Anne Olson of Sebastopol talks with a counselor aboutt her options for Medicare supplemental insurance at a free event sponsored by the West County Health Centers at the Sebastopol Community Center on Thursday, Marck 27, 2014,

Insurers brace for big wave of customers as Obamacare deadline looms

MARTIN ESPINOZA
THE PRESS DEMOCRAT

After an unprecedented national campaign to enroll millions of Americans in health insurance plans, tens of thousands of North Bay residents have signed up for health coverage over the past six months.

Monday is the deadline to apply for subsidized private health insurance sold through Covered California, the state-run marketplace that opened for business on Oct. 1 to implement President Barack Obama's health care law. The deadline also applies to anyone buying private health insurance in the individual/family market.

But then, the next phase begins.

Insurance companies must process a surge of last-minute applications. Many newly insured people must still find a doctor who accepts their coverage. And doctors are bracing for new patients who already are filing into their offices.

While the program got off to a rocky start, the Affordable Care Act is already having an impact in the North Bay. Whether it is good or bad will be debated for months to come.

Six months after Covered California opened for business, more than 35,000 people in the North Bay - or 80 percent of the estimated 44,000 people eligible - have signed up for subsidized private insurance sold through the state insurance marketplace. The region includes Sonoma, Napa, Marin and Solano counties.

Additionally, in Sonoma County alone more than 9,000 people have obtained coverage directly from the government through an expansion of Medi-Cal, the state's version of the federal Medicaid program for low-income residents.

Overall, 1 million people in California - and 6 million people nationwide - are now in the pipeline awaiting their insurance cards.

Health care experts say such enrollment numbers are unprecedented in such a short period of time for an insurance industry that is more accustomed to gradual growth rather than seismic shifts such as the one brought on by the implementation of Obama's 4-year-old Patient Protection and Affordable Care Act.

And on the eve of Monday's deadline, many Californians, from health care officials to insurance brokers to the newly insured, anxiously await what comes next.

"In my 20 years of working in this business. I have not seen an enrollment wave of this size," said Rick Igram, senior vice president of development and contracting for St. Joseph Health in Sonoma County, which runs both Santa Rosa Memorial and Petaluma Valley hospitals.

Igram, who is responsible for contract negotiations with St. Joseph-affiliated physician groups and insurance companies such as Blue Shield and Western Health Advantage, said the "massive" enrollment figures represents a shock to a system not used to enrolling that many people at once.

Among this group, he said, are people who have had to drop their previous insurance plans because they no longer meet Obamacare requirements, as well as waves of people who've never had insurance and understand very little about it. Add to that the droves of Californians who have enrolled into Medi-Cal, and you begin to understand the type of stress being placed on the nation's health care system, he said.

It all culminates Monday, the deadline to sign up for subsidized health coverage, although Californians who start the application process by midnight Monday will have until April 15 to finish their applications.

Those who fail to meet the March 31 deadline or two-week extension will be unable to get health coverage in 2014 and could face a tax penalty. The next enrollment period for coverage in 2015 begins in November.

Special enrollment periods are available to those who experience a "life event," such as getting married, adding a dependent or moving to a different area where the available health plans are different.

Prior to the Affordable Care Act, there were no open-enrollment periods in the individual/family health insurance market. The new deadline now applies to all individual health plans sold, regardless of whether or not they are Covered California exchange plans.

Those who do not enroll could face an income tax penalty of $95 per person per year or 1 percent of income in 2014. Each year the tax becomes more onerous.

Affordable Care Act deadlines and changes do not directly affect most Americans. According to Kaiser Family Foundation, in 2012 only 5.8 percent of non-elderly Americans purchased health insurance in the individual market, while about 56 percent received coverage through their employer. Almost all elderly Americans are covered by Medicare.

About 21 percent were covered by Medicaid or some other form of government insurance. That left almost 18 percent of the population uninsured and either eligible for Obamacare's expanded Medicaid program or subsidized health insurance through the health exchanges.

The recent Obamacare crunch has been frustrating and infuriating, both for those who opposed and supported the new health care law.

Joshua Hicks, a 23-year-old tech-support worker who recently lost his job, is not what you would call technology-challenged. But recently, after months of wrangling with California's Obamacare website, Hicks threw in the towel and went looking for help from a certified enrollment counselor.

Hicks' odyssey navigating the choppy seas of the Covered California health insurance exchange began in November, when he tried to enroll online. Two weeks later, he received an email notifying him that he didn't qualify for Covered California because he was married.

He is not married and nowhere in the enrollment process did he indicate that he was.

Since then, Hicks has tried unsuccessfully to contact Covered California by phone and web chat. The chat, he said, had him waiting three hours for someone to reply before he gave up.

"Mostly I want to avoid the tax but also I want to have coverage," Hicks said, adding that as a supporter of the Affordable Care Act, he feels "embarrassed for the (Obama) administration."

Hicks, who is unemployed, was one of dozens of people who attended a community event in Sebastopol last week aimed at helping people through the online enrollment process. The event, organized by the West County Community Health Centers, the Redwood Community Health Coalition and the county Department of Health Services, enlisted the help of Americorps volunteers who are certified enrollment counselors by Covered California.

Since October, some 12 Americorps volunteers based at six different community health centers in Sonoma County have helped about 1,000 county residents enroll into private insurance through Covered California or Medi-Cal.

In the past two weeks, Americorps volunteers have organized eight enrollment sessions in the county, said Polly vanSonnenberg, coordinator of the clinic coalition's Community HealthCorps program, which is affiliated with Americorps.

"They are the people we have at the health centers that we can say, 'If you need help, they can go the extra mile,'" vanSonnenberg said.

The state insurance exchange offers North Bay consumers four different levels of coverage from five private insurers.

So far, eight in 10 North Bay residents have flocked to two plans that offer the lowest prices and highest deductibles. Thirty percent selected a "bronze" plan, the entry level of coverage, while 55 percent chose a "silver" plan, the next tier up.

Kaiser Permanente captured the largest segment of the North Bay consumers who signed up through Covered California. Nearly 42 percent picked Kaiser, while 35 percent chose Anthem Blue Cross and 15 percent selected Blue Shield. The two smallest insurers active in the North Bay, Health Net and Western Health Advantage, picked up the remaining 7 percent of consumers.

Figures for Sonoma County have not yet been released.

Aside from the enrollment problems, and there have been many of them, some people have deep concerns that the current health care system is not prepared to deal with so many newly insured.

One problem likely to surface could affect people who signed up for the Covered California plans offered by Anthem Blue Cross. Many local physicians and medical groups, including Sutter Medical Group of the Redwoods and Annadel Medical Group, will not accept Anthem's Covered California plans.

The result is a "skinny network" of primary care and specialty doctors that may make it difficult for thousands of people in the North Coast to find a doctor, said David Hodges, a Santa Rosa insurance broker.

"People who choose anyone else besides Kaiser need to make sure that their doctors and their hospitals are on the plan," Hodges said.

Deborah Nitasaka of Glen Ellen is among those who enrolled into an Anthem Covered California plan. Nitasaka, whose husband is self-employed, previously had an Anthem PPO plan.

She began the Covered California enrollment process in November and only recently received verification of coverage. Throughout the process, she ran into numerous difficulties, including having her initial premium payments posted to her former, canceled insurance plan.

"I expected this to be a difficult roll-out because it's such a huge program, but I never expected this to be such a trainwreck," Nitasaka said. "My hope is that Obamacare is but one step forward toward the day when we have single-payer insurance."

Nitasaka said she has been unable to verify whether her current doctor is on Anthem's preferred provider network because of problems with online provider listings. Also, she said her doctor may soon no longer accept insurance plans.

"I have received a phone call from my primary-care physician saying he's converting his practice to a concierge practice," Nitasaka said.

With the unprecedented influx of newly insured, local physicians groups are trying to beef up their roster of doctors, though its unclear exactly how much new business will result from Obamacare.

"There's an awful lot of uncertainty," said Dr. Jim Devore, a family physician and medical director of Annadel Medical Group, which has close to 28 primary-care doctors. "I think we have an expectation, an idea that we are going to get busy. ... In general, our primary-care doctors are getting busier faster than we would have normally expected."

Devore said that prior to the Affordable Care Act, it would take about two years for a newly recruited family physician to build a full roster of patients. The three most recent family doctors who have joined Annadel are adding patients more quickly, he said.

"We're very actively trying to build up our primary-care base," said Devore. "We don't want to be in the situation where we don't have enough capacity to see new patients."

You can reach Staff Writer Martin Espinoza at 521-5213 or martin.espinoza@pressdemocrat.com.

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