DOVER — The stories are not new. There’s the recent college graduate, 22 years of age, wondering if he can still stay on his parent’s health insurance plan or fend for himself in the ... marketplace? Then there’s the account executive recently diagnosed with terminal brain cancer — will insurance companies work with her condition? And what about the couple who own the mom-and-pop coffee shop. Will they be able to afford to give their five employees adequate health insurance?
If congressional officials on The Hill cannot decide whether to support President Barack Obama’s health law, the Affordable Care Act, how can the average person decipher its legislation.
At least that’s what a recent health tracking poll by the Kaiser Family Foundation found.
Roughly 51 percent of the public says they do not have enough information about the ACA to understand how it will impact them in their family, the study stated. A large portion of the uncertainty is shared by the Hispanic population, the uninsured, young adults and those with lower incomes.
Furthermore, 44 percent of the public think either the law has been repealed, overturned by the Supreme Court or unsure if it is still a law.
The Affordable Care Act, signed in 2010, describes the changes to the health care landscape, which includes adding a state-specific health insurance marketplace, in addition to closing the Medicare prescription drug plan “donut hole” and expanding Medicaid within 138 percent of the poverty level.
To combat the uncertainty, states across the country, including Delaware, have unveiled aggressive campaigns to educate the public about the major health care reform, specifically the open enrollment in the health insurance marketplace for small businesses and individual consumers, which begins Tuesday.
“The marketplace opens on Oct. 1, but this is going to be a process,” said Leslie Graham, senior vice president of the Delmarva Foundation for Medical Care.
The Delmarva Foundation is one of the four community organizations slated to provide outreach and education services through the form of “marketplace guides,” on a one-on-one basis for Delawareans about the new health insurance marketplace. The state received a $4.06 million federal establishment grant to facilitate the program and hire the 68 statewide guides. Brandywine Womens Health Associates and Christiana Care will focus directly on outreach in the city of Wilmington, while the Delmarva Foundation and Westside Family Healthcare will take a statewide approach, focusing at times in Kent and Sussex counties.
Delmarva Foundation which is based in Easton, Md., will educate small businesses on the Small Business Health Options Program, or SHOP exchange, which is available on the marketplace for businesses for up to 50 employees.
“We are focusing on finding employees through employers,” Ms. Graham said. “About 75 percent of the individuals who are uninsured actually work either full-time or part-time.”
The foundation has opened three offices in Delaware, she said, in Smyrna, Georgetown and a home-base out of Delaware City. However, the emphasis will not have people come to the office.
But she admitted that there are some difficulties, especially in the more rural areas.
“One of the challenges that is more rural than urban is that the population is more dispersed,” she said.
For lower Delaware, the organization will employ a small-town strategy for their 24 mobile marketplace guides: reaching out to community organizations, churches, businesses and home-hardware stores.
“The social fabric of a small town,” Ms. Graham said.
All of the guides have had more than 30 hours of federal and state training specifically designed to educate the public on the Choose Health Delaware campaign.
AB+C Creative Intelligence, a marketing and advertising firm based in Wilmington, facilitates www.choosehealthde.com, a Web portal that links to information about the marketplace exchange for individuals and families, small businesses and partners.
Through the training, the guides have become comfortable with the website, and how to present the information to an array of demographics.
“It went from everything from understanding what a broker is to using resources to cultural competency,” said Sarah Davis, marketplace guide coordinator for New Castle County through Westside Family Healthcare.
The guides can sit with an individual during the application process, but they cannot recommend programs. For more detailed plans they are referred to a broker.
Westside Family Healthcare has 20 full-time guides, eight for Kent and Sussex counties. Maggie Norris, assistant deputy director for Westside’s marketplace program, said many of the guides are actually bilingual in Haitian, Creole and Spanish to aid with community outreach or people can schedule free appointments to meet one-on-one with a guide.
“We anticipate based on conversations in community there is a lot of education is needed,” Ms. Norris said. “I really anticipate the first month that people need to understand how this will improve ... some people need an extra help and better understanding of what this means.”
In terms of the Affordable Care Act, education is key, especially with 90,000 Delawareans currently uninsured.
“I hope we don’t have to battle too much stigma with doubts with Obamacare,” Ms. Davis said.
State officials have estimated that up to 35,000 people will be insured through the marketplace following Oct. 1, and nearly 30,000 will be able to gain coverage through the state’s Medicaid expansion Jan. 1, 2014.
In August, the Kaiser Family Foundation found that 42 percent of Americans have an unfavorable view of the law, but at least 57 percent say they disapprove of the idea of cutting off funding as a way to stop the law from being implemented.
As such states, like Delaware have moved forward, with the federal government’s backing.
Federal “navigators” have been implemented in 33 states to assist marketplace guides with consumer outreach. Chatman LLC serves as the coordinating body for Delaware.
“We directly report to the federal government,” said Priscilla Chatman, the Delaware navigator coordinator. “To the public it means nothing; we perform the same function. It’s seamless, it’s simply augmenting, there are more people available.”
The Widener University School of Law will house the administrative headquarters but Ms. Chatman said the guides will be 95 percent mobile.
“They will be deployed in locations all over the state from Sussex County to New Castle,” she said. The local religious organizations will be particularly crucial to the navigators.
It has been said that the navigators are trained to provide unbiased information in a culturally competent manner to consumers about health insurance, the new Health Insurance Marketplaces, qualified health plans, and public programs including Medicaid and the Children’s Health Insurance Program.
As of Sept. 19 there are 19 individual health plans and 11 small business group plans available for sale on the marketplace.
Plans currently range from about $190 to $340 per monthly premium, but can be adjusted with federal subsidies.
On Oct. 1, people will be able to use an online calculator to determine their eligibility and amount of tax-credit or federal subsidy and calculate the net cost of coverage. Until then, the Kaiser Family Foundation has utilized a subsidy calculator to help individuals budget in the meantime, at www.kff.org/interactive/subsidy-calculator.
Highmark Blue Cross Blue Shield of Delaware, Coventry Health and Life Insurance, and Coventry Health Care of Delaware are the three insurers for the marketplace — in addition to four stand-alone dental plans.
The plans are separated in levels, designated by metal type. The bronze plan covers up to 60 percent of the qualifying health expenses, a silver plan covers up to 70 percent, a gold plan covers 80 percent and a platinum plan offers 90 percent of covered expenses. There are plans labeled as “catastrophic” for individuals under 30 years of age as well.
As the level of coverage increases, consumers will pay larger monthly premiums and co-pays, but a smaller annual deductible.
Additionally, the premium base rates for all plans also differ slightly based on non-tobacco and tobacco use, with an additional $10-$80 tacked on for tobacco use.
The enrollment period runs from Jan. 1, 2014 to March 31, 2014. Individuals must sign up for insurance by Dec. 15 to be covered by Jan. 1.
Individuals who do not have health insurance must pay an annual penalty, which in 2014 will amount to $95 per adult and $47.50 per child, or 1 percent of the family’s income — whichever is greater.
“By leveraging the power of large purchasing pools we’re finally able to give consumers what they want and need — real choices in the health insurance market place. Delawareans — including me and my family — will have 19 different plans to choose from and many Delawareans will also qualify for federal financial assistance to help further reduce the cost of purchasing insurance,” said U.S. Sen. Thomas Carper, D-Del.
His office conducted a study once the U.S. Department of Health and Human Services released the 53 qualified health plan choices for the 36 states with federally instituted marketplaces.
According to the report, the premiums on Delaware’s marketplace are consistent with those across the country.
For instance, after tax credits for families of four with an income of $50,000, the second lowest silver health plan has, across the board, a $282 monthly premium.
Without the tax credit, those silver-level plans ranged from $584 to $1, 237.
Due to the slew of federal health care reform changes, which include increasing care for patients, Highmark Blue Cross Blue Shield of Delaware, has discontinued several of the products on the individual and small group markets effective on the plan anniversary date after Jan. 1, 2014. Highmark Delaware spokesman, Matt Stehl, said members will have a choice of new products that are ACA-compliant both on and off the Delaware Health Insurance Marketplace for coverage that begins Jan. 1, 2014.
Highmark offers 11 qualified health plans on the individual marketplace, including platinum and catastrophic level plans.
“There are a massive amount of changes coming,” said John Still, registered health underwriter for Still Insurance Agency in Dover. “You can’t keep your insurance the way it is.”
He said he will hold seminars for his clients, many of them small-business owners (almost 4,000 people covered), to educate them on the insurance rate changes.
He is convinced that people would rather pay penalties than shop for the high health insurance.
“They are not going to enroll. It doesn’t matter how many navigators you have, it’s a financial issues for those folks,” he said.
Still, some believe Delaware is on the path toward quality health care reform.
“Even through the turbulent couple of years with uncertainty, I think our state has held steadfast,” said Lolita Lopez, chief operating officer of Westside Family Healthcare for the past 23 years.
Delaware consumers can get help finding Marketplace coverage at Choosehealthde.com or by calling 1-800-318-2596. The HHS report is available at: http://aspe.hhs.gov/health/reports/2013/MarketplacePremiums/ib_marketplace_premiums.cfm.
Staff writer Jen Rini can be reached
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