This is the final week to sign up for 2019 health insurance plans under the Affordable Care Act before open enrollment closes Saturday. And patient advocates are growing concerned.
Compared with this time last year, enrollment is lagging, with 182,000 Georgians selecting a plan under the ACA, also known as Obamacare. “That’s definitely slower than what we saw this time last year,” said Laura Colbert, the director of Georgians for a Healthy Future, which advocates for all people to have health coverage.
While she stressed that the reasons are still unknown and things may well change, she added, “I think there are a few reasons for worry.”
Chief among them is the mixed messages, or simple lack of information, people continue to have about the process. According to a Kaiser Family Foundation poll of Americans who are uninsured or buy their own insurance — those most likely to need open enrollment — nearly 70 percent either didn’t know when open enrollment ends or thought they knew and gave the wrong date.
“Georgia’s starting in a bad position, having the third-highest uninsured rate in the country,” said Fred Ammons, the CEO of the parent organization of Insure Georgia, which helps people sign up. “I think because it’s harder to reach people, particiularly people in rural counties, there are going to be problems.”
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Ammons says he’s seen an impact from the funding cuts made by the Trump administration for advertising for open enrollment, as well as navigation. The ACA incorporated federal funding for navigators, people trained to help people enroll in ACA plans. But those funds have fallen steeply in the past two years. In the end, though, 481,000 Georgians enrolled last year for 2018 plans, just a 2.6 percent dip from the previous year.
The federal office that implemented the changes, the Centers for Medicare and Medicaid Services, said the funds were being redirected to target people who were still uninsured and populations it termed as “left behind.” It also is focusing on more efficient uses, such as targeted emails and internet communication, it said.
Insure Georgia was a large statewide navigator last year, but this year it lost all its navigation funding. So its staffers have tried to register as nonprofit insurance agents and do the work that way. Their enrollment numbers have fallen by two-thirds.
“One of the most effective tools we had before was small county newspapers in rural communities. We would run small ads there when we were having events, and people would come, newspaper in hand, with this little eighth-of-a-page ad,” Ammons said. Now, he said, “essentially we have zero money to spend on marketing our service.”
Insure Georgia was replaced for statewide outreach by a small immigrant-focused organization that has now worked to expand. That organization, Georgia Refugee Health and Mental Health, hired additional navigators and set up two websites to handle the job: HealthcareGA.org in English and ObamacareParaLatinos.org in Spanish. Its phone number is 1-888-230-7772.
The central federal website for sign-up is healthcare.gov.
There is no way to know what the final numbers will be after open enrollment closes. There isn’t even clarity around when open enrollment closes: It’s either Saturday, like the rest of the nation, or later if the state receives an extension as a result of Hurricane Michael.
Factors pushing numbers down may include the declining navigation funding, as well as the lack of news surrounding ACA open enrollment compared with last year. This year, political news has centered on the election campaigns. Also, this year the penalty for not having insurance at all was zeroed out by Congress.
Among the things that could push numbers is the automatic re-enrollment that healthcare.gov does for people who were already enrolled.
Advocates are concerned that people know that if they go to a broker rather than healthcare.gov or a navigator, they should be careful about the information they get for non-ACA plans. There are a small but expanding number of alternatives people can sign up for, including religious-based associations and short-term plans, that do not require the payment of all the services — such as pre-existing conditions and expenses for medications — that ACA-0compliant plans do.
Tamanna Patel, a senior research associate at Georgia State University at the Georgia Health Policy Center, said the numbers so far were disappointing, and she knows from experience helping people sign up that it’s complex without assistance.
But it’s not over till it’s over, she said.
“I don’t’ know what the new climate is going to be now,” Patel said. “I know it’s different than what we’ve seen in the last two years. Whether or not to be concerned I guess only time will tell.”