Enrollment time

In three years serving as a certified enrollment counselor for Covered California, the state marketplace for health insurance spawned by the Affordable Care Act, Steven Naiman has helped hundreds of people get coverage for the first time. Only twice, he says, has someone left his office without signing up.

“The majority of people that come in and find out what their options are, are pretty OK with the cost that they have to pay for insurance,” he told the CN&R.

Many discover their premiums are less than they expected, thanks to government subsidies—one woman he met with recently will pay $50 monthly next year. Others gain motivation, and see added significance in being insured, from an anecdote Naiman shares.

Naiman works for Ampla Health in Chico as outreach and enrollment specialist. In his first year as a Covered California counselor, he enrolled a woman in a high-deductible plan providing preventive services such as a physical exam but also a safety net in case of a major illness or injury.

This woman avoided going to the doctor before getting insurance. During her checkup, her physician diagnosed her with cancer.

“Thank god she got the physical done, and thank god that even though she had the most basic plan under Covered California, it helped her [by her] not having to pay an outrageous sum of money at the hospital,” Naiman said. “She did come in to thank me, and she wanted to purchase a better plan.

“I use that example for other people.”

Naiman, his colleagues in the six counties Ampla serves and Covered California counselors across the state are particularly busy these days, amid the open enrollment period for the insurance exchange.

In a Nov. 16 news release, Covered California said 48,000 new consumers had signed up statewide since open enrollment began Nov. 1, up from 39,000 in the same period last year. (As of the CN&R’s deadline, Covered California had not updated numbers on enrollees nor broken out local numbers, including for Ampla.)

James Scullary of Covered California characterized the initial enrollment as “a solid start”—perhaps an understatement considering challenges that have arisen.

The federal government has sent discouraging signs about the future of exchanges, with the White House announcing condensed open enrollment periods and congressional Republicans mounting repeated efforts to dismantle the ACA, most recently via so-called tax reform legislation.

Meanwhile, Anthem Blue Cross pulled out of Covered California for the majority of markets.

What does all this mean?

For the North State, for now, not much.

• Covered California’s open enrollment period still runs through Jan. 31—though Dec. 15 (the federally announced deadline, applicable in most states) remains the final day to secure coverage effective Jan. 1.

• As Scullary put it, “the Affordable Care Act is still the law of the land.” It will be unless Congress actually passes a bill the president signs changing that.

• Anthem Blue Cross did not pull out of rural Northern California, so this region retains two carriers, Blue Shield being the other.

More than in other years, Naiman has had to debunk misconceptions and address people’s fears.

“Quite a few people come in with the uncertainty of whether they’re going to have this insurance for the rest of this year and if it’s going to be available next year,” he said. “That’s the first thing I hear.”

Scullary, a communications and public relations officer for Covered California, told the CN&R by phone from Sacramento that “it’s probably too early to say” what the federal government ultimately will do with the ACA.

“We’d respond and let our consumers know if there were any changes that would impact them,” he continued. “But, at this point, despite everything we’ve heard [out of Washington], the health care coverage is still available and Covered California is rock solid for 2018.”

Bucking the feds, only state-run exchanges such as California’s could extend open enrollment past Dec. 15; nine of the 12 did so. The U.S. Department of Health and Human Services narrowed the window to six weeks.

“We elected to keep the same open-enrollment period that consumers have grown accustomed to,” Scullary said, “to make sure they have the time they need to examine their options and find out what fits best for them and their family.”

Plans change each year. For 2017-18, shifts are significant. Not only did Anthem’s decision alter the marketplace, rates and subsidies adjusted as well.

The price tag for specific policies has risen—but, ironically, the cost to many consumers has decreased because of corresponding increases in subsidies. A change in federal reimbursement prompted Covered California to impose what’s called a cost-share reduction surcharge on silver tier plans that also bases tax credits on the price of a certain silver plan.

“As that premium rises, so does the amount of tax credit that people receive,” Scullary said. “The way I like to explain it is the price of the product went up, but people are receiving a bigger coupon.

“So most of them will be paying less this year than last year.”

Raising awareness of benefits such as tax credits—and eligibility for the subsidies—constitutes a priority for Covered California and affiliated agencies such as Ampla.

The exchange has mounted a multimedia campaign including Web videos. Ampla has outreach and enrollment specialists (i.e., Naiman) based in the communities it serves, plus a community promotions worker (Alejandra Beltran) who seeks out potential enrollees where farm workers gather (e.g., schools, fields, housing).

At Ampla Health Chico this year, Naiman said, more appointments have been for renewals than new policies. That’s valuable, too: He encourages plan subscribers to make an “active renewal” instead of just rolling over into the same plan or insurer-selected comparable plan for the coming year. Personal circumstances change; so do plan benefits and economics.

Cynthia Peshek, Ampla’s outreach program manager, agreed—plus recommended anyone, with a Covered California plan or not, consult a certified enrollment counselor.

“Why not come in and see what all of your options are? You will be able to enroll or renew with the most appropriate plan that suits your health care needs at a reasonable cost.”