Rollout round two

Around this time last year, talk surrounding the rollout of health insurance through the Affordable Care Act focused on enrollment—or the lack thereof. Website snafus drew headlines and punchlines while subscribers and agents slogged through a slow computer system to submit applications.

Yet, when all was said and done, open enrollment—October through March—yielded 6,235 signups in Butte County for policies through Covered California and around 7,000 more through Medi-Cal. Those numbers continued to grow throughout the year, particularly for Medi-Cal (the government program with different provisions than the subsidized private plans from the ACA).

Open enrollment for 2014-15 began in November and continues through Feb. 15.

As for the signup’s technical side, no news is good news.

“What has changed is the process is working much smoother this year,” said Deanna Abrahamian, assistant director of employment and eligibility services for the Butte County Department of Employment and Social Services, which handles local applications for the state.

“With impending penalties from the government, people are more interested in signing up. That, coupled with the process being ironed out, [has meant] our case numbers have increased quite a bit.”

The penalties to which she refers are federal tax fines for not having health insurance—part of the ACA taking effect in 2015, for tax year 2014. Amounts increase based on the time someone has gone uninsured, but are potentially offset by a grace period and exemptions.

Devin Caspers is a Chico-based certified enrollment counselor (or “navigator”) with the California Health Collaborative, a statewide nonprofit. She says tax considerations have motivated many of the people who’ve sought her assistance. While she’s familiar with the law, “it’s good for people to talk to their tax preparers,” Caspers advised. “It’s a huge thing. People want to know what kind of fine they might have.”

There are several ways to sign up for health insurance.

First, there’s the direct route, via Covered California’s online portal (CoveredCA.com). Filling out the form lets enrollees know whether they qualify for Medi-Cal or Covered California plans.

Alternately, Butte County residents can contact Abrahamian’s department, which operates two call centers and two main offices, along with several satellite facilities.

“We’re embracing the ‘no wrong door’ policy,” Abrahamian said, meaning someone can help with Medi-Cal or Covered California enrollment at any DESS location.

The California Health Collaborative also is trying to keep channels open. For the first rollout, the agency received a Covered California grant to provide educational outreach. This year grant parameters expanded to include advising and assisting new or returning enrollees in 15 Northern California counties.

Caspers is a North State native whose territory includes Butte, Glenn and Colusa counties. She speaks both Spanish and English, as does her fellow navigator.

“We’re providing a free service to ensure that all members of our community have the opportunity to apply for state health coverage,” Caspers said. “We try to do whatever we can to help the consumer, whether that’s going to them or being available after hours, to meet in the evening or a weekend. We’re trying to break down barriers to getting coverage.”

Along with phone consultations and in-person appointments, Caspers conducts workshops. One, last Tuesday night in Oroville, drew about 50 people.

Signing up for health insurance is one side of the coin. Being able to use it is the other. By getting more people covered, the ACA aims to increase access to medical care and relieve the burden on hospital emergency rooms that must, by law, treat anyone who comes—regardless of ailment and ability to pay.

So, how is that working out?

“It’s a mixed bag,” said Mike Wiltermood, chief executive officer of Enloe Medical Center. “Overall it’s been an asset for us, because now people who may have qualified for community assistance, now we’re getting at least some money for those services, so that’s been helpful.”

But Wiltermood said he believes local hospitals will experience a net loss as a result of the expansion.

“The reason I say this is, even if we get a little extra money for people who previously didn’t qualify for Medi-Cal, Medi-Cal doesn’t pay very much at all, maybe 20 cents on the dollar,” he explained. “In order for us to ensure the access [to doctors for patients], hospitals are heavily subsidizing physicians’ practices in order to keep them in the community.”

Hospitals also invest heavily in recruiting doctors, nurse practitioners and physician assistants. Still, many patients with Medi-Cal, and sometimes Covered California, struggle to find practices that accept their insurance, and even facilities dedicated to publicly insured patients feel the supply-demand pinch.

Primary care—the front line of medicine—is particularly impacted, which has led to a new phenomenon in Chico, which Wiltermood calls “specialty shopping.” Patients self-diagnose and seek a specialist who accepts their insurance, thereby “bypassing the primary care network” and contributing to long waits for specialty appointments, too.

Since Enloe accepts Medi-Cal, so do the specialists under its umbrella.

“People as far away as Grass Valley and Eureka are trying to send our clinics those Medi-Cal patients,” Wiltermood said, “and our doctors are understandably upset.

“They don’t mind taking responsibility for patients in our community—that’s our job; that’s our mission—but we don’t want to be a magnet for other communities because they’re not trying to solve their own access problems.”