There are three weeks left in the third open-enrollment period under the Affordable Care Act, and Anne Filipic, president of the national nonprofit Enroll America, is encouraging "navigators" to use the remaining time they have to reach as many uninsured people as possible. About a dozen local workers (some called navigators, who receive grant funding to do often-individualized ACA outreach via local nonprofits like the YWCA, Consumer Health Coalition and the East Liberty Family Health Care Center), as well as local county and city representatives, listened to and engaged with Filipic about the successes and barriers of the ACA in Western Pennsylvania. Filipic's message to the stakeholders in the YWCA conference room: Success in Allegheny County has been great, with 6 percent decrease in the uninsured population since 2013, but there are still those, especially in low-income communities of color, who need to be reached by the campaign.
"You guys are certainly making tremendous progress," she told the room, in regard to 412,000 Pennsylvanians insured under the Affordable Care Act. "This isn't about an advertising campaign or handing out fliers. It's about one-on-one in-person assistance."
Filipic sat down with City Paper to talk more about the ACA deadlines.
What deadlines should people be aware of?
To enroll in the health-insurance marketplace, to get coverage for this year, Jan. 31 is your deadline for coverage. That is obviously coming up, so we just really encourage everyone not to wait until that last day, but to check out your options now. You can go to GetCoveredAmerica.org to learn more about the options available to you.
In your meeting today, you talked about something called a "Plan Explorer" tool and called it “an enormous breakthrough for consumers.” Can you tell me what that is?
First, I think a little bit of context about why it’s such an important tool: One of the great things about the Affordable Care Act and health-insurance marketplaces is it actually allows consumers to compare plans side by side. Before the ACA was passed, if you were on the individual market, it was a very tough thing to try to dig through your options. So the health-insurance marketplace allows you to sort of make those apples-to-apples comparisons. For the first couple years, a lot of the easily accessible information for consumers were premium levels, which is a really important part — that’s the amount that you’re paying every month to get that coverage. But it’s not the full picture. Thinking about deductibles and out-of-pocket costs and also thinking about ‘is your doctor covered by these different plans?’ [are also important]. So the Plan Explorer actually allows consumers to plug in some basic information about their health status and specific doctors they want to see, and it allows them to then compare plans based on that information. So it provides information not only about the monthly premium, but also based on your information, what we might estimate your yearly costs to be.
Is this run by the government or Enroll America?
The Plan Explorer is run by Enroll America. You can go and plug in some information, and if you’re ready to enroll, you can actually enroll through our website on the spot.
According to some recent numbers, nearly one million Pennsylvanians are still uninsured. Who are these Pennsylvanians?
What we’re seeing, and this is really true nationally but also true in Pennsylvania, is that with people of all backgrounds, we find folks who are uninsured. But there are specific communities who are more likely to be uninsured, particularly communities of color, lower-income folks and young people. And that’s certainly true of what we see in Pennsylvania as well. We want to get the word out to everybody, but we look for opportunities to partner with those organizations that may help us reach those individuals who perhaps are more likely to be uninsured.
Another thing that people have been talking a lot about this year are the premium increases. For example, locally Highmark and UPMC premiums have risen. Can you talk about why that happened and how that affects consumers who are looking to get coverage?
One of the first things to understand is that before the ACA was passed, premiums were actually skyrocketing on a much larger scale each year. Part of what we’re seeing now is that new issuers are coming in and finding their place in the marketplace. You sort of go from community to community, and people are finding different experiences in terms of the premium rates. I will say that when you look at the national average, over 7 out of 10 individuals can still find coverage for under $100 a month, when you factor in financial assistance. There truly are affordable options out there. That is a helpful stat to understand, but what people really care about is 'what is available to me?' Whether you have shopped in the past or have coverage you’re happy with or if this is the first time you’re looking at it, shop around, check out your options. Yes, the plan you enrolled in last year, perhaps the premium has gone up, but likely there’s another option there for you that will really fit your needs.
Can you talk about the transition from former Gov. Corbett’s Healthy PA program to Gov. Tom Wolf’s straight Medicaid expansion? (Enroll America's Pennsylvania director Neil Deegan jumped in to answer this question.)
There are obviously differences between Healthy PA and HealthChoices, which is what we have now. The most important thing to note though is that over 500,000 Pennsylvanians have received coverage through the expanded Medicaid program. When you think about the number of Pennsylvanians who were uninsured and the fact that the expansion of Medicaid, regardless of Healthy PA and HealthChoices, has only been on the scene since January of last year, over 500,000 Pennsylvanians having no-cost coverage through that program, [that] is remarkable. It’s a great success and it’s been a huge benefit to half a million Pennsylvanians who wouldn't have had health coverage otherwise.
In the meeting you mentioned that uninsured numbers in Allegheny County have dropped 6 percent. Can you give me a snapshot of what Western Pennsylvania looks like in terms of ACA sign-ups and the uninsured?
Deegan: What we’re seeing in Western PA is in 2013, the uninsured rate was right around 13 percent. Before this open-enrollment period that we’re in began, we saw the uninsured rate right around 7 percent. So you’re seeing a 6-percent drop. To give a sense of how that compares to national numbers, in 2013, the national rate was right around 16 percent, and in 2015, between 10 and 11 percent. So you guys have been ahead of the ball in terms of having more members of your community insured. But it’s great that even though you started with a lower uninsured rate, you have seen a drop that’s consistent with what we’re seeing nationally. We do see, as I mentioned, communities of color are more likely to be more uninsured. We do see that here. The African-American community is certainly a priority for our work in Allegheny County, and certainly young people as well. In terms of pure enrollment numbers, in July 2015 just about 42,800 in Allegheny County had enrolled in the Marketplace. At that time, it was about 10 percent of the total enrollees in Pennsylvania. And Allegheny County has about 10 percent of the uninsured in PA. Again, you guys are sort of ahead of the curve, or right about what you would expect to see.
I read that for last open enrollment there were 472,000 Pennsylvanians who signed up for coverage under the ACA, but by June it had dropped. Why was there a drop off?
Filipic: What you’re seeing is that after you get out of the open-enrollment period, we start looking at not just the raw enrollment numbers, but at people paying their premiums. Again, this is a process for all of us who use health insurance — we pay our premium each month. If you stop doing that, you’re going to drop out of the system. So part of what you see is a little bit of natural attrition as the year goes on and some people haven’t paid their premiums. But that’s one of the reasons that it’s really great to have an open enrollment each year because it gives those folks and the folks who haven’t taken action [a chance] to get back into the system, or get into for the first time.
What advice would you have for people who are now like, ‘Oh crap! There’s three weeks left before the deadline. How do I get insurance?”
The first thing I'd say is check out your options and know that there are affordable options out there. Eighty-two percent of people who have enrolled in coverage in PA in the past couple years have gotten financial help. Then I’d encourage you to go to our website where we have tools like our calculator, so you can get a sense of what you would expect to pay; our Plan Explorer to get a full picture of the plans available to you; or the connector to find in-person application assistance. Jan. 31 is the deadline, but i’d encourage everyone to take action today so they can get all of their questions answered.
Do you have anything you'd like to add?
One last thing I would mention is that as people are considering their options, I would also let them know that if you choose not to take action, that consumers will face a fine of $695, or 2.5 percent of their income. It has gone up. This is the law of the land and it's really important that everyone gets health coverage, but I always want to make sure folks know that piece of the equation, too.