As an uninsured agriculture worker, Salvador Lopez said he’d welcome health coverage so he could afford diabetes medication.
Health insurance would also help his wife, said the Excelsior Springs, Mo., resident. Not feeling well on Saturday, she actually had her blood pressure checked at the health fair the couple attended with their two daughters in Kansas City, Kan.
But organizers said the main point of the two-day fair was to enroll people for health insurance through the new marketplace established through the Affordable Care Act.
Open enrollment for this initial sign-up period ends March 31. Under the act, individuals and families face fines for failing to carry health insurance.
Medicaid covers the Lopez girls. And though Salvador worried that even a government-subsidized plan would strain the family budget, he was optimistic about finding something that fits the needs of him and his wife once he gets paperwork from his employer to finish enrolling.
“It’s going to help me a lot,” he said.
Field workers said they are redoubling outreach efforts in these final weeks leading up to the end of the month, but organizers said efforts would then shift to helping people understand their coverage and how to use it.
“I would say the majority of people that we see have no idea what health insurance is, have never had it,” said Pam Seymour, executive director of Shepherd’s Center Central. The nonprofit has two locations in Kansas City, Mo., and has more than a dozen trained workers to help individuals navigate through the enrollment process using the federal website.
The U.S. Department of Health and Human Services reported Tuesday that 4.2 million Americans have purchased exchange plans through the end of February.
The figure includes approximately 104,000 signups in Missouri and Kansas combined. According to estimates from the department, approximately 1.1 million residents of the two states combined are uninsured and eligible to participate in the exchange.
The Congressional Budget Office estimates that about 6 million people will get coverage through the marketplaces this year, a figure that has fallen by nearly 20 percent due to the rocky rollout of the exchange website in October.
“What we are finding,” HHS Secretary Kathleen Sebelius said upon release of the new enrollment numbers, “is that as more Americans learn just how affordable marketplace insurance can be, more are signing up.”
A department spokeswoman said staff is “busy preparing to handle an anticipated surge in enrollment as we approach the end of March.” The effort, she said, included hiring an additional 2,000 workers for the department’s help line – bringing the total to about 14,000 representatives.
Drafters of the ACA intended for these health insurance marketplaces to operate much like online systems that allow shoppers to compare prices on airline tickets or hotel rooms. The premise is that competition for business will yield the best deals for consumers.
In the health care marketplace, designers also wanted to give individuals the clout of being part of large group similar to if they were included in an employer-based plan.
The health-reform law gave states the option of establishing their own marketplace or participating in a federally run exchange.
According to the Kaiser Family Foundation, 17 states set up their own exchanges. The remaining states are either relying on the federal marketplace or created a hybrid federal-state operation.
In many instances, as was the case in Missouri and Kansas, the decision not to establish a state exchange stemmed largely from conservative opposition to the Affordable Care Act.
In November 2012, Missouri voters approved a proposition that prohibited the governor or any state agency from helping facilitate the establishment of an exchange without legislative approval or voter authorization.
At the Shepherd’s Center, Seymour said, “Everybody is ready and up to the challenge of getting these last-minute people enrolled. We are going to pull out all the stops and do whatever we need to do.”
Shepherd’s Center is also among several agencies and organizations working to get the word out to consumers that time is running out for them to purchase insurance through the marketplace. The next enrollment period begins in November.
Among the initiatives in the metropolitan area are Enroll Wyandotte, the coalition that that sponsored last weekend’s health fair, and CoverKC, a $700,000 effort spearheaded by the Health Care Foundation (HCF) of Greater Kansas City.
The St. Louis-based Missouri Foundation for Health (MFH) has a statewide project called Cover Missouri. In Kansas, the state Insurance Department is working with outside organizations, such as the Kansas Association for the Medically Underserved, to spread the word about the ACA.
Here’s a sampling of some of the efforts to date and plans for the next few weeks:
- Cover Missouri: Has helped enroll about 68,000 Missourians for health insurance through the Affordable Care Act, said Ryan Barker, health policy vice president at MFH. That figure includes a smattering of people who turned out to be eligible for Medicaid. With a multimedia campaign on tap, Barker hopes the effort can enroll a total of as many as 130,000 people by the end of the month.
- CoverKC: Since January, workers have knocked on more than 35,000 doors in the urban cores of Kansas City, Mo., and Kansas City, Kan., according to Jessica Hembree, program and policy officer for HCF. Organizers hope to have hit a total of about 70,000 doors by the end of this month, supplemented by mail, telephone and digital marketing.
- Enroll Wyandotte: Organizers hope to have interacted with about 18,000 residents by the end of the month, said Jerry Jones, executive director of the Community Health Council of Wyandotte County. By the end of the next enrollment period, which ends in mid-January, Jones said their goal is to have 12,000 county residents who were previously uninsured enrolled in plans through the marketplace.
Enrollment workers said the federal enrollment website is working much better than it did in the opening weeks of enrollment in the fall, when the site proved unable to handle the crush of queries.
Though anecdotes from the field indicate that it can take upwards of two, three and even five hours for enrollment if the case is complex, proponents are cautiously optimistic that an anticipated surge in business in the coming weeks will not lead to another meltdown.
“We hope the process works better,” said Linda Sheppard, special counsel and director of health care policy and analysis with the Kansas Department of Insurance. “I assume it will. We will see what happens.”
Back at the health fair in Kansas City, Kan., Renan Raven was a busy man. A bilingual marketing specialist for Blue Cross and Blue Shield of Kansas City, he was explaining the ins and outs of insurance and the federal marketplace to the many Hispanic attendees.
Like Lopez, the man from Excelsior Springs, Raven said he had heard concerns from questioners about their ability to pay for an insurance policy. He gave some tough love as a response, he said.
If it does not fit in the budget, Raven said, then these folks are going to have to rethink choices like a big-screen TV or a fancy car.
“They need to understand that this something that is going to change their lives,” he said. “You have to add it to your budget like any other American.”
Mike Sherry is a health reporter at the Hale Center for Journalism at KCPT.