Across the country, the rollout of President Barack Obama's signature health-care law, the Patient Protection and Affordable Care Act, has been anything but smooth. From the widely publicized failings and security shortcomings of the healthcare.gov website, to the lack of definitive information on the number of enrollees, to the millions of Americans who are now losing their health insurance plans, Obamacare is off to a rocky and often ridiculed start.
In California, one of a handful of states to create its own health-insurance exchange, the new system has escaped widespread scrutiny but is not without challenges of its own.
Under the new law, more people will be eligible for government-subsidized insurance through the expansion and the exchange, which offers private Anthem and Blue Cross plans for Santa Barbara County.
As of Oct. 26, Covered California reported that 179,562 applications had been started in the system. Open enrollment lasts through March 31 but anyone who wants coverage to begin Jan. 1 must sign up by Dec. 15.
Among the obstacles is the lack of trained enrollment counselors to help people sign up. Covered California has a goal of deploying 16,000 counselors statewide, but just 279 are in place, with another 3,824 waiting to get certified, the Los Angeles Times reported recently.
The Santa Barbara County Public Health Department planned to start enrollment efforts in October, but its counselors haven’t been certified yet, assistant deputy director Susan Klein-Rothschild said last week.
More than 40 staff members have been trained to assist people with applications for Medi-Cal or private plans on the state exchange, but the process to get state approval, background checks and the exam is taking longer than the county expected.
“So we’re not actually helping people with the enrollment until November,” she said.
“I think it’s just so many people are wanting to help make this happen; it’s a lot at once, in a short period of time.”
Other local agencies, like the Santa Barbara Neighborhood Clinics and American Indian Health Services, will also have counselors certified soon, according to Liz Snyder, deputy director of Public Health.
The county Department of Social Services already has counselors in place and can help with applications for the exchange as well as Medi-Cal. Click here for Covered California's online application.
Independent insurance brokers have been certified as counselors and are working with clients to navigate the new health-care rules and exchange plans.
For now, however, they’re advising people to hold off on choosing a plan, said Darren Caesar, executive vice president of HUB International Insurance Services in Santa Barbara.
Caesar's company has employees certified as counselors and they’re seeing higher-than-normal demand with people asking questions about the upcoming changes.
“Right now, because we are so impacted, we are primarily focusing on our existing clients and assisting them,” he said.
Some people just want confirmation they can keep their current plans, but at least 25 percent or 30 percent of clients don’t have Affordable Care Act-approved plans and will have to change their insurance, Caesar said.
Since Anthem and Blue Cross still haven’t confirmed their provider networks — which doctors are available for which insurance plans — the insurance brokers are advising clients to get informed but wait to make their decisions.
“There’s a lot of communication now, but no real action,” he said.
It’s difficult for advisers to make recommendations for the individual market with so much up in the air, but the small and larger group plans are “clicking as they have been in the past,” Caesar said.
Bob Hopper, of Bob Hopper Insurance Services, says his phone rings off the hook.
Covered California's web application is so inefficient that his staff is working exclusively with paper applications, he said. People who had individual insurance before March 2010 have their plans grandfathered in with the new law, but people who bought plans after that date, or whose original plans have changed, may have to switch to new ACA-compatible plans, he said.
Hopper is advising people to keep their plans if they can, but to look for subsidized plans if they can’t. He even teaches a class on the complex issue of choosing a plan at Santa Barbara City College’s Center for Lifelong Learning and emails out a decision-making guide to anyone who asks for help.
Most people who purchase individual health-insurance plans buy for affordability, so they will likely opt for the Bronze — the least expensive — plan on the exchange, Hopper said. But the premiums of those new plans are more expensive than current plans, and his clients are seeing their premiums jump 30 percent to 50 percent, he said.
Hopper was frustrated by the slow certification process — it took his paperwork a month — and said there is a dedicated group of local agents who are just waiting for the OK to help people enroll.
Covered California's website doesn’t have a search tool to let consumers check what doctors, clinics and hospitals are included in the health plans. There was one, fraught with errors, which was taken down soon after the site was launched Oct. 1.
It’s a major issue when customers are trying to decide what plan to buy, as well as for providers seeking answers.
Insurance companies are making “narrow” networks of providers (fewer offered for coverage on the insurance plans) to keep premium rates down, CenCal Health CEO Bob Freeman said.
In a recent seminar hosted by CenCal Health, the county’s Medi-Cal administrator, providers said they weren’t sure about their own contracts with insurance companies, and whether they will be accepting patients with Covered California insurance plans.
The foundering federal exchange website has caused widespread frustration and congressional hearings looking into why the problems were never publicized before the Oct. 1 launch.
Because of the troubles with the website, the individual mandate is being questioned by lawmakers in Congress with discussions of delaying it. Obama had previously exempted employers from the mandate for a year. Individuals must buy the new insurance by March 31 to avoid a tax penalty.