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Helping America get health coverage

NEW PORT RICHEY — Ray Clark is a part-time maintenance worker with neither health insurance nor any idea how he's supposed to buy it next year.

Online insurance exchanges? Nobody has ever talked to him about those.

"I haven't heard from anyone," said Clark, 50, who earns $8.50 an hour.

He may start hearing from someone soon.

With the online insurance program required by the Affordable Care Act set to go live on Oct. 1, Washington-based nonprofit Enroll America will begin its "Get Covered, America!" marketing campaign on Thursday. Community health centers in Tampa Bay should soon learn whether they will get millions in federal grants to assist residents. And insurance companies could soon start setting up shop near lower-income neighborhoods, where many residents may be buying insurance for the first time.

"There's going to be an incredible need to get information out to lots and lots of people," said Rachel Klein, executive director of Enroll America. "Most people who will benefit from this new coverage opportunity have no idea it's coming."

The exchanges, which federal officials re-branded "online marketplaces," function much like the travel website Expedia, featuring search engines to help consumers compare plans. The program, aimed at people who can't get affordable insurance through an employer, will also allow consumers to figure out if they qualify for up to $10,000 a year in subsidies to their premiums.

People can log on from their home computers and make the decision on their own. But advocates and industry experts say there will be plenty of questions — and a general unawareness — about the exchanges.

The federal government is providing grants to a number of groups to help people sort through their options. Among those organizations are the nation's community health centers, which provide medical services to a large number of uninsured and low-income patients.

In Florida, the centers qualify for a total of $8.1 million to buy computers and hire and train staffers to teach people about the new marketplace, show them how the website works and help them determine if they qualify for tax credits.

In Pasco County, for instance, Premier Community HealthCare Group has applied for a nearly $135,000 grant to hire two specialists who will talk with the center's patients. About 40 percent of the 18,000 people who visited Premier's clinics last year had no insurance.

But the harder audience will be those who have never set foot in a health center. The new hires will set up booths at community health fairs or other events and maybe even team up with churches, said Cheryl Pollock, business development director.

"Talking about a marketplace and these other buzzwords is foreign," said Pollock. "We have to really drill it down into layman's terms."

The federal government will require training courses for community health centers as well as for so-called "navigators," self-employed people or groups that have applied for federal money to help residents. Private insurance brokers will also receive training on how the online exchanges work, said Carol Taylor, a member of the Florida Association of Health Underwriters.

"The thing is so complicated that the consumer is really going to need somebody who knows the industry," said Taylor, who predicts insurance brokers still have a role to play on the exchanges.

Also filling the information gap? The insurance companies.

Cigna and Florida Blue, for instance, are both about to begin alerting their individual policyholders about the exchanges, where many of them may qualify for help paying their premiums.

Jon Urbanek, senior vice president of Florida Blue, said the insurer also plans to open small, "strategically placed" retail centers. Some may be near lower-income neighborhoods, he said, to attract first-time customers.

"It's one thing to say we're talking to existing policy holders," said Urbanek. "The real key is going to markets we've never talked to."

He acknowledged that carriers with insurance companies aren't neutral observers. "In the end, we want people to make the right decision," he said. "We need to earn the right to tell them why we're the best."

Because the federal government has kept the curtain drawn on its exchanges, it isn't clear how many issues — from online security to pricing to usability — will be resolved. Bob Hurley, a senior vice president of sales and operations at eHealthInsurance, a longtime private online insurance exchange, said he believes the government may have just as much to learn about the program as consumers.

"There is going to be a fair amount of confusion," he said. "Hopefully there's sufficient resources in the industry, including us, to help people through this process."

Jodie Tillman can be reached at jtillman@tampabay.com or (813) 226-3374.

Exchanges help find policies, subsidies

The Internet-based insurance exchanges — also called "online marketplaces" — will begin enrolling people Oct. 1 for 2014, when most Americans are required to obtain health insurance or face a financial penalty. Here's a little more about them.

Who's in charge of the exchanges?

In Florida, the federal government is. A number of other states opted to run their own.

What can I do on the exchanges?

You can shop for an insurance plan for you and your family and also find out if you qualify for a federal subsidy to go toward your premium costs.

Who can shop on these exchanges?

Any legal citizen can purchase coverage through the exchange. But only people who meet certain income requirements may qualify for federal subsidies to help buy coverage.

What kinds of income requirements?

People who make up to 400 percent of the poverty level — or $94,200 for a family of four — and can't get affordable insurance through an employer. "Affordable," in this case, means employees' shares of premium costs do not exceed 9.5 percent of their incomes. The Henry J. Kaiser Family Foundation has a great tool to give you a ballpark idea about whether you might qualify based on age, income and family size: kff.org/interactive/subsidy-calculator

How does Florida's decision not to expand Medicaid coverage play into this?

It could leave some of the poorest people without any help at all. The law, anticipating states would make Medi-caid coverage available to more people, makes the tax credits for the exchange available only to people who make at least the poverty level. So Floridians who don't qualify for Medicaid but still make below the poverty level — say poor, non-disabled men, for instance — may not qualify for the subsidy.

Who's likely to qualify for the subsidies?

Among others, young adults. A recent analysis found that two-thirds of adults under 30 who are either uninsured or buy individual plans should qualify for the tax credits. That's because so many young adults have modest incomes, said Dan Meldelson, chief executive officer of health care consultant Avalere, which did the analysis.

Who's going to be selling plans on the exchange in Florida?

Policy analysts at advocacy group Florida Chain have identified 11 carriers who recently submitted plans to the state indicating they wanted to sell plans on the exchange. The list includes familiar names, such as Florida Blue, Humana and Cigna, but is missing other heavy hitters, such as United HealthCare.

How much do they charge?

Those price tags haven't been released yet. In states where those costs have been released, the rates didn't jump as much as many predicted. But it's hard to compare the individual polices with those on the market now, because under the law the new plans must offer richer benefits.

Jodie Tillman, Times staff writer

Helping America get health coverage 06/16/13 [Last modified: Sunday, June 16, 2013 11:57pm]

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