Open enrollment: Notes from the front lines of health care coverage

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By Wednesday, Dec 27 Viewpoints  1 Comment
Medical students at Zuckerberg SF General Hospital show their support for the Affordable Care Act.

The Affordable Care Act is still the law of the land after a series of failed attacks in Congress. Still, in many states around the U.S., the time frame for enrolling in the ACA’s subsidized insurance plans was cut in half, to a short six-week period ending Dec. 15 (in Massachusetts, residents have until Jan. 23). Federal funds for marketing and publicizing the Open Enrollment period were dramatically reduced.

However, these highly publicized efforts to undermine the ACA seem to have drawn a spotlight – and people — to the ACA and its benefits: during this year’s Open Enrollment season, the surge in sign-up numbers show that people are more determined to get it and keep it — both nationally and here in the Berkshires.

Since Open Enrollment for subsidized insurance began Nov. 1 the U.S. has measured a surge in applications: 2.78 million signups in the first 25 days of November, compared with 2.13 million in that 2016 period – and this does not include numbers from states running their own exchanges, such as Massachusetts. At Community Health Programs, where I work as an insurance enrollment counselor, a similar push is happening: we logged 422 sign-up appointments in November (compared with 288 in 2016); among these, 301 new enrollments, renewals and eligibilities were completed, compared with 249 in 2016.

Our neighbors who apply for subsidized insurance have a bigger challenge than people with workplace health insurance. For employer-insured people, the work of finding, updating and renewing health plans each year falls to HR departments or insurance brokers working with businesses.

But our Berkshire community is filled with self-employed tradespeople, service-sector employees, artists, entrepreneurs, and others who work multiple part-time jobs. These are the people whom ACA enrollment specialists assist in navigating Obamacare. The guidelines are income based: a family of four earning $98,400 qualifies for an Obamacare subsidized health plan. During Open Enrollment, it’s time for these individuals and families to sign up, and for other families to renew — renewal is not automatic. There are tax penalties for Massachusetts residents who are not covered by insurance.

The online enrollment process at https://mahealthconnector.com is a minor investment of time and effort for some. For others, the process can be confusing, and calling the Health Connector can demand time, patience and persistence since jobs, children, possible language barriers and other factors complicate the time required to correctly enroll or renew.

Fortunately, there’s an army of enrollment experts around the state – and in Berkshire County – to help people get and keep their subsidized insurance. We are advocates and problem-solvers. We don’t give up when a challenge arises. We also help and advocate for those who live close to the poverty line and require MassHealth. We work at Community Health Programs’ sites around the Berkshires, at Berkshire Medical Center in Pittsfield, at Fairview Hospital in Great Barrington, and at Ecu-Care, in North Adams.

We do things the old-fashioned way: in face-to-face office meetings where we try to start and finish the process in one sitting. We need to verify applicants’ identification, proof of income, recent tax returns, social security cards, drivers’ licenses, proof of citizenship or legal resident status – for everyone in the family. That’s a lot of documentation–not required of people with job-based insurance. An enrollment counselor may spend up to two hours applying for or renewing a family’s insurance. It may require more than one office appointment, but we will get it done.

For example:

>A local man working two part-time jobs, one at a regional supermarket chain, was paying more than $400 per month for insurance through his grocery job. A diabetic, he couldn’t afford his medication and his premiums. In our appointment, we discovered his income qualifies him for a subsidized plan, and he now pays under $50 per month for his insurance.

>A Puerto Rican woman, a refugee from two hurricanes that killed power to the island this fall, relocated to the Berkshires and badly needed health care: she was being treated for cancer in Puerto Rico, but power failures meant she could not continue her chemotherapy treatment. We were able to expedite her enrollment and connect her with doctors and cancer care.

>A 34-year-old woman with part-time jobs had lost her insurance in the confusion of payments and paperwork. She was soon re-enrolled in a subsidized health plan; her parents discovered that they, too, would qualify for an ACA plan.

>A man relocated to the Berkshires from Tennessee to join his partner, and is now working at Dunkin’ Donuts. He was seeking insurance as a new resident earning a lower income. His application is pending, while his income from Tennessee is reconciled with that of his new, lower paying job.

In most cases, my clients are employed, hardworking Berkshire county residents who are without access to workplace insurance. They can’t afford traditional, marketplace insurance plan without help. The ACA’s subsidies are crucial to their health.

It can take hours to complete the enrollment and application process for a family; it might take multiple appointments to get the paperwork in order. But the effort is worth every minute of my day. If I can ensure that an individual or a family leaves my office with health insurance, we’ve made a difference – and the ACA has made a difference. If my clients have access to preventive and sick care with doctors, dentists and nurse practitioners, nutritionists, physical therapists, eye doctors and mental health professionals, they can avoid more serious and more costly illness later on. If they get sick, they will have relationships with health care teams who can coordinate their care.

Access to insurance has changed lives and health for many, many people. The ACA’s subsidized health care should be viewed by our nation’s leaders as an investment – not a cost – in the health and wellness of everyone.

______

William Cruz is a ​certified enrollment counselor at ​Community Health Programs, a ​countywide network of health centers serving 34,000 Berkshire area residents. 


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  1. Shawn G. says:

    Thanks for your good work William, and for writing this article!

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