Burlington County Times

Assisters Working To Overcome Funding Cuts, Concerns Ahead Of ACA Open Enrollment Period

Burlington County Times — October 29, 2017

By Jenny Wagner

Robin Stockton was penciling in appointments to help people get health insurance more than a week before the Affordable Care Act open enrollment period, which starts on Wednesday.

Stockton directs the navigator exchange program at the Center for Family Services, a New Jersey organization that receives federal funding to employ navigators who are trained to provide free, unbiased assistance with the enrollment process and information about coverage options.

In many ways, this open enrollment period will be a lot like the previous four years, when the Camden center has been a navigator organization.

The ACA, or "Obamacare" as it's commonly called, is still the law. A variety of plans are still available on the marketplaces, and subsidies are still provided for people who can't afford them.

But a lot will be different, too.

New Jersey will have about 100 fewer navigators and other assisters, according to Maura Collinsgru, health care program director for the advocacy group New Jersey Citizen Action.

They'll have less time to do their work because open enrollment will be about a month and a half shorter, ending Dec. 15. And the Healthcare.gov marketplace also will shut down for website maintenance on Wednesday evening, and from midnight to noon on Sundays, except Dec. 10.

"We're hoping we can reach as many people as we can during that time frame," said Pam Gray, a navigator with the Center for Family Services and a Mount Laurel resident.

In-person assistance can take time, depending on the number of people enrolling and what they're looking for in a plan. Website issues, customer service calls and document verification can cause delays as well, so Gray and Stockton are advising people not to wait to set up appointments and enroll.

"We are anticipating having wait lists and having to coach people through on the phone," Stockton said. "There will be more need and less folks on the ground to do it."

That's because federal navigator grant funding awarded to five organizations across New Jersey, including the Center for Family Services, was reduced this past summer by about 62 percent, according to data from the Kaiser Family Foundation. The center, which is the only navigator organization serving Burlington County, received about 64 percent less funding than last year.

The center has scheduled times to assist consumers at the libraries in Maple Shade, Westampton and Willingboro throughout the enrollment period.

"We're still serving seven counties with in-person assistance in English and Spanish," Stockton said. "We wanted to make sure folks ... had some access to a navigator, but we're certainly not there as many hours and as many days as we used to be."

Nationwide, funding for advertising about open enrollment also was slashed by about 90 percent. In recent weeks, former Obama administration officials at the national level and organizations at the state level, including Citizen Action and the New Jersey Hospital Association, have taken it upon themselves to raise awareness.

The New Jersey organizations are encouraging people to go to CoverNJ.org to download information and promotional materials with details on how and where to enroll to distribute in their communities.

"I call it hand-to-hand outreach. It's a real grass-roots effort," Collinsgru said.

Collinsgru and Stockton said there is a lot of confusion this year about what's still in place, and people who are calling navigator organizations like the center are concerned about tax credits, cost-sharing reductions and other provisions of the ACA that have been imperiled by legislation and executive action this year.

"We're having to talk some people through some confusion and upset and panic around that," Stockton said.

One of the provisions still in place is the individual mandate, which requires everyone to have coverage or possibly face a penalty. The IRS recently announced it won't accept tax returns that do not indicate whether people had coverage in the previous year, were exempt because of their income, or will pay the penalty.

In 2018, the penalty increases to $695 per adult and $347.50 per child, up to $2,085 per family, or 2.5 percent of the household income, whichever is greater.

Part of the goal of the mandate was to encourage young, healthy people like David Bria to get coverage. The 28-year-old Bucks County, Pennsylvania, resident operates his own company, so he turned to the state's marketplace for coverage when he aged off his parents' plan two years ago.

It was a lot to digest, he said.

"There are so many plans, there are so many terms that you're trying to learn. What does this mean? What does that mean? What could my actual out-of-pocket costs be?" said Bria, who is running for his local council.

Bria didn't need in-person assistance, but Nayeemuddin Syed and his wife, Zobeida Nayeem, said they wouldn't have been able to get through the enrollment process without Gray.

"We were not aware of so many things," Nayeem said. "She enlightened us with all the information."

"It's a lot to absorb, especially if you're not that familiar with the whole process," Gray explained.

The Cherry Hill couple qualified for a special enrollment period, and they received tax credits and cost-sharing reductions that allowed them to afford a Silver plan for November and December. The different levels of coverage and cost are referred to by names like Silver, Bronze and Gold. Silver falls in the middle and is the most popular.

They're planning to meet with Gray again during open enrollment to select a plan for 2018, but they're not sure what to expect.

Rates for some marketplace plans available to residents in Burlington County will increase by as much as 39.6 percent next year because of the uncertainty surrounding some of the provisions of the law.

"It's very scary," Syed said. "We have to wait to see what will happen in January. We do not know."

But the subsidies for people who can't afford their premiums, copays or deductibles also are still in place for next year, including cost-sharing reductions, which insurers will provide even though they won't be reimbursed for them.

Since subsidies like tax credits are tied to Silver plans, they go up when the rates go up. So in some cases next year, people who receive subsidies like tax credits may pay less than they did this year, according to an analysis by the Kaiser Family Foundation.

Cost has been the biggest concern among people calling the Southern Jersey Family Medical Centers helpline, spokeswoman Mika Highsmith-Hasan said. The center provides enrollment assistance at its clinic in Burlington City.

"They're concerned about if they should get insurance or if they should keep coverage, because they don't know what will happen if the Affordable Care Act goes away," Highsmith-Hasan said. "We're doing everything we can to calm those fears and make sure everyone gets enrolled."

Experts are encouraging people who don't get subsidies to explore options outside the marketplace, which may be cheaper since they're not affected by the uncertainty. And they're encouraging everyone on the marketplace to shop during open enrollment, even if they like their existing plan.

People may be automatically re-enrolled in the same plan or a similar one in 2018, but there won't be an opportunity to switch after open enrollment. Open enrollment is the only time people can sign up for coverage for next year, unless they experience certain life events that qualify them for a special enrollment.

Experts also warn that there may not be extra time allotted at the last minute for people who start the enrollment process, but do not finish by 11:59 p.m. on Dec. 15.

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