Obamacare 2.0

The open enrollment period for the Obamacare insurance exchanges is going on right now. This year, the feds are taking a more direct approach to getting people to enroll.

It's constitutional - deal with it

It’s constitutional – deal with it

Secretary for Health and Human Services Sylvia Burwell, whose appearance at Monday’s news conference [in San Antonio] is part of a national tour to talk up marketplace successes, reported that of those who signed up during the first enrollment period this year, 7 out of 10 had premiums under $100. Nationwide, 65% of applicants qualified for subsidies, she said. In Texas, 84% of Texans got financial help, according to the Center for Public Policy Priorities in Austin.

“We as a people have a moral obligation to see that everybody has access to quality and affordable health insurance,” said Mayor Ivy Taylor who joined Burwell at the news conference. “A community prospers when its citizens are healthy.”

Burwell urged people without insurance to visit HealthCare.gov, choose the best plan among many options, and sign up by Dec. 15 to have coverage starting Jan. 1. Enrollment for 2015 will remain open until Feb. 15.

To those who signed up last time, Burwell emphasized that even if they are happy with the plan they already have, they need to re-enroll. About 90% of the information entered last time will appear on the form so people don’t have to re-enter it. Burwell said it’s important to make sure the information remains accurate and that the plan individuals previously chose is still the best one to meet their needs; 25% more plans were added this time.

The Health Insurance Marketplace enrolled 734,000 Texans in 2014. Bexar County accounted for 77,000 of those newly insured, a number that far exceeded the goal of 46,000, which remains the goal for the current enrollment period. Bexar County Judge Nelson Wolff, in attendance on Monday, has helped lead this effort, but in Bexar County, 27% of the population remains uninsured. Of those, 75% identify themselves as Hispanic, according to Andrea Guajardo, speaking for Enroll SA, a coalition of 40 organizations and 176 trained volunteers in Bexar County trained to help people sign up for insurance.

Asked about HHS’s outreach to Hispanic uninsured residents, Burwell pointed to several initiatives.

  • Spanish language call service. “In the early days of enrollment, out of 200,000 calls to our call center, 20,000 were using our Spanish-speaking call service.”Burwell said.
  • Spanish language equivalent of HealthCare.gov: CuidadodeSalud.gov.
  • Increased the number of Spanish speakers providing in-person assistance to help with online sign-up.
  • Improved interface for mobile users. “The Latino population has a deeper penetration of mobile use than the population as a whole.”

“One of the things we learned from the initial enrollment was the importance of trusted voices,” Burwell said. “I’ve had a chance today to talk with the leadership of the community and the stakeholders about their work and to hear their feedback, so we can make things better.”

Secretary Burwell was in Houston the week before that.

With some 6 million Texans still uninsured, Burwell’s early appearance this go-round shows a renewed fight to increase the health care law’s impact in Texas, where the governor’s office has refused to create a state-run marketplace or accept billions of dollars in federal funding to expand Medicaid to extend coverage to millions more people.

State and local organizers say the first insurance sign-up period helped them become more organized and strategic as they prepared for the 2015 open enrollment period.

They intend to hold multiple enrollment events, provide additional one-on-one application assistance opportunities and include more grass roots organizations and community leaders in educating the uninsured about marketplace coverage. They have data showing where the uninsured live. The key is deploying the appropriate organizations and people to reach target areas and groups, including Hispanics and young people.

“We learned about the importance of follow-up and the need for a lot of outreach,” said Mimi Garcia, the Texas state director for Enroll America, a national insurance advocacy organization. “There’s a lot of work to do in Houston. That’s going to be a big focus area.”

Organizers learned from last year’s open enrollment that the more conversations they have with uninsured residents, the more likely they are to convince someone to buy health coverage, Garcia said by telephone from a conference in New Orleans. She said the goal is for people to view purchasing health insurance as routine a practice as paying taxes or auto insurance.


The state’s uninsured rate dropped about 2 percent this year, but Elena Marks, president and CEO of Houston’s Episcopal Health Foundation, a philanthropy that will fund health care providers, said many Texans gained employer-based insurance as the economy created more jobs.

In comparison, California’s uninsured rate dropped nearly in half, from 22 percent to a little less than 12 percent, in large part to the state’s decision to expand Medicaid coverage to cover more of its low-income, working residents.

Marks said it makes sense for Burwell and other officials to bypass Texas’ political leadership and instead work with local governments, agencies and organizations, including those in the Houston area, to find the uninsured and enroll them in health coverage.

“Having her show up brings attention to the issue,” said Marks, who also is a non-resident health care fellow at Rice University’s Baker Institute.

Marks, who did not attend Burwell’s news conference, said new carriers are making the Texas marketplace more competitive this year.

Risha Jones, deputy director of Houston’s Department of Health and Human Services, said her agency’s goal is to directly contact 100,000 uninsured residents and reach another 400,000 through community and educational outreach. She said federal officials recognize the Houston area needs assistance in reaching its uninsured residents and has pledged to help. They haven’t yet set an enrollment goal.

“They are making us a priority,” Jones said, who introduced Burwell at the news conference. “We’re on the radar.”

It was a nice surprise seeing my friend David Ortez in the story, as an example of someone who was able to get health insurance through the Affordable Care Act and the exchanges. Ortez is a recent law school graduate and one of many people under the age of 30 who stands to benefit from the ACA. There’s a separate effort to get those folks, known as the Young Invincibles, to enroll. Unlike last year with the healthcare.gov meltdown, the first week of the enrollment period saw half a million people sign up, with about that many fill out applications. About half of those enrollees are first-timers. It would be awesome if this year Texas could top the one million mark for coverage. Imagine what it could be if anyone in state leadership had any interest in helping make this happen. Daily Kos has more.

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