The Affordable Care Act health insurance exchange opens Saturday for its second round of sign-ups, building on the experience of almost 500,000 Carolinians who signed up in 2014.
With the enrollment window cut from six months to three, all involved hope the website crashes that marked last year’s launch are history.
This time, advocates want to sign up immigrants, young adults and others who remain uninsured. Tax penalties are lurking for many who opted out of getting insurance in 2014. And those who bought coverage on the exchange are about to learn what their new rates are – and are encouraged to shop again to see if they can get a better deal.
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“We are still in the midst of a journey, but it is good when you can see the destination,” state Rep. Carla Cunningham, D-Mecklenburg, said at a Wednesday news conference to kick off the push.
From October 2013 to March 2014, about 357,600 people in North Carolina and 118,300 in South Carolina bought health insurance on the exchange. Roughly 90 percent got subsidies to reduce their monthly payments.
This time registration ends on Feb. 15, and those who want coverage by Jan. 1 need to make a choice by Dec. 15.
Mecklenburg County Commissioners Chairman Trevor Fuller, a Democrat, said access has become a partisan issue but shouldn’t be. People who don’t have insurance often delay care and come to emergency rooms when they’re extremely sick, requiring costly care that they can’t pay for, he and others said.
“Who bears those costs? We all do,” Fuller said.
Advocates say immigrants are among the toughest people to reach. Those who are in the country illegally aren’t eligible. But even those who are citizens or have green cards might be deterred by language or cultural barriers or fear of the government, especially if they have undocumented family members.
Legal Services of Southern Piedmont, one of the agencies helping people navigate the exchange, has Spanish-speakers stationed at the Latin American Coalition and International House on a regular basis. Madison Hardee, a Legal Services lawyer, said word of mouth is the most powerful tool in reaching holdouts.
Blanca Rivas of Charlotte is one of those spreading the word. Originally from El Salvador, she has worked 25 years in medical billing.
Three years ago, she was working part time without health insurance when she broke her leg, she said Wednesday. Because she couldn’t afford a doctor visit, she waited until her leg was so painful and swollen she had to call an ambulance.
Rivas, 63, says she got insurance through the exchange in November, with subsidies to bring down premiums and out-of-pocket costs. “I am very happy that I don’t have to think twice to see my doctor,” she said.
Young adults who may be working low-wage jobs and view themselves as too healthy to need insurance pose another challenge. Blue Cross and Blue Shield of North Carolina has said one reason rates on the exchange are rising an average of 13.5 percent is that the pool didn’t include enough young, healthy people to bring down overall costs.
Because of the ACA, young adults can stay on their parents’ workplace insurance until they turn 26. But not all parents have employer coverage.
“We all know young men are very invincible – ‘Nothing is going to hurt me,’ ” said Robbie Akhere of Action NC, an anti-poverty group. “Now we know young women share the same mindset: ‘I’m healthy, I’m young, I’m going to be OK.’ ”
Those who stay uninsured another year will face a bigger tax penalty, up from $95 per adult or 1 percent of household income for 2014 to $325 per adult or 2 percent of household income for 2015.
Insurance plans bought on the exchange in 2014 will automatically renew if policyholders do nothing by Dec. 15.
But experts say it’s wise to see if that’s the best deal. Rates will go up for many plans, and other details may change. For instance, the maximum allowable out-of-pocket costs are rising from $6,350 to $6,600 for an individual and from $12,700 to $13,200 for a family.
“Although you might have selected the plan that represented the best value in 2014, that same plan might not be the best value in 2015,” Louise Norris writes in a 2015 enrollment guide offered by HealthInsurance.org. “The amount of your subsidy could change if your area’s benchmark plan has changed, and new plans might be available that offer lower premiums, broader networks or a better overall value.”
In North Carolina, UnitedHealthcare is joining the exchange, offering 10 plans that weren’t available last year. The Blue Cross and Coventry Health Care of the Carolinas menus are also changing. For instance, Blue Cross launched new “Blue Local” plans using the Carolinas HealthCare System network for residents of Mecklenburg and eight nearby counties. Coventry has a similar plan that’s expanding to York and Lancaster counties in South Carolina.
For more than half a million North and South Carolinians, this year’s enrollment period won’t bring them any closer to coverage. They fall into the “Medicaid gap” created in states that declined the federal money intended to expand Medicaid coverage to the poorest adults.
Because of that, people who fall below the federal poverty level – $11,760 for an individual and $23,850 for a family of four – are too poor to get subsidies for private insurance but can’t get government coverage unless they’re disabled or elderly.
Medicaid is high on the agenda for North Carolina’s 2015 legislative session. Gov. Pat McCrory and departing House Speaker Thom Tillis, just elected to the U.S. Senate, have indicated that Republican leadership may consider covering people in the gap. A handful of GOP-led states that initially rejected Medicaid expansion have created their own alternatives, using federal money.
For now, though, there’s nothing for people like Sharon White, who lost her job as a phlebotomist in 2008. Now in her late 50s, she says she’s too young for Medicare but too old to find a good job. She works a couple of hours a day for minimum wage and brings in too little to qualify for subsidized insurance.
White says she has delayed preventive care, such as getting a mammogram, and is trying to pay off an emergency room bill.
A Charlotte native, she feels that she has been left behind: “How can you take citizens who have paid into a system and then when they need a system it’s not there for them?”