Gaston & Catawba

Gaston nonprofits give advice on health insurance

A week after the second open enrollment period for health insurance under the Affordable Care Act began, a group of Gastonia health organizations is once again working to encourage people to buy coverage: Workers are posted inside a shopping mall to try to catch the attention of passers-by.

The nonprofit organizations are working to help people navigate the types of coverage and financial assistance available under the health care law. It took effect last year, requiring most Americans to buy health insurance.

“We have to get our residents informed,” said Dallas Paddon, a spokeswoman for CaroMont Health, one of three organizations involved in the public outreach. The other two are Gaston Family Health Services, a community health center, and HealthNet Gaston, which provides collaborative care. Both are providing staff and coordinating the effort while CaroMont pays for marketing.

Operating out of a storefront on the second floor of the Eastridge Mall, outreach workers with the two health care organizations offered assistance to 156 people on the first day of open enrollment on Nov. 15, enrolling 35 in a health plan.

Toward the end of the first enrollment period, earlier this year, the workers, many of whom speak Spanish, helped sign up about 500 people and assisted four times as many in the three weeks they spent at the North New Hope Road mall.

Such efforts are scheduled to take place across the state until open enrollment ends on Feb. 15, including at churches, community centers and farmers markets.

The idea is not only to help enroll people, but also to clarify certain aspects of the health law, such as comparing policies, co-payments and other out-of-pocket costs.

“Insurance is complicated,” Donna Grissom, executive director of HealthNet, said.

Even though the organizations have gained experience during the past year, challenges remain.

Among them is a shorter enrollment period, three months this time instead of six. For plans to take effect by Jan. 1, people must enroll by Dec. 15. Anyone younger than 65 who does not have insurance by Feb. 15 will face a fine that increases from last year.

And consumers who already have subsidized insurance are recommended to review their plans in the online health insurance marketplace, as rates of many have increased and consumers may have cheaper options. The details of some plans have changed, too.

But a major focus of the outreach efforts remains unchanged: encouraging African-Americans, Latinos and young people to sign up for coverage and reiterating the availability of subsidies for people between 100 percent and 400 percent of the federal poverty level.

In a recent survey by the Kaiser Family Foundation, a nonpartisan research group, a little more than half of respondents nationwide who are uninsured were unaware of such financial assistance.

“Hopefully we’re making a dent in that,” said Sorien Schmidt, North Carolina director for Enroll America, a nonprofit working to promote the health law. About 90 percent of people in the state with health insurance receive subsidies, she noted, adding: “There is significant financial assistance available to many people.”

Despite their role, the outreach efforts nationwide have experienced a decrease in federal funding, dropping to $60 million this year from $67 million last year.

In North Carolina, three organizations received $2.9 million to promote enrollment, down from the $3 million awarded to a handful last year. The biggest portion, about $2.2 million, was awarded to Legal Aid of North Carolina, which oversees a consortium of nine organizations comprising about 40 navigators statewide. The group is replacing the N.C. Community Care Networks, which managed the consortium with a $2 million grant it received last year.

The decrease has undoubtedly affected the reach of the Gastonia organizations, which have only 20 workers this enrollment period, down from 30. Gaston Family Services has some workers in surrounding counties.

The state had one of the highest enrollment rates nationwide last year – more than 375,000 – as part of an outreach effort that involved more than 600 navigators and certified application counselors.

In Gaston and Lincoln counties, however, the number of uninsured is among the highest in the state.

While about 9,000 people enrolled in a health plan between October 2013 and mid-April, nearly 43,000 younger than 65 remain uninsured – that’s nearly 18 percent of the population, according to estimates by the U.S. Department of Health and Human Services. Half the uninsured are below 150 percent of the federal poverty level; the majority are between ages 35 and 54.

But despite the surprisingly high enrollment numbers, hundreds of thousands of people in the state are without health coverage this year, even though they could have qualified for it. That is because North Carolina last year chose not to expand Medicaid, the state-operated health insurance program for the poor and disabled. The expansion would have included those earning less than 138 percent of the federal poverty level, about $16,000 in annual income for an individual.

In Gaston, about 16,000 people have fallen into the Medicaid gap, according to U.S. Census Bureau estimates.