The website to buy a health insurance plan under the Affordable Care Act is healthcare.gov. Plans go on sale Thursday. (AP Photo/Patrick Sison)

Obamacare open enrollment starts Thursday under a raft of changes

Open enrollment under the Affordable Care Act starts Thursday. And it’s going to look different this year.

For those 2019 plans about to go on sale, the individual mandate that all Americans have health insurance is effectively gone.

The statewide “navigators” that formerly helped Georgians enroll in plans under the ACA, also known as Obamacare, have been defunded. The small refugee organization that took over navigation is on an uphill climb. The chaotic talk of repealing the federal health care law is over. In its place are serious proposals from the U.S. Department of Health and Human Services for alternatives to the ACA.

Facing it all, as usual, are customers looking for an insurance plan they can afford.

This may be a bellwether year for the ACA. Despite predictions last year of a huge drop-off, enrollment numbers didn’t tank — 481,000 signed up in Georgia.

Many of the road bumps that have outraged fans of the ACA have been made on the assumption that it is mature now and customers don’t need that much help.

Maybe that’s true and this is the year we’ll find out, said Bill Custer, a health spending expert at Georgia State University.

“There’s changes,” Custer said. “How important those changes are to Georgians is not yet clear.”

A new face in town

Perhaps the biggest single change this year is the shift of “navigator” resources to guide people to choose ACA plans. The federal government, which under the Obama administration poured $3 million a year into navigation in Georgia alone, this year has cut that down to about $500,000. And the statewide organizations that shared it last year were completely defunded this year.

In their place: Georgia Refugee Health and Mental Health, a small organization in Clarkston that as of now is not just serving refugees.

“We’re getting to the top of the mountain for sure,” said the organization’s director, Kathleen Connors. “It’s like I feel like we have just built three organizations in five weeks. But it’s working; we’ve got great people and we’re putting up two new websites, two new Facebook pages.”

The starting gun has already sounded: Window shopping for ACA plans is already underway on the federal website, healthcare.gov, and people are starting to look for assistance.

Georgia Refugee Health and Mental Health has taken a new step in Georgia by putting up a website not just in English but in Spanish. The Spanish website is https://obamacareparalatinos.org. Tuesday it had information posted for the first time, but its home page and some other parts were in English. Spanish-speaking customers can find additional online information on a federal website, https://www.cuidadodesalud.gov/es/.

The English website is https://healthcarega.org/. It just went up this week and does not turn up in Google search results for Georgia navigators. Apparently, it doesn’t yet contain the words “Affordable Care Act.” The organization is taking calls at its 800 number, 1-888-230-7772, answered Tuesday afternoon by a cheerful navigator.

The organization intends to serve other populations as well, and it has navigators who speak a half-dozen languages. There are no special numbers for those customers, but Connors said they often know the navigator in their community or stop by the Clarkston offices on Church Street.

Old hands, new names

What does come up in a Google search for the Georgia navigator is no longer officially a navigator: Insure Georgia, which used to provide navigation statewide, traveling the state with a spate of booth events during open enrollment. After losing federal funding this year, the organization decided to attempt to continue its work as insurance agents.

“We have created what we believe to be Georgia’s first nonprofit insurance agency,” Fred Ammons, the CEO of Insure Georgia’s parent organization, wrote in an email. “This week, we plan to have at least six fully licensed agents, with more online shortly thereafter. We will also have support staff that are not yet licensed that will be able to amplify the effects of the licensed staff.”

Former navigator Cozell Harris of Bryan County was busy Tuesday studying for his insurance agent’s exam.

“It’s important. It’s just important,” Harris said. “In this line of work you see people suffer. They are sick and they suffer.”

Harris backed Custer’s analysis that the people most affected by the loss of navigators would be rural and older people that may not be comfortable with computers or even have any access to them.

“It’s going to be confusing,” Harris said. “Some people live and die by TV. They don’t read. Sometimes the messages on TV — they’re not always there.”

Custer points out that media attention to open enrollment also has a big effect, as researchers found last year. At that time advertising dollars had been deeply reduced, but the public was awash in news stories about efforts to repeal the ACA and the funding decline itself. Enrollment stayed stable rather than plummeting. Custer suggested that media attention on health care in election coverage could have a similar effect.

“One of the notions of the navigator, especially in the early years, was, this is just brand-new,” Custer said, alluding to the Trump administration’s view that it was time to wind down the guidance program or look for new audiences to serve. “That’s the experiment. … It is kind of an experiment with a downside if it turns out that lots of people need navigation. We’ll have not just fewer people enrolled but making choices that weren’t right for them. That’s part of consequences.

“It’s going to be interesting.”

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