly premium had zero deductible but she said she didn’t want to pay anything because she works only when she is called.

“We try not to make anyone make hasty decisions,” Fredricks said. “We give them all the options and enough time to decide what works best for them. Our job is to walk them through the process and put all the options out there. But the decision is theirs.

Graham Bowman, an Equal Justice Works fellow at the Chicago Coalition for the Homeless, explains Medicaid expansion to homeless youth at a Saturday session at Willow Creek Ministry Center downtown. (Suzanne Hanney photo).

Graham Bowman, an Equal Justice Works fellow at the Chicago Coalition for the Homeless, explains Medicaid expansion to homeless youth at a Saturday session at Willow Creek Ministry Center downtown. (Suzanne Hanney photo).

Vivian Ezeji, another Heartland Health Centers navigator, said she sees typical premiums of $150 to $167 per month for people making less than $25,000 annually. However, sometimes the tax credit covers the entire premium. If someone gets a $200 monthly tax credit, they can opt to use $100 for the premium and the $1200 they don’t use over 12 months can be returned as an income tax credit.

What if people do not sign up by March 31?

Becker said the Shriver Center has been pushing the idea of an extension with Families USA and with the National Center on Immigrant and Refugee Rights, which has also pushed the idea up to HHS. “I am confident if they decide to do it, it would be at the very last minute.”

Part of the reason is political; health care expansion “can’t be seen as a failure in any way.” But another reason is that insurance companies based their risk tolerance on a set deadline. “We saw in December they extended another day or two for people already in the system. We have our fingers crossed there’s some kind of mechanism for people who are trying to do the right thing.”

People who are not covered this year risk paying $95 or one percent of their income – whichever is higher – on April 2015 income tax returns. Open enrollment will begin again next November for 2015, so it will not deflect first-year penalties.

“I think we’ll be seeing a lot of news this time next year when people see they didn’t have health coverage and they have to pay on taxes,” Becker said. “But we’ll do another story about that then.”

If you still need help getting past websites and phone lines, you can find local navigators by checking the following websites. Plug in your ZIP code at https://localhelp.healthcare.gov/ and you get addresses and hours of assistance for organizations near you with insurance navigators. If you go to http://getcoveredillinois.gov/get-help/ and enter your ZIP code, you get a streamlined list of organizations and the languages they speak. Click on the + for address, phone number, hours of service. If you are part of a group that would like to host an enrollment clinic for your community, please contact Jessica Palys of the Illinois Campaign for Better Health Care at jpalys@cbhconline.org or 312.913.9449. The Campaign has five navigators in the Chicago area.

Suzanne Hanney
StreetWise Editor-In-Chief

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