Sometimes big ideas can have ragged launches. For example, implementation of the Affordable Care Act (ACA) and the workings of the state’s Federally Facilitated Exchange (FFE) are showing mixed results, according to local health insurance experts.
Akin to Social Security, the ACA ultimately relies on many people, including younger working people, to be successful in delivering both expanded health care coverage and affordable premiums – even to those who couldn’t get it before the act.
“It should really be called the Accessible Health Care Act,” said Ed Gussio, owner of Benefit Logic, a Flagstaff-based insurance broker. He explained that it is not necessarily more affordable for everyone. “This health care reform is based on getting everybody enrolled, to spread the risk.”
On the other side of the coin, Arizonans who were previously not able to either afford or even qualify for health insurance now can get it under ACA. “We have enrolled people who previously were declined,” said Gussio.
Another Flagstaff-based health insurance broker, Leslie Barton of KLB Insurance and Financial Services, is seeing a similar mix of clients that are either being helped a lot or are disappointed as the ACA rolls out in the Northland. “People are upset,” said Barton. “They are finding out the new ACA-compliant plans are more expensive. I’d almost say it’s 50-50 – those who benefit and those who don’t.”
Meanwhile, as it has been reported nationally, Flagstaff and Northern Arizona are seeing a dearth of younger people signing up for health insurance under ACA. As of mid-January, as this article went to press, some two million Americans had signed up for government-subsidized insurance but nationally, only some 24 percent of those enrollees were in the younger set, ages 18 to 34.
However, according to experts at both Benefit Logic and KLB Insurance, they have already helped many individuals who can now qualify for and afford health insurance. “I would say the new plans benefit people who are mostly single with dependents – those who are self-employed with dependents,” said Barton.
Benefit Logic told Flagstaff Business News that they have signed up close to 200 individuals and many businesses on ACA-compliant plans. Those enrollees are both on and off the marketplace. “We have had individuals elated to be able to purchase plans who were previously uninsurable,” said Gussio. “We have also had many customers upset with the higher costs associated with ACA plans, those not eligible for subsidies.”
What both insurance brokers also emphasized are the complexities and potential pitfalls involved in enrolling for health insurance under the ACA. Both KLB Insurance and Benefit Logic do not charge their clients any more to guide them through these complexities and help them sign up for health insurance. That is, they are not commission-based; their modest fees are built in.
Another mechanism that was set up to assist individuals in signing up at Healthcare.gov is via the role of health insurance “navigators” like those in Northern Arizona at North Country Healthcare.
In the past, prior to the ACA, signing up for health insurance, say, under an employer-sponsored set of benefit plans, has always been complex – even frustrating and sometimes mind numbing. Now, under the ACA, add in additional factors such as whether an individual or family qualifies for a subsidy, their particular situation in terms of qualifying income related to that potential subsidy, how can one be sure they are really covered after signing up on Heathcare.gov and what network, what doctors and facilities, are actually available to the enrollee under ACA-compliant plans here in the region?
Then, there are other pitfalls such as ghost and orphan policies. “An orphan policy occurs when an individual signs up for coverage through the government’s website and believes they have completed the process and are covered,” explained Barton in an email. “In reality, the government has a record of the applicant but the insurance company never received the enrollment data and therefore does not have them covered. A ghost policy occurs the same way, only the insurance company has a record of the applicant but the government does not.”
One way of being efficient, thorough and for maximizing one’s time in investigating local and Arizona options under ACA is to visit a local, specifically qualified broker and have those experts help you truly “navigate” the new system and options. Gussio of Benefit Logic gave Flagstaff Business News the example of another pitfall encountered by one small business owner he worked with recently. When he more closely researched 16 pages of options or base plans potentially available for this businessperson, Gussio found out while the first three of those plan options had better pricing, they did not include Flagstaff doctors in the networks – so-called narrow networks.
Benefit Logic has six Flagstaff-based agents in the local office. “We are all certified for the federal marketplace, the FFM,” said Gussio. He added that some of their agents have 10 years of experience in health insurance products; others have 15 years of experience. Meanwhile, Leslie Barton of KLB Insurance underwent six months of training in preparation for the implementation of the ACA and the use of Arizona’s federally facilitated exchange. In addition to previous qualifications and that KLB has been in the industry serving Flagstaff since 1988, Barton became a Chartered Health Care Consultant earning this training designation from the American College. It’s the most current and comprehensive designation in the new realm of heath care. “It was a series of courses and it took over six months,” said Barton.
In contrast to local insurance brokers, the new navigators under the ACA receive about 10 to 20 hours of training. “This navigator system isn’t all that it’s cracked up to be,” explained Gussio, adding that in addition to the disparity in training, under the law navigators cannot recommend specific health insurance plans or suggest the best fit in health insurance providers. And, navigators can’t even send people to a qualified broker. “Why not direct people to groups who are certified in the FFE to help people through the process?” Gussio asked, expressing some frustration in the ACA’s current implementation, adding that he has seen “people who are enrolling online and don’t know what they are enrolling in. They can be enrolling in a plan that has no physicians in Flagstaff.”
Meanwhile, after initial major glitches, enrolling using the Healthcare.gov website has gotten better and more people are signing up via the government’s website.
Gussio offered another example of the mixed results locals are experiencing. “So we’re seeing two things that are a concern to me. Younger people, people in their 20s, are not enrolling,” he said, adding that they do not enroll because they are not happy after they see the premiums. “Older individuals who do not qualify for a subsidy are also surprised by the cost.”
Overall, in the Northland, as this story goes to press, the nation’s new health care reform law is helping some and is hurting others. “The new law did not address affordability,” said Barton. “[It] addressed accessibility – that’s what it did.” Going into the ACA’s implementation, “I thought that a lot of people would qualify, and now I would say there are a lot of people that qualify and are getting significant breaks.”
Going forward, Gussio and his team are also ready to assist, but “health insurance isn’t easy,” he said. Because the ACA is premised upon getting millions of people to sign up, including young people, Gussio has ample cause for concern about the future of the ACA, Healthcare.gov and the Federally Facilitated Exchanges. “The system is built around getting millions insured,” Gussio said. “If we don’t do that… I am concerned about a collapse of the system.” FBN
Steele Wotkyns, a Flagstaff Business News contributor, is the principal of WotknsPRplus, a public relations firm serving clients in Northern Arizona.