Great Barrington — If, as many Republicans insist, the Affordable Care Act (a k a Obamacare) has been a failure, you wouldn’t know it from the number of families and individuals, especially in Berkshire County, who have signed up for coverage in the first few weeks of open enrollment.
Though President Donald Trump promised to “repeal and replace” the ACA last year while campaigning for the highest office in the land, serious efforts to do so in Congress have failed though Republicans continue to try to weaken the act, shorten its enrollment period and hinder its implementation.
Most recently, a massive Republican tax bill proposes to eliminate the ACA’s mandate that individuals must be insured or face a penalty. If the individual mandate is repealed, even as insurers are required to cover those with pre-existing conditions, people could simply wait until they get sick to purchase health insurance, which some experts think could send the health care system into a death spiral.
But even as uncertainty looms over the ACA and its associated programs, enrollment numbers are up, both nationwide and in Massachusetts. At Community Health Programs, a Great Barrington-based health care provider with offices throughout the county, enrollments are up substantially in the Great Barrington and Pittsfield offices.
At those two offices, CHP counselors counted 422 appointments, up 46 percent over last year. These appointments led to 301 new enrollments, renewals or eligibilities, compared with 249 in November 2016.
Since Massachusetts is one of 11 states that have their own exchanges, the state is free to extend the enrollment period, so Bay State residents who cannot get insurance through their employers at an affordable rate have until Tuesday, Jan. 23, 2018, to enroll. Depending on eligibility, individuals and families can enroll in MassHealth (Medicaid) or one of the ACA insurance exchanges through the Massachusetts Health Connector.
Similarly, Cheryl Thomson, healthcare access program coordinator at Fairview Hospital, told The Edge that, in the 2016 calendar year, she enrolled 1,766 in either MassHealth or one of the connector programs. So far this year, the number is about 3,000.
At the Health Connector itself, which permits individuals to sign up online, enrollments are also up substantially. In the first 15 days of November, the most recent period for which numbers are available, “26,343 people selected a plan or enrolled by paying their first premium for 2018, compared to 18,695 in the first 15 days of last year’s Open Enrollment,” the health connector said. For a more extensive rundown on the statewide numbers, click here.
In neighboring Connecticut, the enrollments in Access Health CT, which Fairview sometimes refers its Connecticut clients to, enrollments are on track to rise about 8 percent despite a shorter enrollment period.
Nationally, almost 2.8 million people signed up for Obamacare during the first 25 days of open enrollment in the national exchange (those numbers exclude the 11 states such as Massachusetts that have their own exchanges). During the same period last year, the total was 2.13 million people.
No one seems to know for sure why the numbers are higher. Theories abound on the national level: individual subsidies are up; better communication through email marketing. Others have speculated that people are nervous that the ACA might be repealed and are therefore anxious to enroll before it can be taken away.
In the Berkshires, observers think it could have to do with the ever-evolving economy, or, as CHP consultant Ellen Lahr put it, “Especially because there are so many people around here who are self-employed and/or part-time and/or doing the Berkshire shuffle — in other words, no workplace insurance plans.”
Her colleague, CHP enrollment specialist Octavio Hernandez, thinks it might also have to do with rising health insurance premiums offered by employers. In Massachusetts, employees are required to take their employer’s health plan if it’s offered, unless the employee contribution amounts to more than 9.5 percent of household income for the year.
“Then at that point it would be considered not affordable, and then you can go into the marketplace or MassHealth as well, depending on your level of income,” Hernandez said in an interview.
Most people go onto the health connector website and sign themselves up. But it can be confusing, especially for a family, and that’s where Hernandez and his colleague William Cruz, an enrollment specialist in Pittsfield, come in.
“They can help people who are running into problems. William and Octavio are seeing people who have hit the wall with the online system,” Lahr explained. “So they know how to cut through the difficulties.”
“The increase could be because people become frustrated with trying to do the process themselves,” agreed Thomson. “It’s not so easy to just go online and make their changes.”
Cruz agrees that increasing numbers of workers who cobble together a living with multiple part-time jobs is having an effect on applications to the health connector.
“Let’s say you have person working three jobs,” Cruz said. “They are probably coming to us because it’s less it’s expensive than the employer’s policies.”
Thomson shares Cruz’s assessment: “We have people coming in saying, ‘I can’t figure how to explain my income.’ There’s not a lot of jobs out there that are full-time.”
Cruz related a recent story about a woman who worked at Stop & Shop and was paying $200 per month for coverage, but only working 30 hours a week total.
“Based on her income, I was able to get her $43 a month through Obamacare,” Cruz recalled. “I was able to save her more than $160 a month. Cases like that come through our door all the time.”
As an example of the complexities that drive people to an enrollment counselor, Hernandez pointed to a man who recently moved to the Berkshires from Tennessee, where he was making $40,000 to $50,000 per year.
“So he moved here to join his partner, but did not have insurance, so we asked him what his situation was,” Hernandez said. “He was working at Dunkin Donuts, so his income had dramatically changed.”
But the income the man had made at the better-paying job in Tennessee earlier had to be calculated in determining his household income for that year. In frustration, the man came to CHP.
“He tried to do it on his own but he got stuck,” Hernandez said.
But beyond the confusion and changing nature of the Berkshires’ economy, Cruz is convinced one of the major reasons for increased enrollment is a positive one: “I think people are more caring about healthcare and insurance and their health overall, and their families’ health. I think people are being more responsible in getting insurance.”