When the federal health insurance exchange rolled out Oct. 1 as part of the Affordable Care Act, trained navigators were standing by in Charlotte to help anyone who needed assistance to buy a policy.
But because the website isnt working properly, they have yet to help their first client buy insurance.
A month after the launch of the sign-up, We havent had anyone enroll in an insurance plan during an appointment, said Madison Hardee, a lawyer with Legal Services of the Southern Piedmont, one of three Charlotte agencies that received federal money to train navigators. Its possible that they have gone home and signed up but I havent heard about any that bought insurance.
So far, Hardee and other navigators have helped consumers with the first step, completing applications, sometimes on paper, to determine eligibility for insurance and subsidies. They usually cant get far enough into the online process to compare insurance plans or find out whether their clients qualify for subsidies.
Nicole Stanfield, a navigator at North Carolina MedAssist, managed it once. On Oct. 25, she was able to get through the crippled website to help a client compare private insurance plans and learn that she was eligible for a premium subsidy of $6,624 a year.
It only took 25 days, said Susan Royster, a supervisor at MedAssist, a Charlotte-based free pharmacy for low-income people. We hoped we would be busier by now.
This is not the way it was supposed to work.
What was supposed to be mere minutes of online data crunching has turned into frustrating weeks of idle downtime, a consequence of the much publicized crash of Healthcare.gov, the public gateway created by the Affordable Care Act. The online portal was designed to instantly verify household income, spit out a subsidy allotment, and display detailed health plan options.
But despite the high-tech debacle, navigators plod on. In Charlotte alone, they have distributed dozens of paper applications and processed them for people eager to get the application process underway. Most will remain in limbo until the government fixes the website and allows the enrollments to go through.
Trying to stay on track
To keep the momentum going on subsidized insurance, navigators have patched together a combination of paper forms, federal phone banks and insurance company websites to keep the uninsured on track.
With the federal website expected to be down for at least several more weeks, the public is dependent on other sources of information about the insurance mandate: navigators, insurance agents, counselors and the governments phone-in customer service reps, as well as a growing list of online resources.
The new law, dubbed Obamacare, not only requires most Americans to obtain health insurance but includes a financial penalty for failing to do so. The health law provides subsidies for people within certain levels of household income, and it allows for exemptions for those who qualify for economic hardships.
The law primarily applies to the minority of residents who buy individual policies or are uninsured, about 1.3 million in North Carolina. Those who already have coverage through their employer, Medicare or Medicaid are not directly affected.
Across the state, navigators say they can walk clients through the application process all the way to the point of enrolling and have done so several times. But the final step requires getting through on the government website or calling the federal toll-free number.
Little data available
The number of successful enrollments remains unclear, and insurance companies refuse to discuss their enrollment figures, but the federal government says it will disclose state-by-state totals in mid-November.
Navigators say there is no urgency to apply just yet. Dec. 15 is the deadline to get coverage starting Jan. 1.
The first step for most people is figuring whether they qualify for a federal subsidy and, if so, the amount. Only two insurers offer subsidized coverage in North Carolina: Blue Cross and Blue Shield of North Carolina and Coventry Health Care of the Carolinas.
By subtracting the monthly subsidy from the monthly insurance premium, shoppers can calculate the amount they would pay for insurance. People at the lowest income levels will qualify for the biggest subsidies, in some cases offsetting most of the monthly premium.
But there are many other financial considerations: deductible amounts and cost-sharing obligations, as well as the provider network offered in any given insurance plan.
In the absence of the federal subsidy calculator, subsidy amounts can be requested by mail, a delay of at least several weeks. In the interim, navigators are relying on a number of unofficial calculators, including applications created by the Kaiser Family Foundation, WebMD and EnrollAmerica.
ValuePenguin.com, a private consumer finance website in New York, is designed to mimic several key functions of Healthcare.gov. It has uploaded details of North Carolinas subsidized health plans, showing estimated subsidies, premiums, deductibles and other details in the counties where those plans are being offered.
In October, the site had 100,000 visitors, including 5,000 from North Carolina, said co-founder and CEO Jonathan Wu. He said the sites subsidy estimates may not always be exact, but they are reliable.
Still waiting to hear
On the first day of enrollment, Hardee, the Legal Services navigator in Charlotte, helped Lisa Knight, 52, fill out a paper application. They had hoped to hear back in a couple of weeks whether Knight and her husband qualify for premium subsidies that would make insurance affordable.
The Charlotte couples income is about $15,700 a year, which puts them just over the federal poverty level. They would have qualified for Medicaid if North Carolina had not declined Medicaid expansion, the part of the health overhaul intended to cover the poorest of the poor.
But Knight, who is uninsured and takes medicines for multiple conditions, is hoping she will qualify for a subsidy. Her prescriptions cost more than $150 a month. One drug, Spiriva, prescribed for her breathing problems costs $500 a month. She quit taking it because she couldnt afford it.
Hardee checked in last week with Knight, who still hasnt received a response about her eligibility for a subsidy.
If Knight doesnt get a notice soon, Hardee said shell help her resubmit the application to make sure she meets the Dec. 15 deadline. Hardee said she hopes consumers will continue to make appointments with navigators.
We can at least get them started in the process, she said. Were hopeful the process will get smoother as the months go on.