By John Murawski, Raleigh News & Observer
They plan to fan out across the state visiting community centers, school gyms, churches, libraries, waiting rooms and shopping centers. Their goal: Sign up as many North Carolina residents as possible for subsidized insurance under the nation’s health care law.
Dozens of nonprofits and local agencies that provide social services to the poor are embracing the Patient Protection and Affordable Care Act as their mission. The federal law will put health care coverage within reach for many low-income residents for the first time by providing subsidies to offset insurance costs.
A number of North Carolina organizations are applying for federal grants to become contractors in the national effort to enroll legions of uninsured. Additionally, some social service providers are planning to promote subsidized health care with the assistance of hundreds of volunteers.
Many of the contractors won’t be selected until mid-August, leaving the volunteers, counselors and “navigators” who will aid the uninsured barely a month to organize before enrollment begins Oct. 1. Coverage begins Jan. 1, but enrollment will be open for six months.
The groups will attempt to fill a void created when North Carolina officials decided not to promote the new health care law, a policy decision that left the job to local and regional agencies. After taking their online crash course on the health care law, which will require a minimum of 30 hours of training, they will instruct residents on the looming insurance mandate: subsidies, penalties and waivers for those too poor to pay for even discounted insurance.
“What they’re going to be doing is relying on lots of volunteers,” said E. Benjamin Money Jr., CEO of the N.C. Community Health Center Association. “The question is: Is there going to be enough volunteers to suffer through the federal training and go out and find people to enroll by the first of October?
“That’s a big if,” Money said.
The feds had allotted $27.2 million to the N.C. Department of Insurance, but state officials elected not to endorse the law, commonly known as Obamacare. Instead, grassroots organizations will get about one-fourth of that amount to do the same amount of work.
Last week, the U.S. Department of Health and Human Services awarded $4.1 million to 32 community health centers, including more than $800,000 in grants for three centers in the Triangle, for outreach on the Affordable Care Act.
Next month another $2.2 million will be awarded to other groups. Applicants include Legal Aid of North Carolina, N.C. Cooperative Extension, Community Care of North Carolina, N.C. Agromedicine Institute, N.C. Council of Churches, N.C. Association of Community Development Corporations and possibly others. Many are coordinating with local social service groups to carry out the work.
“There’s at least 50 organizations across the state that are committing volunteer efforts to enrolling the uninsured,” said Lee Dixon, director of policy and resource development at Community Care of North Carolina. “This really will happen down at the local level.”
Sign-ups may top 1 million
The names or number of organizations that have applied are not being released by the Center for Consumer Information and Insurance Oversight, the federal office handling the pending applications for federal grants.
More than a million North Carolinians are expected to sign up for subsidized insurance in the coming months. Many of those eligible for the coverage have lower incomes and limited education and are largely unaware of the Affordable Care Act. Plenty are confused.
“They’re getting bits of info and a bunch of misinformation,” Money said. “These are the folks you not only have to educate, but re-educate.”
Project Access of Durham County, a nonprofit social service agency, is coordinating with Durham Health Innovations, El Centro Hispano and other groups to conduct an outreach campaign without federal funding.
“I see it on a daily basis with my patients,” said Krystal Holman, project coordinator at Project Access. “They just don’t have a clue that it’s coming in a few months.”
Health insurance will be mandatory for an individual making about $16,000 a year and for a four-person household with income of about $33,000 a year.
Details about subsidized insurance policies that will be available in North Carolina are still not known.
The N.C. Department of Insurance is reviewing proposed plans and expects to issue approved rates by the end of this month. Three insurers have filed proposals, submitting more than 60 subsidized plans between them.
Influx of customers
The 2010 federal health care law makes it illegal for insurance companies to turn away customers because of pre-existing conditions, or to charge older people exorbitant rates.
To compensate for the expected influx of customers in poor health, the insurance companies are doing their own outreach in a bid to sign up as many healthy, young people as possible. Young people – called “invincibles” in industry parlance – are considered ideal customers because they pay into the system but use it infrequently.
“Invincibles” are also the least interested in getting insurance, and most likely to opt out of coverage. In the first year of the Affordable Care Act, the penalty for failing to get insurance is $95 or 1 percent of income, whichever is greater. By 2016, the penalty will be $695 or 2.5 percent of income. However, many won’t have to pay the penalty because the IRS will collect the penalty only from those who get tax refunds.
Enroll America, an independent nonprofit organized to promote the Affordable Care Act, conducted research that found that young men, aged 19 to 34, and nearly half of them Southerners, are “incredibly skeptical” about the value of insurance.
Blue Cross and Blue Shield, the state’s largest insurer, has launched TV commercials and rolled out billboards to attract young customers with a promotional campaign titled “Live Fearless.” The campaign features action footage of high divers, horseback riders and mountain bikers, interspersed with images that warn of life’s unplanned consequences: leg braces, wheelchairs and newborn infants.