Enrolling Ohio

Groups attempt to educate Ohio’s uninsured while the GOP tries to slow down Obamacare


s the Oct. 1 opening date approaches for the Affordable Care Act’s (“Obamacare”) online marketplaces, outreach campaigns are beginning to take root and aim at states with the largest uninsured populations, including Ohio.

But the campaigns have run into a series of problems in the past few months, with many of the issues driven by regulatory changes and opposition from Republican legislators at the state and federal level.

In Ohio, the campaigns will need to reach out to the more than 1.25 million working-age Ohioans who were estimated to be uninsured by a 2013 Ohio Health Issues Poll analysis from the Health Foundation of Greater Cincinnati. 

The efforts aren’t meant to persuade anyone to support Obamacare; instead, they’re large education campaigns that aim to raise awareness about opportunities that anyone, even the harshest critics of President Barack Obama, could benefit from. If the efforts are successful, most of Ohio’s uninsured population will gain coverage as many of them receive tax subsidies to participate in an online marketplace that will allow users to compare and select various insurance plans.

The campaigns are eager to get started as they approach an October deadline, but the latest problems have prevented them from launching their efforts in Ohio. 

The latest problem: So far, none of the state’s “navigators” — the federally financed organizations that will participate in outreach campaigns and help enroll people into marketplaces — have been certified by the Ohio Department of Insurance.

The Ohio Association of Foodbanks, which is leading a consortium of 15 organizations participating as navigators, was notified on Aug. 15 that it would be receiving nearly $2 million in federal funding for its efforts. But the consortium hasn’t been able to apply through the state and tap into the federal money because it still needs to get staff through 20-hour federal training courses that opened on Aug. 28.

Efforts have also been weakened by H.B. 3, a state law that went into effect on July 30 after it was signed by Gov. John Kasich on April 30. H.B. 3 excludes any organization that receives payments from a health care payer from being designated as a navigator.

The limitation blocked Cincinnati Children’s Hospital Medical Center from receiving a $124,419 federal grant that would have gone toward the hospital’s own outreach campaign, Cincinnati Children’s spokesperson Terry Loftus told CityBeat.

Lisa Hamler-Fugitt, executive director of the Ohio Association of Foodbanks, says losing hospitals like Cincinnati Children’s is a huge blow to navigators.

“It’s significant. Where do people go when they’re experiencing a health care crisis? They go to hospital emergency rooms,” she says. “Who’s on the frontlines of providing critical care to the uninsured? It’s hospitals.”

State legislators passed the restrictions to clarify regulations on navigators that avoid potential abuses and conflicts of interest, such as a hospital campaigning to put more people into an insurance system that will end up paying for the hospital’s medical services.

But Obamacare’s supporters argue H.B. 3 is part of a nationwide effort from state and federal Republicans to obstruct Obamacare’s implementation.

The federal government intends to enroll 7 million people into Obamacare’s online marketplaces, but 2.7 million have to be young adults to keep costs low. Otherwise, older, less healthy Americans will fill up the marketplaces, exhaust health services and drive up costs.

Supporters of Obamacare acknowledge that signing up so many young adults will be difficult, so they’ve taken to national and state-by-state education campaigns that tell young adults about the benefits and cost savings made available through the president’s signature health care law. Navigators and other outreach campaigns are supposed to ensure those enrollment goals are met.

But opponents, particularly Republicans, are preventing some of the efforts by investigating navigators and passing regulations at the state level that limit what navigators can do and who can be classified as a navigator.  

Despite the hurdles, Hamler-Fugitt remains optimistic about the efforts. She says the consortium of Ohio navigators will be ready to reach out to potential enrollees through different forms of media, brochures and pamphlets. 

Still, Hamler-Fugitt acknowledges navigators are facing a significant challenge.

“This is a heavy lift overall in very short order,” she says. 

Enrollment for Obamacare’s marketplaces will remain open until April. That, Hamler-Fugitt explains, provides a tight window for Ohio’s navigators, especially compared to Medicare Part D efforts in 2003 that applied to a considerably smaller population and had a two-year phase-in.  

Hamler-Fugitt says the Ohio-specific outreach is necessary to help balance no- and low-income Ohioans’ finances. Citing her organization’s data, she says that 42 percent of people who turn up at a foodbank, food pantry or soup kitchen are making choices between food, medicine and medical care.

Meanwhile, some national groups are partnering with Enroll America in campaigns that will target critical areas, including Ohio. The nationwide campaigns will bring in hospitals, health insurers, faith-based organizations, an LGBT group and various others.

One lingering concern for the campaigns is the Medicaid expansion. Under Obamacare, states are asked to expand their Medicaid programs, which insure low-income and disabled populations, to include anyone at or below 138 percent of the federal poverty level. If states accept, the federal government will pay for the entire expansion through 2016, then phase down its payments to an indefinite 90 percent.

Despite pleas from Kasich, Ohio’s Republican legislators have so far rebuked the expansion, citing concerns about government-run health care programs and the federal government’s ability to uphold its Medicaid payments, even though the federal government has met its Medicaid commitments for nearly four decades.

“It’s important this works in conjunction with the Medicaid expansion,” Hamler-Fugitt says. In particular, Hamler-Fugitt explains she’s worried a large group of Ohioans will remain in a “coverage gap,” meaning their incomes will be too high to be eligible for current levels of Medicaid but too low to qualify for tax subsidies through Obamacare’s marketplaces.

Those who do qualify for the marketplaces will likely get health care at a much lower price than would be possible without Obamacare, according to recent reports.

An Aug. 29 study from the RAND Corporation, a reputable think tank, found individual health care premiums in Ohio will rise to an average of $5,312 under Obamacare in 2016. Without the law, premiums would reach an average of $3,973 that year. But when Obamacare’s tax credits are plugged in, the average Ohioan will only pay a premium of $3,131 — $842 less than he or she would pay without the law.

Avik Roy, a conservative health care economist and prominent critic of Obamacare, found even better results for the state. His model found individual premiums will drop by 30 percent in Ohio, although they’ll rise by 24 percent on average for 13 states, including Ohio, and the District of Columbia as a whole. Unlike RAND, Roy’s calculations don’t take subsidies into account, so the final cost for the average Ohioan is likely much lower.

The numbers only apply to Ohioans in the individual health insurance market. Under Obamacare, individuals will be able to enroll for health insurance through an online marketplace, which, in the case of Ohio, will be set up and managed by the federal government because the state government refused the task. Participants between 100 percent and 400 percent of the federal poverty level, or those making between $11,490 and $45,960 in 2013, will get varying degrees of tax subsidies, with the lowest income levels getting the most subsidies and the highest income levels getting the least.

The majority of Americans, who get health insurance through their employers or public programs, fall under different regulations.

For outreach coordinators, letting people know about the financial benefits is one step to getting them enrolled and improving the American health care system. 

“We are on an unsustainable course in the area of health care spending in our nation. We spend twice as much as any other industrialized nation on health care, yet we have far worse outcomes,” Hamler-Fugitt says.

Enrollment in the online marketplaces will open in Ohio on Oct. 1 and remain open for six months. The plans offered on the marketplaces will become active on Jan. 1, 2014, along with a slew of Obamacare regulations that will apply to all health insurance plans. ©

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