Homeless in Arizona

How do you spell socialism - Obamacare!!!

Massive Obamacare insurance sign-up planned in Arizona

Massive insurance sign-up planned in Arizona

By Mary K. Reinhart The Republic | azcentral.com Sat Sep 21, 2013 11:29 PM

Leaders of Arizona’s social safety-net organizations may be facing the most daunting challenge of their careers.

They’re experts in their field, many with decades in the health-care and non-profit sectors. Now, they must facilitate the biggest health-care expansion in two generations by getting people signed up — beginning Oct. 1 — for insurance coverage under the Affordable Care Act.

Arizona’s 1 million uninsured are a diverse group of people who, polls show, have at least one thing in common: They know little about the federal health-care overhaul that requires most of them to have coverage next year or pay a fine.

Most are unaware that the new law offers free or subsidized health insurance to nearly all of them. That includes thousands of people with chronic medical conditions, including roughly 3,000 with HIV/AIDS.

The ranks of the uninsured include the state’s many refugees, who speak dozens of languages. They also include the homeless, people recently released from prison, college students, retirees not yet Medicare-eligible, children and the mentally ill.

In Arizona, there is no state or federal agency charged with finding them, educating them about the complexities of premiums, copays and deductibles, or helping them enroll in the right plan. Arizonans who don’t use insurance agents or brokers, or who don’t qualify for Medicaid, are expected to navigate the federal online marketplace and choose their own plan.

Gov. Jan Brewer declined to set up a state-run marketplace where consumers could shop for insurance, limiting the public funding available to educate the public. She cited cost, lack of state control and the unknowns associated with running a state-based exchange when she ceded that duty to the federal government two years ago.

That leaves a loose coalition of more than 300 social-service providers, health-care organizations and advocacy groups, called Cover Arizona, to step in. The coalition’s steering committee has been meeting since April to hammer out strategies.

“We need to figure out how to get these people covered,” said Kim VanPelt of the Phoenix non-profit St. Luke’s Health Initiatives, which is coordinating Cover Arizona.

Aiding the effort is Enroll America, a national non-profit funded by the health-care industry, insurance companies and private and non-profit donors, and run by staffers of President Barack Obama’s re-election campaign. Arizona is one of 10 states targeted by Enroll America because of its large number of uninsured, lack of a state-run online insurance marketplace and its history of successful community-based health-care outreach efforts.

The health-care law set aside money for states to build and market their own exchanges, but it didn’t anticipate that so many would opt out. So federal funding is being transferred from public health and other programs to the 37 federal-marketplace states for outreach and enrollment assistance, but it’s spread thin.

Arizona non-profit groups have been awarded $5.4 million in federal grants to hire “navigators,” outreach workers and others trained to answer questions, encourage participation and to help people enroll through the marketplace or in the state’s expanded Medicaid program. Joining about 100 paid navigators and hundreds of trained application counselors are staff and volunteers from Arizona hospitals, health centers and advocacy organizations. Arizona’s four grantees are scrambling to hire navigators, at annual salaries ranging from $30,000 to $40,000.

It’s a far cry from the publicity splash in some of the 17 states that have opted to build their own insurance markets. Connecticut’s Access Health CT has billboards, radio spots, TV ads and “Get Covered” sunscreen. California kicks off an $80 million media and marketing campaign next month. In Oregon, singer Matt Sheehy strums his way through the state’s scenic landmarks performing “Long Live Oregonians” in a TV commercial promoting that state’s online health-insurance market.

“We were drooling over the Oregon commercial,” VanPelt said. “We have no money. We just have to work together.”

‘Get them in quickly’

Arizona isn’t starting from scratch on outreach and enrollment. Most of those on the Cover Arizona steering committee have worked together before on health-care issues, including outreach for KidsCare insurance and a temporary federal health plan for people with pre-existing conditions.

There’s a sense of urgency, particularly when it comes to reaching people with chronic health conditions. Thousands who receive health benefits through federal programs that end Dec. 31 are eligible for free or subsidized coverage under the Affordable Care Act beginning Jan. 1. But it’s not automatic; they have to enroll and they have less than three months to do it.

People who sign up by early to mid-December should be covered when the new insurance programs begin Jan 1. Those who purchase coverage through the marketplace or private insurance agencies have until March 31 to enroll for 2014 coverage. Low-income Arizonans who qualify for Medicaid can enroll anytime beginning Oct 1.

Rose Conner, manager of Maricopa County’s federally funded Ryan White program for people with HIV/AIDS, is determined not to let her 3,000 clients fall through the cracks. “We have to get them in, and we have to get them in quickly,” Conner said.

At the same time, organizers seek to dampen expectations for early enrollment. It took years to accomplish other health-care rollouts, and they were bumpy, such as Medicaid in the 1960s and the prescription-drug benefit added to Medicare in 2006.

“I think it’s important to manage expectations,” VanPelt said. “I just don’t think it’s fair to deem success or failure based on October enrollment numbers.”

Some people will rush to sign up, motivated by ailing health or because they already are familiar with government-run health-insurance programs.

“We believe that those people who will be losing the pre-existing program will be very interested in finding coverage quickly because they know that their coverage ends January 1,” said Allen Gjersvig, director of health-care innovation for the Arizona Alliance for Community Health Centers.

People who have lost free health coverage since lawmakers froze enrollment in a portion of the Arizona Health Care Cost Containment System, the state’s Medicaid program, or who have been denied AHCCCS coverage, also are expected to sign up early.

Organizations that traditionally help people sign up for Medicaid and other social-service programs, such as community health centers, hospitals, clinics, food banks and advocacy groups, have been participating in almost daily presentations around the state. Other partners include private companies, such as the tax-preparation company H&R Block, which plans a pilot program with insurance agents.

Public libraries also are gearing up to assist patrons who want insurance but lack Internet access. In a partnership with federal health officials, the nation’s libraries are training employees about states’ online marketplaces and Medicaid policies.

The national non-profit Young Invincibles is working with the Arizona Public Interest Research Group to attract young adults, who have the highest uninsured rate of any age group but also are the least likely to know about the new health-care law. Advocates will set up tables on college campuses to reach some of the nearly 340,000 young adults in Arizona who are uninsured.

And there’s a partnership in four states, including Arizona, among the Centers for Medicare and Medicaid Services, community-action agencies and the Americorps volunteer program to enlist retirees to help low-income families find coverage.

People earning less than 133 percent of the federal poverty level, or $15,282 for an individual, can qualify for expanded Medicaid. Those who earn less than four times the poverty level, or up to $46,000, can receive subsidized coverage through the online marketplace.

In June, Brewer and a bipartisan group of lawmakers approved Medicaid expansion, which will insure an estimated 350,000 more Arizonans. The law is being challenged, but that won’t affect enrollment.

AHCCCS is beefing up its online enrollment system, Health-E-Arizona, to match new eligibility requirements under the health-care overhaul. Other than a new name — Health-E-Arizona Plus — people already on AHCCCS won’t see much of a change, said Monica Coury, assistant AHCCCS director for intergovernmental relations. “They’re still going to apply the way they always applied. It’s not a massive sea change happening in Medicaid.”

Hostile climate

Navigators and others assisting with the effort will face a hostile political climate, where polls show a significant number of Americans view the Affordable Care Act unfavorably. The short training window also has raised questions about how prepared workers will be to field questions, many from people who have never had insurance and don’t know a copay from a deductible.

“We’re starting at a deficit because for so many people, this is a negative,” said Tara McCollum Plese of the Arizona Alliance for Community Health Centers. “You’re going to have this group of people who ... want to derail this and will try to prevent it from working well.”

For the uninsured, however, and the people who encounter them every day, Oct. 1 begins a welcome challenge and an enormous opportunity.

Beverly Barnette and her husband were still paying the bills from her gall-bladder surgery last year when tests showed a tumor on an intestine. After two surgeries and a virulent infection, she’s awaiting another operation to reattach her colon and seeking wound care and other treatment at St. Vincent de Paul’s Virginia G. Piper Medical and Dental Clinic. Barnette, 63, has worked most of her life but has no insurance. She doesn’t know how she’ll pay for the surgery or further treatment. “There’s not anything she’s done wrong,” said Barnette’s daughter, Cami Nuttall. “She just falls through the cracks.”

Janice Ertl, director of the St. Vincent de Paul clinic, hopes Barnette can be one of the first in line to get help from a navigator to enroll in AHCCCS or find a subsidized plan on the online marketplace. The clinic has been swamped since enrollment in an AHCCCS program for childless adults was capped in 2011 and, like other free health-care clinics, can treat only a fraction of people who seek care.

“We’re just keeping them patched up until they can get more definitive care,” Ertl said. “We’re trying to keep them out of the hospital the best that we can.”

-------

Health-care reform

To learn more about health coverage under the Affordable Care Act, go to healthcare.gov or call the 24/7 toll-free help line at 800-318-2596.

To find a community health center near you, go to aachc.org or call the Arizona Alliance for Community Health Centers at 602-253-0090. In southern Arizona, call the Pima Community Access Program’s health hotline at 800-311-0627 or go to mypcap.org.

Need help signing up?

These agencies received federal “navigator” grants to help people sign up for health insurance:

Arizona Association of Community Health Centers: www.aachc.org; 602-253-0090; 700 E. Jefferson St., Suite 100, Phoenix, AZ 85034.

University of Arizona, Center for Rural Health: crh.arizona.edu; 520-626-5823.

Campesinos Sin Fronteras: www.campesinossinfronteras.org; 928-627-5995 or 928-627-1680; 201 N. Bingham Ave., Suite 1, Somerton, AZ 85350.

Greater Phoenix Urban League Inc.: www.gphxul.org; 602-254-5611; 1402 S. Seventh Ave., Phoenix, AZ 85007-3902.