By Kristine Crane
“Navigators are adding extra hours this weekend,” said Lauren Vagelakos, an associate planner at WellFlorida Council and the coordinator of navigators in North Central Florida.
“We’re doing our best to work around the clock and get everyone in before March 31st,” she said.
Although early last week the Obama administration announced a deadline extension of April 15, that only applies to people who by Monday have already begun the sign-up process, Vagelakos cautions.
“As long as you attempt to apply by the 31st, you’ll be in the system,” she said. She suggested applicants “take screenshots (of online applications) in case there are any issues.”
Since last fall, Vagelakos has been working with her team of navigators to enroll people in insurance plans, and as of February, 314 people had signed up for insurance in North Central Florida, and another 3,545 had been reached through the WellFlorida Council’s outreach events. Alachua and several other North Florida counties combined have had 171 people sign up, and 73 people in Marion and Sumter counties combined have signed up. Some experts point out these are small figures.
“There was poor take-up in this area because of single insurers and high deductibles,” said Dr. David Guzick, president of UF Health.
Blue Cross and Blue Shield, or Florida Blue, is the single provider in Alachua County, and many people were outraged last fall at premiums that had doubled or tripled to offset costs of the ACA.
“I think (Florida) ended up doing better than anyone would have thought, as opposed to this particular community,” Guzick added.
The WellFlorida Council was one of several organizations to receive part of a $4.2 million grant given to the University of South Florida last August to help cover navigator expenses.
Vagelakos said that in the past couple of months there’s been a spike in phone calls from people scrambling to get health insurance.
To “a good portion of people, we have to say, ‘We’re sorry,’ ” particularly to those in rural areas, Vagelakos said. That’s because many people in this part of the state fall into the “coverage gap,” meaning they make too much money to qualify for Medicaid and too little to qualify for insurance in the federal exchanges and the subsidies that help many people shoulder some of the insurance costs.
The coverage gap
Florida has the second-highest number of people in that gap, at about 764,000 people, according to the Kaiser Family Foundation in Washington, D.C. The foundation estimates that the coverage gap includes nearly 5 million people nationally — 16 percent of whom live in Florida, and 20 percent in Texas.
Neither Florida nor Texas expanded Medicaid, an optional provision under the ACA, leaving many people uninsured. UF Health Shands Hospital sees a number of patients in that gap. An estimated 8 percent of its patients are uninsured, costing the hospital about $80 million annually, Guzick told The Sun previously.
Many of those patients, too, will invariably be readmitted, often as emergency room patients, which adds to the costliness of taking care of them, Guzick said. Those patients underlie other ACA mandates targeting improved quality measures at hospitals. One of these issues is reducing hospital readmission rates, a challenge for a hospital like Shands, Guzick said, because of its steady stream of repeat uninsured patients. As a result, Shands has implemented its own programs designed to improve patient follow-up and reduce readmission rates, Guzick continued, adding that many of these predate the implementation of the ACA.
For a number of locals, especially those with pre-existing medical conditions that limited their ability to get insurance, the dawn of the ACA has been a joyous occasion.
“A lot of the people we encounter are excited,” Vagelakos said. “(Insurance) is like a novel thing for people in North Central Florida.”
‘Young Invincibles’ get insured
One of the ACA’s main targets has been the “young invincibles”— people between ages 18 and 34 — a population that before the ACA went largely uninsured or underinsured.
The idea was to have young, healthy people sign up for coverage, helping to hold down premiums for everyone else. The law also allows children to stay on their parents’ insurance plans through age 26.
Allyson Hall, a University of Florida professor in the College of Public Health and Health Professions, said that young adults are one of the biggest “winners” of the ACA locally.
“The most obvious thing in this town is young adults being able to stay on parents’ insurance plans,” Hall said.
That includes many UF students.
“Most of them are probably covered by their parents’ plan at this point,” said Kat Lindsey, the assistant director for health administration at UF.
UF is also requiring, for the first time, that incoming students enrolling in fall 2014 have insurance. That requirement was stated in students’ acceptance letters sent out on Feb. 14, and ever since, Lindsey has received calls from “an influx of parents trying to fill out the waiver online,” she said.
That means they are covering their children under their own plans, Lindsey added.
The UF insurance plans have attracted a number of students and are a good deal, she continued. It costs $1,897 annually, which is down $500 from what it used to cost as more healthy students have signed up, expanding the risk pool.
“When it was a voluntary plan, it was the sicker students who bought it,” Lindsey said. “Some parents are finding what a school plan offers may be more affordable than what they have with their employers.”
Lindsey said that since insurance is now mandatory, financial aid will also cover the UF student plans.
“The university right now is primarily wanting students to have resources so they can stay well,” Lindsey said.
“We’re hoping this will decrease medical withdrawals, and withdrawals due to medical debt,” she continued. “We’re not trying to compete with the ACA initiative; we’re just sort of moving along parallel to it.”
Vagelakos said that after mid-April — the new deadline for completed health insurance applications — the navigators will still be holding outreach events for people who have signed up for insurance and need help following through with payments, finding a primary care doctor and all the other novelties for first-time insurance customers.
They will also be helping people who can still sign up for insurance during the interim period before open enrollment for 2015 starts next fall. These are people who get married or divorced, lose their jobs or have a baby, among other conditions. For a full list, go to the healthcare.gov website, under the “Learn” tab.
For Professor Hall, two areas to watch are potentially rising premiums with employer-based coverage and employers who have stopped covering employees, instead giving them money to use on the exchanges.
“Are employees going to end up better, or are they not going to have enough premium dollars to buy a really good plan?” Hall said.
What to watch for nationally, Hall continued, are the mid-term elections in November.
“If the Senate changes (to a Republican majority), they may have the power to remove an individual mandate,” Hall said. “If I were the Democrats, that’s what I could be concerned about.”
Monday is the official deadline for enrolling in the federal health insurance exchange — the main provision of the Affordable Care Act — and local navigators, charged with helping people enroll, are swamped.
To sign up for insurance: www.healthcare.gov
To speak to a local navigator: Alachua and Putnam counties: 1-352-317-7261; Marion and Sumter counties: 1-352-359-2519 To find out about WellFlorida Council’s ACA information events: http://wellflorida.org/services/health-insurance-marketplace/