CLEVELAND, Ohio -- With the sign-up deadline for insurance coverage fast approaching, events are popping up throughout Ohio and the country, the final push to connect uninsured adults with an affordable health insurance policy on the insurance exchange.
After a rocky start of the healthcare.gov website last October, the Obama administration has worked hard to make up for lost time. President Obama and his delegates have been making the case for the Affordable Care Act in advertisements, late-night television and Internet appearances, and visits across the country. The message: Get covered, or face a fine.
Health and Human Services Secretary Kathleen Sebelius has visited Cleveland twice this year, most recently on March 14, to deliver a personal pitch.
On Wednesday, Cuyahoga Community College's metro campus was the site of the local "Countdown to Get Covered" event, organized by Get Covered America.
“When you think about it, 140,000 Ohioans have health insurance today [as of last week] that didn’t have it on Dec. 31, 2013,” said U.S. Sen. Sherrod Brown, who was on hand for the event.
One group that has not signed up in the numbers that the Obama administration has hoped – and at whom the event was largely aimed – are college students and other 20-somethings.
“Young people are even more likely than the rest of us to wait until the last minute,” Brown, a Democrat from Ohio, said. “That’s why we’re here, and why I think these numbers are going to surge, [especially] in the last 10 days.”
Seeing banners around campus announcing “Countdown to Get Covered” helped persuade Sheryl Malone to make an unplanned detour. Before grabbing lunch, she pulled up a chair at Barb Wynveen’s table.
With the help of Wynveen, a navigator working with the Carmella Rose Health Foundation, Malone signed up for Medicaid insurance. A full-time student studying human services at Tri-C, Malone, 55, had forgone doctor's visits and medication because she couldn't afford insurance.
WHERE TO GO FOR HELP
United Way of Greater Cleveland and the Cuyahoga County Health Alliance are offering help to residents shopping for the best coverage, and to those enrolling in Medicaid, by staffing both the county's 2-1-1 Call For Help line and sites across the city with trained navigators. Go to the website at 211cleveland.org or call the 2-1-1 to find an enrollment site or a local navigator near you.
You can enroll on your own at healthcare.gov. Additional assistance and navigator services are available at ohioforhealth.org, by calling 800-318-2596, or by texting the word "covered" to 97779.
MetroHealth Medical Center's "Enrollment on Wheels" RV, providing help in signing for insurance, hits the road beginning Friday. Its first stop, from 10 a.m.- 1 p.m. Friday, will be outside of Mound-STEM School, 5935 Ackley Rd., Cleveland. From 10 a.m.-5 p.m. Sunday, the RV will be at Imani Temple Ministries, 2463 N. Taylor Rd., Cleveland Heights.
For other information about local sign-up events, go to getcoveredamerica.org/events
In less than 30 minutes, Wynveen showed Malone the computer screen that told her that her application had been accepted.
The vast majority of people Wynveen has helped since completing online navigator training last fall have qualified for Ohio's expanded Medicaid program which was enacted at the start of the year.
One person she has not been able to successfully enroll on the open exchange is herself.
A "silver plan" that Wynveen signed up for, with about 30 percent of costs coming out of pocket (for her, that would mean a $312 monthly bill and a $7,000 deductible) was supposed to have kicked in March 1. Instead, glitches in healthcare.gov have kept her application in limbo.
"Medicare applications go through easier than those on healthcare.gov," said Wynveen, who has been told that her application has been "escalated." But if it doesn't get approved by March 31?
“I don’t know,” she said, before turning to help a second woman who approached her table for assistance.
What’s going on in Cleveland this week is neither happenstance nor isolated. The Obama White House, congressional Democrats and interest groups have mobilized nationwide with ads and outreach – holding more than 4,000 enrollment-promotion events this month, they say -- for their own version of March Madness, with a countdown to March 31.
That’s the last day to enroll for coverage in 2014 under the ACA without facing a penalty. The penalty is $95 or 1 percent of yearly household income, whichever is greater.
The fines, as well as tax subsidies available to many to reduce the cost of their premiums, may or may not be enough to get those who lack insurance to comply. But for political and financial reasons, the penalty is not as important at this moment as is the desire to have millions of Americans covered. The Congressional Budget Office, or CBO, in February estimated that 6 million people will enroll by March 31. That’s lower than the projection last year of 7 million, but the exchange’s kickoff last fall was married by a technological and public relations fiasco, with computer networks crashing and consumers frustrated with their inability to shop for policies.
Enrollment in exchange plans has bypassed 5 million already, the Department of Health and Human Services said Monday, a number suggesting that the outreach campaign might be working – and that enrollment for the first part of March outpaced that for all of February. The department would not say how many people have actually paid premiums to start their coverage.
Anne Filipic, president of the pro-ACA group Enroll America, on Wednesday said that nearly 79,000 Ohioans had enrolled on the open exchange, with 85 percent of them receiving financial assistance. Still, more than 1 million residents could still benefit by enrolling in Obamacare, she said.
“With only two weeks to go, we’re continuing to work hard to ensure that every American who wants to enroll in affordable coverage by the deadline of March 31st is able to do so,” Marilyn Tavenner, administrator for the Centers for Medicare and Medicaid Services, said on a blog post Monday. “So don’t delay; tell your friends and family to sign up today."
The White House and the organization Organizing for Action, an offshoot of Obama's election machine, have pushed enrollment messages nearly every day recently. Organizing for Action said that its volunteers and supporters have pledged to spend more than 500,000 hours signing up people for coverage by the end of March.
Their work in Cleveland was evident on Wednesday at Tri-C; Brown was joined by Filipic; Cleveland Health Commissioner Karen Butler; Stephanie Kight, CEO of Planned Parenthood of Greater Ohio; and Sarah Hackenbracht, executive director of Cuyahoga Health Access Partnership.
The White House is likely to claim victory with any number near 6 million by month’s end, but the higher it gets, the bigger the political bragging rights.
Still another 8 million low-income Americans are expected to gain coverage this year through Medicaid and the Children's Health Insurance Program, both expanded through the ACA. Although some states have refused to participate in the Medicaid expansion, fearing they could get stuck eventually with billions in costs if the federal government drops its funding commitment, Ohio Gov. John Kasich, a Republican, is among the governors who opted in.
All told, those gaining coverage when they had none before -- through exchange plans, Medicaid and CHIP -- should total 13 million this year, according to CBO estimates released this month.
CBO provides projections 10 years into the future to help lawmakers plan, and the most recent projections are that between 2017 and 2024, 24 or 25 million people a year will get health insurance through the exchanges, and 12 million or 13 million more will be enrolled in Medicaid or the Children’s Health Insurance Program. Although 6 million to 7 million fewer people will get insurance through their employers, the net difference will be that 25 million fewer people will be uninsured, the CBO estimates.
For private insurers, however, this is not only about gaining so many clients. The ACA put limits on how much in premiums an insurer may charge its oldest clients compared with its youngest, with a ratio of three to one. But older people tend to have more health care needs, so it helps for insurers to have a large share of younger enrollees -- those between 18 and 34 -- so their premiums offset the medical costs of the older ones.
That has been a challenge, markedly so in Ohio.
Enrollment for individual and family policies in Ohio reached 78,925 by March 1, but the age of the enrollees was skewing higher than the national average. Thirty-six percent of Ohio enrollees were ages 55 to 64, compared with 30 percent nationally. The enrollment age in Ohio skewed higher than the age of the state’s population, census data show.
Conversely, young adults ages 18 to 34 accounted for 25 percent of marketplace plan selections nationally as of March 1. Critics said that was too small, considering some analysts estimate that enrollees in this age group will need to account for 40 percent of all enrollees to even out the risks and costs of older participants.
In Ohio, the share of 18-to-34-year-olds was only 21 percent as of March 1, a shortfall that could not be explained by the state’s age breakdown. It appeared that too few young adults in Ohio might have enrolled in ACA marketplace plans.
HHS has maintained, however, that the average age of enrollees is getting younger steadily and that it expects the age to keep falling with the approaching deadline. Older Americans may have been eager to get insurance while younger, healthier ones were more likely to procrastinate, officials and some insurance executives said.
But Ohio insurance executives also said they were watching this closely as the deadline approaches. The ACA has financial protections for insurers if their claims outpace their premiums, including a reinsurance fund and a three-year risk-sharing arrangement between the federal government and insurers. But insurers say that if claims come in too high this year because too few young people enroll to absorb them, they may have to raise premiums in 2015.
This story was reported and written with Plain Dealer Washington Bureau Chief Stephen Koff.