Federal official: Insurance exchange advice will be easy to find

jholleman@thestate.comAugust 12, 2013 

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When the time comes for South Carolinians to sign up for new health insurance under the Affordable Care Act, they will have nearly as many options for advice as they will have for insurance.

The consumer education effort is beginning to pick up speed as the Oct. 1 opening of the insurance exchanges nears. Anton Gunn, director of external affairs for the U.S. Department of Health and Human Services, spoke with a group of health care leaders at the S.C. Hospital Association headquarters Monday, and the get-the-word-out effort dominated the discussion.

“Our goal is to make sure that there are people on the ground to help consumers make the decisions and then enroll them so that we can have the card mailed to them,” Gunn said.

The Health Insurance Marketplace, the official name for the exchange, opens in 50 days. People who are uninsured or pay for individual policies will have up to six months to make their choices.

Starting in 2014, everyone will be required to have health insurance or face a fine under the terms of the Affordable Care Act. About 725,000 in South Carolina are uninsured and eligible for the Health Insurance Marketplace. Many more insured under private policies likely will find better deals under the exchanges. Those covered under government or large company policies will stick with existing coverage except in very rare situations.

Gunn’s agency has a multi-pronged effort to educate people on their choices and work them through the process.

•  The first stop for those with Internet access should be www.healthcare.gov, where a simple set of questions is designed to show the cost and coverage options. You can create a personal account on the website now, but you can’t plug in numbers and get good estimates until Oct. 1.

•  The federally qualified health centers in the state — including Eau Claire Cooperative Health Centers in Columbia — were awarded a $2.4 million grant to hire and train workers specifically to help their patients and residents of their surrounding communities navigate the process.

•  The feds will contract with additional organizations to serve as paid navigators. Those groups in South Carolina will be announced on Thursday, Gunn said.

•  A much larger force of unpaid Certified Application Counselors will be recruited and trained through a Champions for Coverage program. U.S. Rep. James Clyburn, D-S.C., is actively recruiting churches, fraternal organizations and community groups to join the effort. “That’s the way you make this grass roots,” Clyburn said. “You want to be champions for your members so they have quality health care.”

In those cases, the organizations, not the government, will foot the bill for the effort. Those who pass the training courses will be listed on healthcare.gov.

•  In South Carolina, the well-established Benefits Bank will have trained personnel available to guide people through the process. The Benefits Bank is part of the state Office of Rural Health that helps connect people with benefits available to them.

•  Independent insurance agents and brokers also can help people decide the best of the options if they decide not to go with the federal insurance exchange. Many health-related businesses such as pharmacies — and even the public libraries — will have trained employees to help with the paperwork.

“In a couple of months, there’re going to be a lot of people you don’t expect who will be helping you make health insurance decisions,” Gunn said.

That will include celebrities, at least in terms of national public service announcements. Think Will Ferrell doing a skit on health care, Gunn said.

“There are millions of people who will pay more attention to what they see on VH1, BET or Spike TV than to a health professional,” Gunn said.

The S.C. Department of Insurance announced on Aug. 2 that four companies had filed the paperwork and been approved to offer insurance through the federal exchange in South Carolina before the July 31 deadline.

Another eight companies have filed to offer insurance outside the exchange. Two more companies have filed outside the exchange since then, and more could join that list before a mid-September deadline. Those outside the exchange meet fewer of the federal requirements, and people who buy insurance through them won’t be eligible for federal tax subsidies.

Ray Farmer, director of the state insurance department, has estimated the premiums for people using the exchange for private policies will go up 50 to 70 percent. Gunn said he hasn’t been able to crunch the South Carolina numbers, but he doubts increases will be that high.

States that are estimating such high increase “aren’t comparing apples to apples” in terms of what’s covered by current policies and what would be covered by ACA-mandated policies, Gunn said. His agency has compared rates in 16 states, and they generally have gone down.

Clyburn fretted that one group remains left out of the insurance discussion. Because South Carolina turned down Medicaid expansion, people making less than about $12,000 will not be eligible for either the exchange or Medicaid. Their options will include the federally qualified health centers (which charge on a sliding scale), free clinics or hospital emergency rooms.

“I stay awake at night worrying about people who fall into those categories,” Clyburn said. “I’ve seen too many people who come into my office who are working every day and making less than $15,000 and trying to raise a family.”

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