Six weeks after launch: the status of Obamacare

The clinics already provide care to uninsured Georgians who are a focus on the health care law. Trying to help them sign up “is an ongoing, non-stop process, all day,” Bowden said.

Navigators say they are focused on explaining the law to consumers until the site is up and running.

Seedco, a nonprofit that won a federal grant to help a group of Georgia organizations deploy navigators, is focused on education instead of sign-ups. Seedco and its partners have sent navigators to libraries, churches, fund-raising walks for cancer and AIDS and town hall meetings to explain what Obamacare could mean for individuals.

Many consumers wouldn’t be quite ready to sign up for coverage on the marketplace, even if the website worked perfectly, said Ben Thomases of Seedco. They need time, he said, to just learn about how the law works and to consider their options.

Navigators hired by the University of Georgia, which also received a federal grant, have reached roughly 5,000 consumers through outreach and education events in 56 counties. They’ve also helped 1,000 people with the marketplace through workshops, town halls, one-on-one consultations and presentations at their county extension offices, among other places.

“There is a tremendous amount of misinformation, so navigators are doing a lot of education,” said Deborah Murray, the university’s associate dean for extension and outreach.

Looking for help? Here’s how to reach a navigator:

Seedco

855-899-6092

www.seedco.org/healthcare-access/georgia/

Email: GeorgiaNavigator@seedco.org

Community Health Centers

All centers have navigators. Here’s a link to find one near you.

www.gaphc.org/gaphc-member-directory

University of Georgia Health Navigators

www.uganavigators.org

WSB/AJC joint report

wsbtv.com, wsbradio.com, myajc.com and ajc.com will offer a live stream of a special webcast Monday night — “Obamacare in Georgia,” produced by WSB and featuring Clark Howard and AJC reporters Carrie Teegardin and Misty Williams. The webcast will be on all four sites simultaneously from 7:30 p.m. to 8 p.m. Afterward, Teegardin and Williams will host a live question-and-answer session on the web. The show will be webcast again at 1 p.m. the next day, with another live Q&A session following.

This was supposed to be Obamacare’s shining moment.

Millions of Americans were supposed to be shopping online in a new marketplace, many of them acquiring the first health insurance they would ever have. Millions of others, already insured and content with their plans, would be free to keep those plans. Low-income people with no hope of buying insurance would be moving onto a vastly expanded Medicaid program.

In Georgia, as in much of the rest of the nation, none of that has come to pass.

“Is this a joke?” asks Dr. Barbara Schlefman, an Atlanta podiatrist who has bought her own health insurance for three decades. “Is the Affordable Care Act this unaffordable?”

Schlefman was looking at a notice from Humana telling her that switching from her current health plan to one that complied with Obamacare would bump her monthly premiums from $279 to $523.

Six weeks after the disastrous launch of the long-awaited Health Insurance Marketplace, the website that promised to offer comprehensive, competitively priced health plans still doesn’t work. The president’s promise that Americans could keep their insurance if they wanted to was, at best, misleading, and he took the extraordinary step of apologizing for it last week.

The question now: can Obamacare pull itself together and eventually emerge from this messy launch as popular as Medicare, or will its stumblings continue to give detractors the ammunition they need to bring down the law?

Time is running short. The Affordable Care Act gives consumers until Dec. 15 to sign up for coverage that is to kick in on Jan. 1. The law’s supporters believe most people will like what they see when they gain access to the website.

But many who want to take advantage of the law’s promises aren’t confident that they will actually be able to.

“This is like standing in a bread line during the Depression except instead of starving for food, I’m starving for information,” said Robert Shlora, an Alpharetta resident who went through an application process for a Marketplace plan over the phone two weeks ago. The agent told Shlora he would get a packet of information by now allowing him to select a plan — but he hasn’t. He got an email saying he had “messages” awaiting on Healthcare.gov — but he didn’t. When he called, he was told there were no messages and that the emails he got “were a technical issue.”

Shlora is now paying $2,797 a month for health insurance for himself, his wife and their son — more than $33,000 a year. He hasn’t been able to shop around for years due to pre-existing conditions and the health law was expected to offer him much more affordable options. The Atlanta Journal-Constitution has followed Shlora’s story for months to track how the law might help him and others. But for Shlora, who eagerly awaited the marketplace’s opening, the law’s promise is being undermined by its malfunction.

“There is a stain on this whole thing,” Shlora said.

Promises, provisions fall by the wayside

The Patient Protection and Affordable Care Act became law in 2010 and important elements of the landmark legislation have taken effect since, including new requirements for insurers to offer no-cost preventive screenings and the ability to keep children up to age 26 on a parent’s health plan.

But very little has gone according to plan. A Supreme Court decision allowed states to reject the massive Medicaid expansion and 25 states including Georgia have done just that. The requirement that large employers offer plans or face a penalty has been pushed back a year. The opening of the Marketplace has been a technical failure.

To top it all off, the president’s promise that consumers who liked their plans could keep them has been proven untrue.

In recent weeks, millions of people who buy their own insurance got notices that the law will require them to switch to a new plan in 2014 that in most cases will cost them more.

Supporters urge Americans to take the long view: any massive federal program is bound to have problems at startup, they say, and a few years from now, when Obamacare is working smoothly, people will look back and wonder what the fuss was about.

“I find it a little bit insulting”

Betsey Weltner, an Atlanta native who owns a communications company, won’t be one of them. She was among those who received a notice from her insurer.

Since she is self-employed, Weltner has purchased her own insurance for years and now pays $289 a month with a $5,000 deductible. Getting an Obamacare-approved plan will more than double her monthly bill and push her deductible to $6,000 a year.

Costs are rising in many cases because plans have to include the law’s “10 essential benefits” that cover everything from maternity and rehab to prescriptions and hospitalization — more comprehensive coverage than many people who buy their own plans felt they needed. Weltner and others in business do not like the idea that the plans they selected are now somehow considered to be subpar.

“I find it a little bit insulting — as many other self employed and business people do — the implication that we’re not able to make intelligent business decisions for ourselves,” she said.

Weltner said she carefully evaluated her options when she selected a plan. Her decision was tested, she said, when she had unexpected cardiac surgery this summer. She has since completely recovered. She said her insurance plan gave her exactly what she needed: it covered the costly medical procedure and ongoing rehab at a gym and even gave her assistance from a nurse who has called regularly to check on her progress.

“It was a once in lifetime event when I really needed [the insurance] and it was there for me,” she said.

Weltner plans to stick with her insurer. “The costs for a new policy will double in order to cover additional services that I will never utilize,” she said.

Schlefman, the Atlanta podiatrist, said she doesn’t expect to benefit by paying twice as much for an Obamacare-approved plan.

At 61, Schlefman is in good health. But she’s frustrated by all the changes in health care.

It’s not just that her insurance is going up. She said all the new bureaucratic and technical demands on doctors drove her to retire earlier than she otherwise would have.

“It makes me mad because I am being hit from both ends,” she said.

Humana gave her two options when it sent her its notice: Get an ACA-compliant plan now for $523 a month. Or delay the pain and renew her plan now for $304 a month. But when renewal time comes around next year, she’ll have to switch to the higher-priced plan. She took the cheaper option to delay the financial hit.

Schlefman said that every time she renews her insurance plan and pays yet another increase, she just reminds herself how close she is getting to Medicare. “This is worse than it has been in any previous year,” she said.

Better results in states that embraced the law

It’s possible that many consumers who buy their own health plans now could find competitively priced plans on the Health Insurance Marketplace. Some might even qualify for tax credits that would actually make their insurance costs lower than there were last year. Last week, a study estimated that about 654,000 Georgians will be eligible for tax credits to help pay for a plan, if they shop for coverage on the Marketplace.

The failure of HealthCare.gov has made it nearly impossible for consumers to research their options and learn how Obamacare might actually benefit them.

The federal government has yet to release definitive data on the site’s performance, leaving most states in the dark about how — or whether — it’s working. Thirty-four states, including Georgia, chose not to build their own insurance marketplace sites, leaving it up to the feds instead. Information has been more readily available in states that chose to run their own sites.

In Kentucky, for example, about 32,500 people had enrolled in health plans as of Nov. 1 through the state exchange, called Kynect, state data shows. Nearly 28,000 of those qualified for Medicaid.

Obama administration officials say they plan to release enrollment data for the federally run marketplaces as early as this week. The site, they say, will also be fixed by the end of the month. Insurers have also remained silent. Anecdotal evidence and testimony by Obama administration officials, suggest the site is not functioning. Even the president suggested that getting on the phone was the best way to try to buy a plan.

Officials have said they are waiting so long to release data on the site because they want to make sure that it’s accurate. Another possible reason for the information blackout: the numbers are embarrassingly low.

“Right now, I’m pleasantly surprised”

After hearing of HealthCare.gov’s troubles, Sally McDonald decided to call the Obamacare help line instead of trying to shop for a plan online.

A self-employed therapist who lives in Chamblee, McDonald has had better luck than most consumers interviewed by The Atlanta Journal-Constitution.

“I was pretty amazed that I got a live person pretty quickly,” McDonald said.

Forty minutes later, with the help of a customer service representative, she had successfully completed an application for the marketplace. Now, she’ll wait for confirmation via mail that will also inform her whether she’s eligible for a tax credit, and if so, how much. Then she can finally select the plan that works best for her.

McDonald, 59, thinks she and her husband, 60, can get a decent plan for $400 or so a month with the help of a tax credit. That’s similar to what they pay now for a bare-bones plan, but the new coverage would be more comprehensive. The couple’s current plan has a $3,000 deductible with upfront out-of-pocket costs that have led them to put off regular physicals and diagnostic tests.

“Right now, I’m pleasantly surprised,” she said.

One navigator, 14 enrollments, no jail time

Frustration with the website is understandable, said Amanda Ptashkin, outreach and advocacy director for the nonprofit Georgians for a Healthy Future. Ptashkin, a licensed navigator, has traveled to roughly two dozen events statewide since HealthCare.gov’s cringe-inducing Oct. 1 launch.

She has resorted to using paper applications rather than the malfunctioning website to help people begin the enrollment process. Despite its challenges, Ptashkin remains hopeful the site will be fixed and Georgians will obtain the coverage they need. There have been some success stories already, she said, and consumers seem to know a bit more about the law’s basics.

Misinformation, however, is still a problem, said Monique Winters, a navigator with St. Joseph’s Mercy Care Services.

“I had someone ask me if they’ll go to jail if they don’t sign up,” Winters said.

She has helped roughly 40 Georgians navigate Obamacare so far, with 14 of them successfully enrolling.

More people will be able to sign up once the site is finally up and running correctly, Winters said, but education is the most important piece.

“It’s crucial for people to understand their options,” she said.

While Obamacare opponents continue to rip apart HealthCare.gov and its creators, the law’s supporters remain optimistic.

“We know that in the long run this is going to be great for uninsured people and that’s the message we’re putting forward,” said Ben Thomases with Seedco, a New York-based nonprofit that won a federal grant to help a group of Georgia organizations deploy navigators. “Everyone has to be patient in their own way.”

The hundreds of thousands of Georgians who planned to shop on HealthCare.gov will run out of patience, however, at some point soon. Many with pre-existing conditions have health plans that will expire at the end of the year and they know that they need to sign up by Dec. 15 to avoid any lapse in coverage.

Shlora, the Alpharetta resident who is paying nearly $2,800 a month for his family’s current plan, expects to get a better deal through the marketplace — if he can ever purchase a plan. He said he wants time to study the options, including which doctors and hospitals are included in the networks of each plan, and he said other consumers preparing to buy plans will need that, too.

Federal officials have said HealthCare.gov will be fixed by the end of the month, allowing two weeks of enrollment time for those who need coverage in January.

“They are going to get so many people trying to swarm the system that then it will really implode, I would think,” Shlora said. “I guess that remains to be seen. I’m just hoping for the best.”