Posted January 23, 2014

State Decision to Opt Out of ACA ‘Exchanges’ Creates Information Gap

Some residents are frustrated, confused as they must fend for themselves as state provides scant assistance


Samy Cheng-Robles had a friend who was a struggling artist with no health insurance. When the friend came down with an ailment that required a visit to the gynecologist, she paid the doctor out-of-pocket. But a few weeks later, she received a $600 bill for laboratory work that took her months to pay off. When the friend developed a problem with her eye several months later, she opted to not go to a doctor, saying she would go next year when she could afford it.

While Cheng-Robles has health insurance, her friend’s dilemma awakened her to the plight of those who don’t have coverage.

So when Congress passed the Affordable Care Act, designed to make sure everyone has health insurance, and New Jersey officials did little to help its residents obtain coverage, she got annoyed -- annoyed enough to join Organizing for Change, which advocates for President Barack Obama’s agenda.

Over the last two months, Cheng-Robles has visited Ocean County Community College, libraries, local pharmacies and supermarkets, explaining to people how to obtain coverage under the new law and telling them where they can go for help in applying.

She said there were about 30 people at the college, alone, who wanted to sign up but didn’t know how.

Cheng-Robles also created a business-card-sized handout, at her own expense. It has contact information in English and Spanish for the federal government’s ACA hot line and for the FoodBank of Monmouth and Ocean Counties Inc., which has “navigators” charged with helping people enroll in new health plans, as well as links to articles that explain the ACA and the tax credits that help offset the cost of insurance premiums.

“When there was a swine flu epidemic three or four years ago, you couldn’t go anywhere or look on any of the state, county or township websites without seeing information about how to find the nearest clinic for a swine flu shot,” Cheng-Robles said.

An electrical engineer by trade and a self-described technology geek, Cheng-Robles says even she had a hard time finding information in New Jersey about the new law. What little is available through the state is confusing and unclear, she said, mostly advising residents to contact the federal government or call their insurance company if they have questions.

That’s a far cry from Kentucky’s state government website, which has a sign-up option right at the top of the page, Cheng-Robles said. Even Kansas, a so-called “red” state, had a pdf file on its state website summarizing all of their available insurance plans and how those plans change under the ACA.

When New Jersey opted not to run its own healthcare exchange, she said, it should still have come up with a clear road map showing residents how they can then obtain coverage at the federal level, Cheng-Robles said.

“What frustrated me was not hearing anything about the ACA in my area. And then I came across an article saying the governor had been sitting on federal grant funds that could have been used to disseminate information about the plan? That’s when I decided to act,” she said.

Indeed, the state’s Department of Banking and Insurance (DOBI) was awarded $7.6 million in federal funds over a year ago to educate consumers about options available in the so-called health insurance “marketplace” as well as through Medicaid. So far, these funds have not been spent.

Cheng-Robles isn’t the only one expressing frustration over that. Last month, several consumer groups sharply criticized Gov. Chris Christie for failing to spend that money and expecting the federal government to educate New Jersey residents about their healthcare options.

Raymond Castro, a senior policy analyst for the New Jersey Policy Perspective, a left-leaning think tank, went so far as to publicly call Christie’s actions a passive-aggressive attempt to undermine the Affordable Care Act. A few weeks later, his office issued a report saying that while the governor chose to have the federal government run the state’s health insurance marketplace, New Jersey’s banking and insurance department is still responsible, under state law, for regulating insurers and assuring that consumers are protected as the ACA is rolled out.

“The entire purpose of the (Department of Banking and Insurance) is to balance the self-interest of the free market with the real needs of consumers,” New Jersey Policy Perspective wrote in its report. “Consistent with that mandate, the department should oversee, monitor and evaluate the process and act to guarantee that consumers are aware of all their insurance options and rights and do so in close cooperation with the federal government and the insurance industry.”

The state DOBI does provide background information on the ACA, as well as information on NJ Protect, a program created under ACA for people with major or ongoing medical problems that the department ran between 2010 and 2013.

In fact, Ed Rogan, a spokesman for DOBI, said his agency has been answering consumers’ questions about the ACA since the law was enacted in 2010. But when he was asked why there’s so little information on the ACA on state websites and why state officials aren’t doing more to help New Jersey residents through the process, Rogan replied, “The state does not operate the Health Insurance Exchange; it is operated by the federal Department of Health and Human Services.”

Donna Leusner, a spokeswoman for the state Department of Health, said the same thing, but added, “The Department of Health does not administer insurance programs.”

That’s left people like Barbara Stehle, a 42-year old college professor from Jersey City, in the dark. Stehle said the only information she received about being eligible for health insurance under the ACA was from two insurance companies -- her current one as well as one she had 10 years ago.

After hearing horror stories about how difficult it was to sign up for coverage through the federal website, Stehle decided to wait until almost mid-December before trying to use it, but still encountered technical problems with the online application process.

“So then I looked online to see if there was a New Jersey hot line to call, and I realized that in New Jersey, there was nothing in place to help us,” she said.

After receiving another warning letter from her current insurer, Oxford Health Plans, she called the insurer and says she was told, “New Jersey is not going to be able to help you.” The insurance company gave her the number for the federal healthcare hot line, where she said the person who answered the phone clearly explained to her all of her options for health insurance, as a New Jersey resident. She then signed up for a “gold” plan through AmeriHealth right then and there, and is now awaiting paperwork.

“For me, it was pretty simple, considering everything I’d heard. But I had no help from New Jersey,” Stehle said. “The people who were most helpful to me were actually my current health insurance company and the one I used 10 years ago. They helped me figure out I was eligible for coverage under Obamacare and who to contact.”

But even those able to navigate the new health insurance landscape on their own are now having trouble finding out if they’re really covered – particularly those who were enrolled in NJ FamilyCare. Many say they have not received their new insurance cards or confirmation of coverage.

“They told me I’d get something in the mail from NJ FamilyCare, but I haven’t,” said Carmel Calcagno, 58, of Belmar. She says she called NJ FamilyCare and said she hadn’t received anything. She was told she was listed as having coverage, but she still hasn’t received written confirmation.

“I have no insurance cards. I have nothing. That’s weird, isn’t it?” Calcagno said.

Claudine Ohayon Moore, 47, of Montclair, hasn’t received confirmation of coverage either. While Horizon Blue Cross Blue Shield of New Jersey, the company through which she and her husband have coverage, gave her a verbal assurance of coverage, NJ FamilyCare, the program in which her children were supposed to be enrolled, said she is not yet covered.

Even though she got all of her paperwork in well before the December deadline, NJ FamilyCare representatives told her they have an enormous backlog right now, and that her children are not likely to be enrolled for 30 to 60 days. When she asked if she would be reimbursed if one of her children happened to be hospitalized in the interim, she says she was told “absolutely not.”

“They said I can go buy private insurance if I don’t like it,” Ohayon said. “Their take on it is that didn’t set things up properly and because of that, they have this enormous backlog. And so they have no way of servicing everyone on time.”

Elizabeth Scalley, 47, of Brick, hasn’t even gotten that far in the process. Unemployed since early last year and not particularly computer savvy, she’s been having a hard time finding information about the subsidies to which she would be entitled under the new federal law, and how they fit in with the various state programs from which she already receives money.

She currently receives food stamps and a subsidy for her utilities but not for her rent. She’s unemployed but didn’t work enough hours per week under her prior job to qualify for unemployment benefits. And while she was taking classes to obtain a bachelor’s degree, she’s only got one class left at this point, not enough to qualify her as a student.

“I’m not elderly, I’m not young. I’m not a student. I’m not working full-time. I’m not completely on public assistance. I don’t qualify for Medicaid. And I’m not disabled. I feel like I fall through the cracks,” she said.

But more than anything, she wants to make sure she won’t be fined for failing to obtain coverage.

“Nobody has any answers for any of this,” she said. “And you don’t know where you’re supposed to go to find those answers. You do a Google search, and you just come up empty. It’s very frustrating.”

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