Affordable Care Act faces death by a thousand cuts

The official word from the United States government, while muddled, is clear about a couple of things. Enrollment for the Affordable Care Act marketplace runs from November 1 through December 15, half the time that was allowed last year. That window’s not being advertised by the federal government. Word is rampant, as well, that navigator programs designed to help people find health insurance coverage at affordable prices has been cut considerably.

The unofficial word, as anyone who reads or watches understands full well these days, is confusing. The president has ordered that federal subsidies designed to make insurance affordable won’t be paid. Legal challenges are under way across the nation. Insurance rates that were supposed to have been set by now are in flux. Everyone is trying to figure out what the federal government will be chipping in for its own laws, its legislated obligations. The same goes regarding what’s required of citizens in terms of the insurance they need to be buying, especially if there are no longer challenges to not buying insurance, as well as what insurance must include.

Where do things stand in New York State?

On October 5, the state Department of Health put out a press release announcing that NY State of Health, the state’s official health plan marketplace, had signed up more than four million people, with 680,000 enrolled in its Essential Plan. More importantly, the state would be extending its open enrollment period from November 1, 2017 to January 31, 2018.

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NY State of Health executive director Donna Frescatore was quoted as saying. “Despite the ongoing debate in Washington over the future of the Affordable Care Act, New York’s marketplace remains open and strong as ever.” Of the marketplace enrollment, 2,837,735 were through Medicaid, 346,067 through Child Health Plus, and 227,796 in Qualified Health Plans in addition to Essential Health Plans.

“Consumers in all counties of the state have a robust selection of health plans to choose from. New York expects to both renew coverage for more than 400,000 households during the open enrollment period and enroll new consumers. Most marketplace consumers qualify for financial assistance to pay for coverage,” the Department of Health press release continued. “Among QHP enrollees who qualify for tax credits, premium costs for the most popular silver plan will be about the same or lower compared to last year.”

Other states that have extended sign-up or renewal periods — which proponents of the new six-week deadline have said was a way of keeping citizens from “gaming the system” — include California (www.coveredca.com), the District of Columbia, Massachusetts, Washington state, Minnesota, Colorado, Rhode Island and Connecticut.

68 percent don’t know when enrollment starts

During a Kaiser Family Foundation web discussion of where things stood with the nation’s healthcare held last Wednesday, it was noted right off the bat that 68 percent of the nation didn’t know for certain when ACA enrollment was opening, while 81 percent had no idea when it would be closing for their state. For those already enrolled, those figures were halved, but still high.

If, instead of signing up with a navigator for a new year of what so many like to call Obamacare, one chose to simply “auto renew,” KFF officials continued, there would be a strong possibility you would be “re-assigned” to a new insurance program. There was a general worry among all speaking that there might not be an appeals system in place for the coming year. At least they’d not yet seen evidence of any.

“Act early,” was the main suggestion. “There’s always been a surge towards the end; that will likely increase this year. It is as yet unclear whether those caught ‘in line’ when the sign up period ends will be allowed to extend their application until completed, as in previous years.”

Within the six weeks of ACA sign-up most of the nation will enjoy, the federal website for sign-ups will be taken offline every Sunday from midnight to noon, for maintenance. Other such stoppages should be expected, it was added.

Plus, it seemed that the feds were going to refuse enrollment this year to anyone with unpaid ACA debts from previous enrollments. Or possibly other federal debts. Adding to this, one wouldn’t know that was a problem if rejected. That’s another process no longer transparent online.

No one was certain whether the government would be implementing penalties for not carrying insurance in 2018.

When a reporter from the Associated Press asked about subsidies, one of the big Tweet-oriented topics of the past month, KFF Director of State Health Reform Jennifer Tolbert said that “if there are rebates they would go to the feds and not consumers.”

KFF Senior Vice President Larry Levitt talked about a variety of challenges, including “planned outages in some states,” and “increasing premiums because of the Trump administration’s actions.”

Finding a navigator

When we checked with our own navigator, which because of shifts in freelance and other employment seems to be necessary now every few months, she told us that from what she’s heard New York State is making a push to sign up younger people. Her office handles actual outreach work towards that goal.

She noted hearing about troubles in Ulster County. “Search through the New York State of Health website,” she advised, asking that her name not be disclosed. “Also try Googling ITA navigators for Ulster County.” The state marketplace website has a long list of agencies that provide navigators, county by county. At least one of them, the Phoenicia Library, had an old address that’s not worked for a few years.

Searches for marketplace help and navigators on Ulster County’s Department of Health and Mental Health and Healthy Ulster County websites found no mention of the Affordable Care Act or individual insurance options. At the Ulster County Department of Social Services, a section entitled medical assistance program offered up an incorrect website URL for the NY State of Health marketplace website. The right number for the program (855-355-5777) provides a fully-staffed customer service center which will work to hook those calling with navigators.

One can also reach out to Fidelis Care, the “faith-based, mission-driven health plan” founded in 1993 as the Catholic Health Services Plan of Brooklyn and Queens and since grown to encompass the whole state.

Federal attacks

In the meantime, federal attacks on state funding mechanisms for healthcare have continued. On October 13, New York State Medicaid director Jason Helgerson sent out letters to the state’s hospitals about payment plans tied to the U.S. Congress’ failure to renew the Medicaid Disproportionate Share Hospital Payments, which he said had resulted in a $2.6-billion federal funding cut to the state’s public hospitals.

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And the political fate of the short-term fix Congress has been considering, known as the Alexander-Murray bill, was still up in the air as of press time.

Find a navigator now. Call 855-355-5777 until you have one speaking to you.

Also, consider attending an upcoming forum on single payer health care such as that being sponsored by the Dutchess County Progressive Action Alliance, in collaboration with the Physicians for a National Health Program, New York Metro Chapter and the Social Justice Committee of the Unitarian Universalist Fellowship, at the Unitarian Universalist Fellowship,  67 South Randolph Avenue, Poughkeepsie on Thursday, November 2 at 7 p.m. The forum will “feature medical members of the community to present information on single payer, as well as answer questions from the audience.” Small business owners are being encouraged to attend. To learn more about the Physicians for a National Health Program, see www.pnhp.org.