Community members who help people sign up for health insurance are prepared to field complicated questions about coverage tiers, doctor networks and out-of-pocket expenses as the Affordable Care Act’s fifth annual open enrollment season kicks off Wednesday.
But a more basic line of inquiry has been dominating many of their early interactions with the public: Does the Affordable Care Act, also known as Obamacare, still exist? Is subsidized health insurance still available despite months of acrimony in Washington?
The answer to both those questions is yes — and in Austin and some surrounding areas there actually are more subsidy-eligible health plans to choose from on the federal marketplace for 2018 than there were for 2017. Enrollment for 2018 insurance under the Affordable Care Act begins Wednesday and will last six weeks through Dec. 15.
Misconceptions about the law’s fate appear to be widespread, however, leading to fears that many people won’t sign up and instead will forgo their chance to gain access to affordable medical care for 2018.
“People are confused, and they’re telling us when we’re out at events that they can’t sign up” because the law is no longer in effect, said Jill Ramirez, chief executive of the Latino Healthcare Forum. “Right now, there is so much confusion about what is going on. We have been out there clarifying what the ACA is.”
The United Way for Greater Austin, with support from Central Health, is providing a call center for information and assistance during the enrollment period. To access the service, local residents should dial 211 on their phones and then press option one.
While the basics of the Affordable Care Act haven’t changed — including the individual mandate that everyone have health insurance or pay a fine — consumers will have significantly less time to sign up this year than in previous years, when the enrollment period lasted three months instead of 45 days.
They’ll also have less information about enrollment because the budget for promotional advertising from the federal government has been cut, and they’ll have less access to federally funded specialists, known as “navigators,” if they need one-on-one help filling out their insurance forms — although local health advocates are trying to bridge that gap with an increase in volunteers.
“We have to serve twice the number of people in half the time,” said Elizabeth Colvin, director of the Insure Central Texas program at Foundation Communities. “But the community response has been tremendous. When we made our call for volunteers, people responded.”
Colvin said her group has trained nearly 130 people as volunteer “certified application counselors” this year, compared with 61 last year.
Meanwhile, residents of Travis, Williamson and Hays counties have more choices on the federal marketplace for 2018 coverage, because Oscar Health has joined existing insurers Blue Cross and Blue Shield of Texas, Sendero Health Plans and Ambetter Health in offering subsidy-eligible plans. Combined, the companies are offering 33 marketplace plans in the region, compared with a total of 30 for 2017.
Republicans opposed to the Affordable Care Act — including President Donald Trump, who has called it “a disaster” and campaigned on doing away with it — have thus far been unsuccessful in their efforts to repeal the law.
But the Trump administration nonetheless has taken actions that the law’s proponents say could reduce its effectiveness by lowering enrollment. Those include shortening the sign-up period, cutting money for an annual federal promotional campaign by 90 percent — to $10 million — and reducing funding for health care navigators, or organizations that educate people about their choices and help them sign up.
In Texas, funding for navigators has been cut by 34 percent this year — to $6.1 million from $9.2 million last year — according to the Kaiser Family Foundation.
Trump also recently announced that he would eliminate payments designed to reimburse insurance companies for reducing out-of-pocket expenses for low-income people. That change has resulted in big spikes in premiums for the most popular tier of plans — although consumers who qualify for subsidies will be protected from the increases.
In Travis County, the average premium for “silver” plans, which are the most popular tier, is climbing 32 percent for 2018, according to an analysis by the Center for Public Policy Priorities, while average premiums in the bronze and gold tiers are climbing by about 6 percent. Only consumers who pay the full cost of their health insurance will feel the impact of the higher premiums.
But the actions by the Trump administration have taken a toll on public perceptions as the enrollment period gets underway, proponents of the law say.
“There is so much noise out there that some people maybe have even concluded that Obamacare has been repealed,” said U.S. Rep. Lloyd Doggett, D-Austin, who has attended a number of local events recently to urge people to research their options and sign up. “The message being conveyed regularly (by the Trump administration) is that this will not work for you and your family.”
Amid the current rhetoric surrounding the law, local health care advocates say enrollment might not equal last year’s numbers. A total of 68,199 Travis County residents signed up for 2017 coverage through the federal marketplace, according to the federal Centers for Medicare and Medicaid Services, while 23,893 people signed up in Williamson County and 9,338 people signed up in Hays County.
“There is a risk” that fewer people will sign up for 2018 coverage, Colvin said. “But it’s our job and our commitment to not let that happen. We have our biggest volunteer class we’ve had ever, and we’re excited about the open enrollment period.”
Ramirez wasn’t as positive.
“Unfortunately, I think that there is so much confusion that people are not going to be able to make up their minds and may not have enough time to really understand what is happening,” she said. “I’m trying to be optimistic, but I really don’t think it’s going to be OK from what we are hearing out in the community.”