OCTOBER 5, 2014 LAST UPDATED: SUNDAY, OCTOBER 5, 2014, 1:06 PM BY LINDY WASHBURN
STAFF WRITER THE RECORD
After a year in which the Affordable Care Act transformed the health insurance landscape and hundreds of thousands of New Jersey residents gained coverage, advocates are targeting the remaining 400,000 uninsured residents who are eligible for coverage but still haven’t signed up.
They may be a tougher sell than previous enrollees. Whether they were turned off by the disastrous technical problems of the federal enrollment website, unable to afford a plan even with financial aid, or simply too busy or out-of-touch to figure it all out, they did not join the 12.8 million nationwide who signed up for coverage the first time around. They weren’t even moved by the threat of a tax penalty for not enrolling.
Nonetheless, the first year enrollment figures were striking, with many New Jersey residents being able to get needed care for the first time. An estimated 520,000 people in New Jersey gained insurance, cutting the percentage of uninsured in half, to 11.5 percent of adults under age 65, according to a Robert Wood Johnson Foundation study. The newly insured include some 50,000 people in Bergen County, and another 50,000 in Passaic County, federal and state reports indicate.
The second open enrollment starts in six weeks.
In Washington, the agency that runs HealthCare.gov, the online marketplace selling the Obamacare plans in New Jersey, has a new team in charge and promises a smoother experience. But everyone is watching to see “whether the lights go on,” as one observer put it, on Nov. 15, the day sign-ups start. With enrollment starting much later than it did last year, and running just three months, instead of six, the hurdles are great.
“Our work is far from over,” said Alescia Teel of Enroll America, a non-profit organization that has worked in New Jersey and 10 other states to coordinate grass-roots outreach and enrollment efforts. “We need to reach out to people to get them information they need. There are thousands of people who still need coverage.”
Despite last year’s problems with the website and the enrollment process, the Affordable Care Act succeeded in New Jersey beyond its proponents’ grandest dreams.
New Jersey Medicaid, which expanded with federal help to cover poor, childless adults, had 329,000 new enrollees through August — with 19,000 applications still being processed. An additional 162,000 bought private coverage on the federal marketplace, and 84 percent of those received subsidies. Others bought policies directly from insurance companies or decided to participate in their employers’ plans because of the new insurance mandate.
The success has attracted insurance companies to the New Jersey marketplace: Two additional insurers — for a total of five — will offer coverage for 2015, increasing competition as well as choice.
AP FILE PHOTO
“It shows that the health reforms are working as intended,” said Katherine Hempstead of the Robert Wood Johnson Foundation, and a co-author of its report.
Most of New Jersey’s uninsured wanted health insurance but had found its premiums beyond their reach, she said. Now, with federal support, many find it affordable.
Governor Christie’s opposition to the law, and his refusal to establish a state-run marketplace, meant that the state received comparatively few federal dollars to spend on education and outreach last year. Grass-roots groups and insurance companies had to make up the
difference. But unlike other Republican governors, Christie did agree to expand Medicaid, which absorbed the majority of the newly insured.
“There was a lot of concern that outreach and public education was inadequate,” Hempstead said. “We don’t know what would have happened if the campaign was more robust. But we are meeting and exceeding our projections.”
Among those pleased with the coverage — and the subsidies — is 28-year-old Rodney Hammond, a graduate assistant at Montclair State University who works part time as a security guard. Since March, he’s paid $82 a month for a “silver plan” from AmeriHealth of New Jersey after a subsidy of $180 a month.
“Without that, I don’t think I could afford it,” he said Thursday. “It’s even cheaper than my cellphone bill.”
He’d been without coverage since he turned 26 and aged out of his mother’s plan. He used a number of services — visiting a specialist for stomach pain and another doctor to get a battery of blood tests. And he visited a dentist for the first time in his life.
Garfield resident James Spoto, who does yard work part time, found when he applied in March that he was eligible for free coverage under Medicaid. His plan, through Horizon Blue Cross Blue Shield of New Jersey, has covered his medication for a chronic condition, lab tests to check the medication levels, and dental care. Most of those Medicaid services have just a $5 copay.
“It was the first time I’d had a cleaning in seven years,” he said. Since then, he’s had two root canals. If Spoto hadn’t qualified for Medicaid, he said, “I wouldn’t have been able to keep up paying my bills.”
But some, especially those hoping to sign up for Medicaid, faced frustration in the past year. First, the federal website was unable to convey their application details to New Jersey, if they got onto the website at all. As a result, many applied again, online with the state or in person at county social service agencies. Sorting out the redundancies and verifying eligibility has taken months; the state is still processing thousands of applications filed through the county offices.
One woman said she received coverage in June, only to have it withdrawn in September after the state requested more information. Another man is awaiting the results of a formal appeal to have his 14-year-old son, who has autism, covered by Medicaid. Although his son was denied Medicaid coverage, his 10-year-old daughter was approved.
A Medicaid spokeswoman said the flow of applicants’ information from HealthCare.gov to New Jersey Medicaid has been corrected, tested and now works.
While Medicaid sign-ups continue throughout the year, the open enrollment that begins in November is for those whose incomes are high enough that they need to buy private coverage. Insurers are hoping to get 150,000 people to purchase such policies for 2015.
The challenge this year is two-fold: to attract customers who didn’t sign up in the first open enrollment and may be harder to reach, and to retain those who enrolled last year, even as the choices, premiums and subsidies change.
“Was last year’s enrollment low-hanging fruit?” asked Heather Howard, a former New Jersey health commissioner and current director of the state health reform assistance project at Princeton University’s Woodrow Wilson School. “How do you reach the second wave of people that weren’t motivated last year?”
A powerful motivator a year ago was the threat of a penalty for going without insurance. The penalty for 2014 — $95 or 1 percent of household income, whichever is higher — is to be paid when federal income taxes for 2014 are filed. In 2015, the penalty increases dramatically, to $325 or 2 percent of income.
Agencies and community groups that help with enrollment also are analyzing the 2014 data to identify where to target potential new enrollees.
“The populations that are going to be key are the ‘Young Invincibles,’Ÿ” — or those under 34 who are comparatively healthy — “who were reticent to buy insurance and turned off by the technology glitches,” said Linda Schwimmer, vice president of the New Jersey Health Care Quality Institute. In addition, she said, “It’s still a big struggle with the Latino population.”
During the earlier sign-up, advocates discovered that personal, one-on-one help was most effective in getting people to enroll, and it took at least two contacts to chose a plan and finish the application, said Teel of Enroll America. “People were twice as likely to enroll if they had in-person assistance,” she said.
Yet this year, New Jersey will have fewer navigators, or federally supported assistance counselors, to help people sign up. Four non-profit agencies received $1.7 million to field navigators this year, down from six agencies that received $2 million for the first enrollment. And so far, none of the agencies plans to assign navigators in Bergen County.
Only one — the Community Health Law Project of South Orange — includes Passaic County among the four counties where it will do outreach. It plans to work with the Employers Association of New Jersey to help hourly or part-time workers who don’t get coverage at work to sign up. None of the agencies has a specific plan to reach Spanish-speaking residents of Passaic and Paterson, where the need is great.
However, a government subcontractor is opening two walk-in enrollment centers — in Cliffside Park and Iselin — on Nov. 3. Together, they’ll employ 70 staffers to provide free, in-person help to apply for coverage. They will be open six days a week — seven after Jan. 15.
After much retooling of HealthCare.gov, a “soft opening” is planned this month. Customers can start an application, determine their eligibility for subsidies, and browse last year’s insurance offerings. But details of this year’s plans and premiums won’t be posted until Nov. 15, when enrollments begin.
To help those who’ve already signed up stay enrolled, the federal government announced last month that it would automatically renew people for the same plan next year. Those customers should expect to receive letters from the government this month, explaining the reenrollment. They’ll need to revisit HealthCare.gov to provide up-to-date information about their incomes. The premiums, the amount of subsidy and the cost-sharing for each plan may change.
“Everyone should go back to the marketplace and shop again,” said Raymond Castro, a senior analyst with New Jersey Policy Perspective. “Everything is going to change. … If you’re a prudent purchaser, you should go in and see if you get a better deal.”
In New Jersey, for example, the addition of two companies — UnitedHealthcare and Oscar Insurance — increases the choices available. United, the nation’s largest insurer, already covers nearly 1.6 million New Jersey residents through various products, including its subsidiary Oxford Health Plans.
Oscar, a start-up in the New York City area last year, is moving across the Hudson River to offer coverage in nine northern counties of the state, including Bergen and Passaic. It emphasizes its telemedicine coverage and computer apps.
They join three companies — Horizon, AmeriHealth and Health Republic of New Jersey — that participated last year. They may tweak their offerings and change their premiums when details are announced next month.
All of the companies will be launching advertising campaigns in the next few weeks to pitch their insurance products as well as make people aware of the Affordable Care Act and what it requires.
For enrollment guidance
Two walk-in centers will open on Nov. 3, to help people determine if they are eligible and apply for coverage under the Affordable Care Act. Each will be open six days a week until Jan. 15, when they will add Sundays, said Anthony Borges, outreach coordinator for north and central New Jersey for SRA International, which holds a contract with the federal government to run the centers.
Cliffside Park: 596 Anderson Ave., Suites 202 and 203. Telephone: 201-414-0465. Iselin: 670 Route 1 north (next to the Woodbridge Mall). Telephone: 732-484-9710.
Both sites will be open Monday through Friday, 10 a.m. to 8 p.m., and Saturday, 9 a.m. to 5 p.m. Email: [email protected]