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Thursday, 26 September 2013 15:19

Affordable Care Act experts are dispensing a healthy dose of information

Written by  Todd Mishler/Walworth County Sunday
Audience members chime in with questions during an Affordable Care Act informational session earlier this month at Matheson Memorial Library in Elkhorn. Open enrollment for the health insurance marketplace begins Tuesday and many are struggling to get up to speed on the new law. Audience members chime in with questions during an Affordable Care Act informational session earlier this month at Matheson Memorial Library in Elkhorn. Open enrollment for the health insurance marketplace begins Tuesday and many are struggling to get up to speed on the new law. Terry Mayer/staff

WALWORTH COUNTY SUNDAY -- A few dozen hearty souls across Walworth and Rock counties have undertaken the Herculean task of educating tens of thousands of residents about the monolithic maze known as the Affordable Care Act.

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A first step in that process involves the state’s health insurance marketplace, called an exchange by some, which allows people, mostly those who are uninsured or underinsured, to apply for coverage and compare plans and prices -- MercyCare and Dean Health Plan are among the companies that plan to sell insurance through the exchange.

The initial open enrollment period runs from Oct. 1 through March 31, 2014. However, people must sign up for and pay the first premium by Dec. 15 for the insurance coverage to kick in Jan. 1. That’s when most Americans must have health insurance, either on the open market, through a state marketplace or from an employer.

Wisconsin Department of Health Services statistics show that the assumed marketplace enrollment in Gov. Scott Walker’s budget will be an estimated 11,243 in Walworth County from Jan. 1, 2014, through June 2015, including 1,888 transitioning adults -- those moving from BadgerCare Plus to the exchange. Those numbers in Rock County are 21,506 and 3,181, respectively.

So, the first and biggest task for state health officials has been figuring out how to reach their target populations.

They have patterned their outreach efforts after Milwaukee’s example, creating 12 regional grassroots enrollment networks to utilize word-of-mouth efforts. Rock will join Jefferson, Green, Lafayette, Iowa, Grant and Crawford counties; Walworth County is in a network with Waukesha, Washington, Ozaukee and Fond du Lac.

That means they are connecting to food pantries, free clinics such as Open Arms and HealthNet, homeless shelters such as Twin Oaks and other advocacy groups with trained counselors equipped to help citizens weed through the process.

One of the key players in Walworth County is Katherine Gaulke, an instructor with the University of Phoenix in Madison and Milwaukee who also teaches through Upper Iowa University's center in Elkhorn. She is a volunteer at Open Arms Free Clinic and the chairwoman of the Walworth County ACA Awareness Steering Committee.

"The group of 30 community stakeholders was created to mobilize and inform residents about the Affordable Care Act, the marketplace and BadgerCare changes and to reach and enroll as many of the 11,000 uninsured in Walworth County as we can," Gaulke said. "We also are contacting local grocery stores, asking them to include English and Spanish fliers. We also are concerned with how the prescription assistance programs will be impacted."

The second part of the equation is carrying out the strategy and explaining the nuts and bolts of the ACA marketplace. And experts agree about the four or five most important pieces that should help people complete their puzzles.

"The most important thing for people to know is to go to or," Gaulke said. "These are the only places to receive subsidies and tax credits. or is an easier way to shop for health insurance. It simplifies the search by gathering all options in one place. One application, one time, and an individual or family can explore every qualified insurance plan in the area."

David Thompson, deputy director of the Walworth County Department of Health and Human Services, said is a one-stop shop for consumers.

"They can sign up for email or text updates about the marketplace and submit applications for insurance," he said. "This is the fastest way for consumers to obtain answers to their questions and apply for insurance coverage."

Those most affected by the law are individuals near the federal poverty level. People with incomes between 100 percent and 400 percent of the FPL may be eligible for federal premium tax credits to help pay for private health insurance through the marketplace. Individuals with incomes between 100 percent and 250 percent of the FPL also may be eligible for additional cost-sharing reductions to help lower their out-of-pocket expenses for co-pays and deductibles.

"Most people will get a break on costs," Gaulke said. "Ninety percent of people who are currently uninsured will qualify for discounted or free health insurance."

Gaulke and Thompson said that the website also offers clear options with apples-to-apples comparisons, and all health insurance plans in the marketplace present their price and benefit information in simple terms -- no fine print allowed.

"Consumers have more control over their insurance options because the marketplace information is presented in simple language," Thompson said. "This includes discussions about premiums, benefits and protections. Consumers can make comparisons and choose the combination of price and coverage that fits their needs and budgets."

Allison Miller is the government relations director for the American Cancer Society’s Cancer Action Network in Madison and member of the Wisconsin Access Network, a collaboration of patient and consumer advocates, health care providers and insurers committed to discussing and educating issues related to accessing quality health care, especially implementation of the ACA.

"It’s hard to narrow down the ACA into the top few things consumers need to know ... " she said. "However, I think these points are key: All insurance plans on the exchange will cover doctor visits, prevention services, maternity care, prescription drugs and hospitalizations; and if you have a pre-existing condition, insurance plans cannot deny you coverage."

Another segment of the targeted population is veterans, and Walworth County Veterans Service Officer Chris Jordan has spearheaded an outreach campaign to find uninsured veterans and make sure their benefits and out-of-pocket costs don’t change.

"Veterans currently enrolled in the VA health care system meet the standard of the law, which requires minimal essential coverage by Jan. 1, 2014," Jordan said in a press release. "However, uninsured veterans should consider enrolling with the VA as a good option for obtaining coverage. Enrolled veterans pay no premiums or deductibles. Some veterans do have co-payments for medical services and prescriptions."

Jordan pointed out that not all veterans are eligible for Veterans Administration health care benefits. Some may not meet the minimum active duty service requirements, and certain categories of veterans are subject to a financial means test to determine eligibility.

In the market

More than 490,000 people in Wisconsin are expected to shop for coverage through the marketplace, including about 92,000 currently on Medicaid who will lose their coverage in January -- Gov. Scott Walker proposed, and the Republican Legislature earlier this year approved, new income limits that restrict BadgerCare coverage to adults earning less than 100 percent of poverty.

In the meantime, Gaulke and Sara Nichols said their grassroots mission, which has included town hall meetings, is paying off.

"Katherine has read every page (of the ACA) and taken the time to learn all of the legalese, and she simplifies it for the general public," said Nichols, the volunteer clinic manager at Open Arms. "We’ve been working together on how to best mobilize our resources. All of the stakeholders have been coming to the table, so I’m confident that we can, in searching every nook and cranny, reach everybody."

They are part of the network of certified access counselors to help the public navigate the marketplace, a system that Gaulke said will make a huge difference in people’s lives.

"The marketplace increases competition and puts choices back in the consumer’s hands," Gaulke said. "It puts everyone on the same playing field. And it gives people the support … it tells them what to do and where to go. It gives them the resources and user-friendly materials, so it empowers the people."

People in this conversation

  • Guest - Krystal Butler

    Nice work Katherine and thanks for helping me better understand the Affordable Care Act! With you help I am able to follow in your footsteps and educate those who do not understand what ACA will do. Keep up the good work!

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