Working To Overcome Health Care Law Confusion

The Record ( — Thursday, October 3, 2013


Big ideas inevitably breed small questions.

Sometimes those questions actually get answered.

Sometimes not.

And so, on Day Two of the great health care rollout and in the midst of a federal government shutdown, several dozen community organizers and pastors gathered in a windowless room in Totowa. They came with a litany of concerns about the Patient Protection and Affordable Care Act, also known by admirers and critics alike as Obamacare. But, as they and others across North Jersey in places like Englewood and Hackensack quickly learned, this massive legislative and bureaucratic monolith, which may be one of the most transformative events in recent history, is not going to be a smooth ride.

"This thing is so doggone complicated," the Rev. Allan Boyer, the pastor of Paterson's Bethel A.M.E. Church, said as he leaned forward in his chair during Wednesday's gathering of the Passaic County Workforce Investment Board in Totowa.

"I remember Medicare and Medicaid and even Social Security," Boyer added. "We didn't have this."

Exactly what "this" is may take time to explain – perhaps even more meetings like the one that took place Wednesday afternoon. But as that informal gathering demonstrated, the greatest enemy of America's health care reform movement may not be the hardy band of Tea Party conservatives that rules the House of Representatives in Washington, D.C. The biggest problems come from ordinary people still not fully understanding what is actually taking place with Obamacare.

"There are a lot more questions than answers," said Carolyn McCombs, a pastor who also runs a family counseling center in Paterson. "It's not just what we want to accomplish but how we accomplish it."

William Henry, who advises convicted criminals, asked: "Are people getting out of prison eligible?" (They are.)

Pastor Boyer asked: "What if you are unemployed?" (Yes, you can enroll in some circumstances.)

Another woman asked: "How do people know where an enrollment clinic is located?"

The answer to that question is slightly more complicated. Federal, state and local agencies are still compiling the names of clinics and their addresses.

Such questions, however, underscore the complexity of the new health reform legislation and why the federal government has instituted a six-month enrollment period.

But the questions voiced in Totowa were hardly isolated. Across North Jersey on Wednesday, other community leaders voiced similar concerns.

"Confusion. There is a lot of confusion," said Englewood's library director, Catherine Wolverton, who is opening up the library for a series of seminars on the health care act in the coming weeks.

And then there is the question of the federal government shutdown, which House Republicans describe as an attempt to derail the federal funding of Obamacare.

"Some people think that the health care enrollments did not start yet because of the shutdown," Wolverton said, adding that the shutdown has not stopped the health care act from accepting applications.

A basic obstacle in the process, Wolverton said, is the fact that many people enrolling with health care plans have never had health insurance before. So they may not fully understand the language of "copays," "referrals," "health exchanges" and "preexisting conditions" that are ingrained in the application process.

In Totowa, one man seemed to echo Wolverton about this new vocabulary of health care.

"What is a navigator? Can you explain that?" he asked.

Diego Arias, a health reform expert from New Jersey Citizen Action who had come to the meeting to clear up misconceptions about the new law, smiled as several others in the room laughed at the question.

Arias conceded that the term — navigator — might seem odd. He said it merely described a new kind of health clinic staffer, hired primarily with federal funds, whose sole job now was to help would-be applicants for health insurance fill out the complex series of forms.

Nationwide, some 43 million people don't have health insurance, with about 900,000 of them in New Jersey. The eligible population ranges from low-income families in Paterson to young adults from some of Bergen County's wealthier towns who may have recently graduated from college and are starting out in jobs that don't offer health insurance.

Manny Diaz, a supervisor at the North Hudson Community Action Corp., said that his group had hired outreach workers in each of its 11 satellite clinics in Bergen, Passaic and Hudson counties to advise people who might want to enroll in the health insurance plans. But on Wednesday, only one of the workers was on duty. The rest were attending a training seminar.

Diaz said each of North Hudson's sites, which include offices in Englewood, Hackensack and Garfield as well as two more in the city of Passaic, drew an average of 40 people on Tuesday, the first-day applications for health insurance were accepted. But because of computer glitches on the federal application system, few applications were actually processed. Most people were reduced to merely filling out intake forms and would follow up on the application at a later date.

"Right now they're just hungry for information," Diaz said of the visitors to the sites. "They don't know how the health care law works. They don't know what the requirements are."

In Totowa, Pastor Boyer compared the enrollment process to voter registration.

"Yes," a woman said, "but at least you know where to vote."

As the meeting ended, Phillip Schulman, a former Texas pastor who now runs the Lakeland Fellowship in Passaic County, shook his head and said, "This undertaking is enormous."

He paused, then added: "We're counting on the belief that our society will be better, but we don't know that. I wonder if that's clear."

The room fell silent, then erupted in laughter when a woman tried to change the subject to a discussion of a seminar being planned for business owners who may suffer damage from storms.

"Talking about health care reminds me of other disasters," she said, quickly realizing she did not mean to equate health reform to a disaster.

She quickly added "natural disasters."

It was a lighthearted moment, to be sure. But it illustrated a fear lurking just beneath the discussion of health care reform:

Will it work?

And if not, how much will it damage a nation with an already vulnerable economy and a rising national debt?

In Englewood, Catherine Wolverton said she is fully aware of such concerns. But the process, she said, is merely beginning.

"We're just getting limber," she said.

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