Lauren Jonkman, pharmacist and faculty member at University of Pittsburgh, makes notations in charts in the pharmacy at the Birmingham Free Clinic on the South Side. The clinic has been among those planning for changes coming by way of the Affordable Care Act, set to begin in October.
By Steve Twedt Pittsburgh Post-Gazette
Open enrollment for the health insurance marketplace plans being offered under the federal Patient Protection and Affordable Care Act begins Tuesday, but don't expect a floodgate effect.
"This is the largest policy change in a generation and it's very complex. Something with this many moving parts will always start slowly," said William England, Pennsylvania state director for Enroll America, a non-partisan group based in Washington, D.C.
Mr. England's staff of 11 is charged with educating and enrolling as many of the 1 million to 1.2 million uninsured Pennsylvanians as possible during the open enrollment period, which runs from Tuesday through March 31. Coverage under the plans begins Jan. 1.
"Everything is moving very quickly," he said. "It's getting to be dizzying."
Mr. England and physician Matthew G. Heinz, national director of provider outreach for the U.S. Department of Health and Human Services, spoke to a group of hospital personnel Wednesday that included CEOs as well as clinicians at a Hospital Council of Western Pennsylvania seminar in Warrendale.
Beginning Tuesday, an estimated 150,000 uninsured people in southwestern Pennsylvania will become eligible to sign up.
On Wednesday, HHS reported that Pennsylvania consumers will be able to choose from an average of 56 plans. "Rates in the Pennsylvania Marketplace are even lower than originally projected," said HHS Secretary Kathleen Sebelius.
The report said monthly premiums, on average, will be about $229 for the lowest-cost plan but can go lower depending on income. For example, a 27-year-old Pennsylvania resident making $25,000 a year will pay $109 per month for the lowest cost, or bronze, plan and $145 per month for the silver plan, when tax credits are included. A family of four with a household income of $50,000 a year, meanwhile, can purchase a bronze plan for $152 a month.
Most uninsured residents also will be eligible for a subsidy to defray the cost. Dr. Heinz recommended a Kaiser Family Foundation website, kff.org/interactive/subsidy-calculator, to help people see if they qualify.
All plans have to cover basic care needs such as annual checkups and vaccinations, emergency room visits, hospitalization and prescriptions.
Still up in the air is whether Pennsylvania ultimately will decide to expand its Medicaid program, a move Republican Gov. Tom Corbett balked at initially out of cost concerns but became more of a possibility when he announced his own plan for restructuring Pennsylvania's Medicaid program, using the federal money earmarked for expansion but also including a work-search requirement for able-bodied adults as well as other eligibility requirements.
"It seems like a good-faith effort to make this happen," said Dr. Heinz, who added that he knows the Corbett administration has met at least once with federal officials since the governor's announcement.
Dr. Heinz, a former Arizona state legislator who practices in Tucson, sees enrollment for the health insurance marketplace plans unfolding in three bursts -- an initial "pent-up demand" among those with pre-existing medical conditions who can't get affordable insurance now; a second one in December as the Jan. 1 start date looms; and a third as the open enrollment period closes at the end of March.
To make it easier to enroll, the application has been condensed from 20 pages to three, he said, and 24-hour help is available to answer questions at 1-800-318-2596.
Mr. England said Pennsylvania has five so-called "navigators" to provide enrollment assistance for people who need help deciding on a plan and getting enrolled. Philadelphia-based Human Resource Development is covering the Pittsburgh region in partnership with the Allegheny Intermediate Unit.