According to the Dec. 11, 2013 issue of the New York Times, “nearly 365,000 people picked a health insurance plan through state and federal exchanges established by the Affordable Care Act (ACA) through the end of November. While the pace of enrollment picked up last month, it is still a fraction of the 1.2 million target that the Obama administration had set for the first two months.” In Iowa, the target was 6,970 individuals enrolled with only 11 percent attainment (757 individuals). What’s going on?
In 2012, the American Community Survey, found the number of uninsured people in Iowa was 254,275 uninsured, or 8.4 percent of our population. I’m not a statistician, but enrolling about 7,000 by Nov. 30 seems a reasonable target. Out of the whole, there are some, where household income exceeds $50,000 (91,073 uninsured), and non-citizens (28,901 uninsured), who would not be eligible. Nonetheless, enrolling only 757 individuals is an embarrassingly low number.
The enrollment period for coverage Jan. 1, 2014 was extended after the website trouble to Dec. 23, so some may have delayed to use this time. I submit, at its core, the problem is a cultural issue, rather than policy. Here are my thoughts:
People I know don’t understand health insurance is mandatory in 2014, and if they do, the perception is there is no reason to get it given the slight penalties.
Wellmark, the largest health insurance company in Iowa is not in the exchange, indicating that if one has insurance where the policy is grandfathered, it may be better to wait to change policies until Wellmark enters the exchange for the 2015 calendar year
The exchange requires some married couples to move from a joint policy to individual policies. That doesn’t seem right, and it was not explained well, if at all. Why change unless one understands this aspect of the ACA?
The folks at the exchange I spoke with were not prepared to deal with the idea that some people do not know how much income they will have in 2014, thus creating uncertainty about the amount of the tax credit, and how much will be paid out of pocket. Uncertainty for this and other reasons will be an obstacle to enrollment.
There have been success stories about people who have benefited from the Affordable Care Act, using expanded Medicaid and the insurance exchanges. On the ground level, the failure to attain targeted enrollments seems to be a failure on the part of government to recognize that enrolling in the exchange is not intuitive, and that people who may qualify for insurance may also need persuasion. This is particularly true given the all-out assault on the Affordable Care Act by some Iowans, including Rep. Steve King (R-Kiron).
Too, where is Organizing for Action? While enrolling people in the Affordable Care Act may not be their primary mission (Organizing for Action is the grassroots movement to pass legislation relating to the Obama administration’s agenda), failure to gain a better degree of compliance with the ACA will result in a policy failure for the administration, and hinder OFA’s progress going forward. OFA has a self interest in the success or failure of the ACA. Having missed identifying the need for persuasion, it seems doubtful anyone in the administration picked up the phone to call OFA.
With the deadline for Jan. 1 2014 coverage less than two weeks away, what’s a person to do? For me, that means keeping the policy I have for another year, even if we qualify for a less expensive policy on the exchange. For the tens of thousands of Iowans who don’t have health insurance it remains to be seen. While the benefits of the ACA are pretty clear, even those who would be helped the most by the law are just not buying it.