The Affordable Care Act's Marketplace enrollment deadline of March 31 is only days away, and many Austinites without insurance are faced, in effect, with an ultimatum: Enroll in a health insurance plan now, or pay a fee later. [See also Update below.]
After the Health Insurance Marketplace open enrollment period ends Monday, those without insurance (but who don't qualify for an exemption from enrollment) will be required to pay a fee in one of two ways, depending on which amount is higher: either 1% of a household's yearly income (if above the tax filing threshold), or $95 per person for the year ($47.50 per child under 18 years). Those who do not select an insurance plan before the deadline will have another chance to enroll during the next period: Nov. 15, 2014 to Feb. 15, 2015.
As of March 1, out of Texas' population of more than 26 million people – a quarter of whom have no insurance – only 295,025 had selected a health insurance plan through the Marketplace, according to a report released recently by the U.S. Department of Health & Human Services. In Austin, the numbers are no more encouraging; according to Enroll America's Texas state profile, between 15,000 to 25,000 uninsured reside in West Austin neighborhoods, and East Austin neighborhoods are home to between 35,000 and 100,000.
Enroll America's Central and West Texas organizing lead, Ken Flippin, said a lack of health care-centric education is largely responsible for the daunting numbers of uninsured. "A lot of folks don't know the enrollment is still open but closing quickly," Flippin said. "Then there are people who don't know or maybe have not been educated to the fact that there is financial help available and they can find an affordable policy."
Advocacy programs like Insure Central Texas, Get Covered America, and Enroll America have been trying to address this lack of education. Each day, over 100 people line up outside the Foundation Communities' Highland Mall location to seek help in selecting a health care insurance plan through the ACA's digital Marketplace. Others wait in local recreation centers for their turn to meet with insurance navigators. Elizabeth Colvin, the Insure Central Texas director at Foundation Communities, said the process has made her realize how critical organizations like hers are in helping people navigate the health care insurance process. "It's not just about the application," Colvin said. "It's about educating, and just the need for a comprehensive level of education about services. It's key."
Colvin and Flippin also work to educate audiences about common misconceptions about the Affordable Care Act. Colvin said she often runs into people who do not realize the Marketplace is not a program like Medicaid – it is an actual marketplace consisting of private health insurance companies. Flippin said people most commonly fail to realize how affordable Marketplace plans are. "I think people don't understand that financial help can make it affordable for a lot of Texans and Central Texans," he said. "Another thing is that some people still think the website isn't working ... The website is working now, and there's great in-person assistance."
Amelia Ciskey, music teacher and Austinite, was one of the first people in Central Texas to successfully select an insurance plan through the Marketplace. Unsure of where or how to begin, Ciskey enrolled with the help of Insure Central Texas' in-person assistants. She said finding an insurance plan has given her peace of mind.
"You know when you have to accept something the way it is because you can't do anything about it, so you put yourself in a box and don't let yourself have basic things everybody should have?" Ciskey asked. "I used to feel like, I can't go to the doctor, because I don't have money to go to the doctor. I don't feel like that anymore. I don't feel restricted or boxed in."
Despite success stories such as Ciskey's, some Texans have been turned away: people who could find insurance through the Marketplace, but will not receive necessary financial assistance because, according to federal standards, they should qualify for Medicaid. Regardless of federal standards, however, these people will be turned down for Medicaid in Texas because Texas leaders have declined to expand Medicaid.
Jillian Gowen, a veteran and mother of one, falls into this "coverage gap." Because of a neurological disorder, it is difficult for Gowen to work full time when she is not able to manage her illness through medical visits. These medical visits, however, are out of the question until she finds insurance – the cheapest of which is three times what she is able to afford. "It's meant wondering what would happen to my daughter if I got hurt," Gowen said. "Any time I start to feel sick, I feel worried it would escalate."
Flippin said while it can be discouraging for a person to find they are in the Texas coverage gap, many people incorrectly assume they are in that predicament. "We encourage them to go and find out for themselves because they may qualify," Flippin said. "They can get the peace of mind of knowing that one accident won't cause them to go bankrupt."
Update March 27: Federal officials confirmed Tuesday evening that those who have attempted or begun the Marketplace enrollment application by the Monday deadline will receive a special enrollment extension until mid April. Obama administration officials have stressed that Monday remains a hard deadline, though they will not attempt to determine whether late applicants have actually previously begun enrollment.
The main website for enrollment under the Affordable Care Act is www.healthcare.gov, but there are other resources still available for those still looking to select a healthcare plan.
› www.GetCoveredAmerica.org has lots of information, and a useful benefits calculator.
› Lone Star Circle of Care can help guide you by phone or in person; see www.lscctx.org for info.
› Sendero Health Plans, in partnership with Latino HealthCare Forum, is sponsoring a 36-hour Enroll-A-Thon: 7am Thursday to 7pm Friday, at the LHCF office, 6601 Felix www.senderohealth.com.
› Insure Central Texas (a program of Foundation Communities) offers free drop-in service, no appointment needed, at four locations: Community Financial Center, 2600 W. Stassney at West Gate; Highland Mall, 6001 Airport Blvd. (upper level by food court).; LifeWorks, 835 N. Pleasant Valley Rd.; Round Rock Public Library, 216 E. Main www.foundcom.org.
› Enrollment events will occur Saturday, 10am-3pm, at both Gus Garcia and Dove Springs Rec Centers.
Copyright © 2015 Austin Chronicle Corporation. All rights reserved.