hill country observerThe independent newspaper of eastern New York, southwestern Vermont and the Berkshires




Health care reform hits home

Area navigators describe progress, pitfalls in covering the uninsured



Contributing writer

The rollout of new state-run health insurance exchanges in New York, Vermont and Massachusetts hasn’t been free of problems, but in the past few months thousands of people in the region have been able to use the new system to shop for better health care coverage or buy it for the first time.


The state exchanges, set up under the federal Affordable Care Act, serve individuals as well as businesses with fewer than 50 employees. State officials and various third-party “navigators” who’ve helped people to sign up for insurance through the exchanges say the program generally has been well received.


All three states in the region chose to create their own health-care exchanges and Web sites, thereby avoiding the problems of the infamous federal healthcare.gov site. But neither Massachusetts’ nor Vermont’s Web sites have functioned correctly. The same contractor, Montreal-based CGI Group, was responsible for both and may face legal action by the states.


New York’s Web site, in contrast, has worked smoothly, state offi cials say, and most New Yorkers who have signed up for insurance have done so using the site.


New York expects to enroll 1.1 million people through its exchange -- 615,000 as individuals and the rest as small-business employees. Vermont aims to reach about 100,000 residents. In Massachusetts, the state-run Commonwealth Care system introduced in 2006 under then-Gov. Mitt Romney was a model for the Affordable Care Act. As a result, the state had already extended health coverage to almost all its 6.6 million residents, but an estimated 250,000 people still fell outside the program.

All three states have taken advantage of an option to increase the income limits for the federal Medicaid program for low-income adults.


Expanding the safety net

Buying health-care insurance can be confusing, especially for people who haven’t had it before. So the Affordable Care Act created a state-by-state system of people trained to help clients complete application forms, review their insurance options, and see if they qualify for subsidies to help with the premium costs. These helpers usually work for a social service, health care, or business service organization.


Cheryl Thomson, a certified application counselor at Fairview Hospital in Great Barrington, Mass., is program coordinator for Advocacy for Access, part of Berkshire Health Systems.


“We filed 1,981 applications in the last quarter,” Thomson said. “We get a lot of people who are self-employed or who are working two or three part-time jobs that don’t offer health insurance.”


Because the Affordable Care Act changed eligibility thresholds, single people who hadn’t qualified for Medicaid and other subsidized programs in Massachusetts are now eligible, she said.


Thomson said she sees people “who need care and know they need insurance.” She’s also worked with low-income and younger people who, thanks to the health-care exchanges, “have gotten richer coverage than they’ve ever had before.”


Although Thomson is based in Great Barrington, she said she receives inquires from all over Massachusetts as well as from people who live just over the state line in New York or Connecticut. Although she can’t sign up out-ofstate residents for Mass Health Connect, “I can steer them in the right direction,” she said.


Statewide, as of Jan. 16, there were 5,373 new enrollees who received coverage starting Jan. 1, said Jason Lefferts, director of communications for Commonwealth Health Connector. Another 26,000 are in temporary coverage through Mass Health while their applications are processed. About 254,000 residents who were already receiving state health benefits will be moved to other programs as the state reorganizes its health coverage to meet the criteria set by the federal law.


Vermont: 54K sign up

In Vermont, the goal of Vermont Health Connect is to reach the uninsured and underinsured, said Lindsey Tucker, a deputy commissioner in the state Department of Health Access. Thanks to state programs such as Dr. Dynasaur for children, Catamount Health, and Vermont Health Access, “Vermont has a relatively low uninsured rate, around 7 to 8 percent, but a relatively high underinsured rate,” Tucker said.


The state trained 370 in-person helpers so that every county would have coverage, Tucker said.


“Insurance is complex and complicated,” Tucker said. “The decision is important for a family.”


So some people, she said, need “to sit down with a navigator who can explain the difference between a deductible and a co-pay.”


Although implementation of the new health care system has been controversial in some parts of the country, Tucker said that despite some problems the program seems to enjoy strong public support locally.


“Vermonters in general are very supportive of health care reform,” Tucker said. “We’ve had pretty progressive health programs for decades.”


From the beginning of open enrollment on Oct. 1 through Jan. 1, more than 54,000 Vermonters obtained health care coverage through the state exchange. That number includes small-business employees, individuals and families, Tucker said.


Joann Erenhouse, executive director of the Bennington Area Chamber of Commerce, volunteered to train as a navigator to help small businesses find their way through the insurance options.


“I’ve seen tons of people,” she said. Because of the state’s malfunctioning Website, Erenhouse described the experience of serving as a navigator as one of “shifting sands -- the portal didn’t work, then it did, then the state went to paper, then there weren’t enough people to process the paper.”


Erenhouse began advising small business owners to contact the state’s two approved insurance carriers directly.


“People who called directly to the carriers have had great success,” she said. “It took the Bennington Area Chamber of Commerce four minutes to transfer our coverage with Blue Cross-Blue Shield to Vermont Health Connect.”


Some of Erenhouse’s business clients, especially those with seasonal or relatively lowpaid employees, chose to stop offering health coverage. The advantage of this strategy is that their employees probably will qualify for subsidies to reduce the cost of their premiums if they buy insurance individually, whereas businesses aren’t eligible for subsidies.


“It’s a mixed bag,” Erenhouse said. “Most people fi nd they’ll be paying less.


“It’s probably a very good program,” she said, though she added that “it’s an extremely Byzantine system.”


County by county

In New York, about 20 percent of those enrolling through New York State of Health are in the Mid-Hudson, Capital District and North Country region, according to the state. As of Jan. 20, more than 587,000 New Yorkers had completed applications and more than 328,000 had enrolled, putting the state on track to meet or exceed its enrollment goal of 1.1 million by the end of 2016.


Of those who’ve signed up, almost half had no health insurance at the time. Sixty-seven percent of enrollees bought private health insurance, while 27 percent were accepted into the expanded Medicaid system and the rest went into the state Child Health Plus program. Of those who bought private insurance, just over two-thirds were eligible for federal subsidies to cover some of the cost.

Seventy-five percent of enrollees completed their application on the state’s Web site, while another 20 percent worked with one of the state’s nearly 6,300 in-person helpers at a health care center, town hall, library, or social service agency. According to state data, people who were seeking fi nancial assistance were more likely to seek help in person.

Helpers are available in every county, but the number of sites and how widely they’re dispersed around a county varies. Washington County, for example, has six sites in six towns. Rensselaer County has five, all in Troy.


Some sites offer help in Spanish or other languages. The Southern Adirondack Independent Living Center in Warren and Washington counties can conduct interviews in American Sign Language and can provide screen readers for people with poor vision. The Adirondack Health Institute in Queensbury provides enrollment services to Warren, Washington, northern Saratoga and four other counties to the north. The proportion of uninsured people in this region ranges from 11.9 percent in Saratoga County to 28 percent in Hamilton County.


“We see a variety of people, mostly middleaged adults with no insurance,” said Renee Bazan, a navigator at the Adirondack Health Institute. “We also see some young adults who can’t afford their employer’s health insurance. Then there are people who are self-employed -- that’s a big one. We’re definitely seeing a lot of Medicaid applicants, because the income threshold has changed.”


The state Web site had some problems in the beginning, “but that’s been cleared up; it’s quite user-friendly,” Bazan said.


The clients who seek her help “are just intimidated by the Web site,” she added. “They may not have computers or don’t have computer skills.”


Adirondack Health Institute doesn’t have numbers on how many people it has enrolled.


“An appointment may have several outcomes,” explained Phil Kahn, an education and outreach specialist for the institute. “Some people want to think about it and come back. Some go home and complete the application themselves, and the navigators don’t know about it. A lot of people are grateful to be in Medicaid or getting a subsidy.”


New York also has a telephone call center. From Oct. 1 until Dec. 24, the last day to sign up for coverage beginning Jan. 1, the center took more than 350,000 calls. During the last two weeks leading up to Dec. 24, the average call volume per day topped 15,000.


Staffers at the call center mostly answered questions, but they could also take applications directly. Six percent of people statewide who enrolled in a plan did so over the phone.


Open enrollment in all three states continues until March 31.




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