Although President-elect Donald Trump has said he considers it a priority to repeal the Affordable Care Act, President Barrack Obama’s signature policy achievement remains in place — for now. A key component of that plan, the health insurance marketplace, continues during the annual sign-up period, with a deadline of Jan. 31.
“There’s an unprecedented swelling of curiosity,” said Jessie Menkens, navigator program coordinator with the Alaska Primary Care Association. “People are seeking our help. There’s a lot of questions looming with the upcoming administration.”
Last month, attending by phone, Menkens and Monica Anderson, Seldovia Village Tribe outreach and enrollment coordinator, met with the Homer News to discuss anticipated changes to the Affordable Care Act, or ACA, commonly called Obamacare.
The Alaska Primary Care Association is an Anchorage-based organization dedicated to helping to create healthy communities by supporting community health centers like the SVT Health and Wellness Center.
No matter what happens in Congress and the White House, Menkens said people who enroll now have a guarantee of one more year of health insurance under the contacts they sign.
Senate Majority Leader Mitch McConnell, R-Kentucky, has made it clear that looking at the ACA will be a priority in the next Congress.
“What that looks like, we don’t have an answer on,” said Karina Petersen, communications director for Sen. Lisa Murkowski, R-Alaska.
Murkowski has been critical of the ACA. For example, in a press release last September announcing introduction of the Ensuring Health Care Opportunities Act with Sen. Dan Sullivan, R-Alaska, and Rep. Don Young, R-Alaska, Murkowski said, “We have seen time and time again that the Affordable Care Act does not work for a low-population, high-risk state such as Alaska.”
Menkens noted those challenges.
“The marketplace in Alaska has been struggling for quite some time. It is a combination of many, many things. We have extraordinary costs of care, very high costs of delivering that care,” she said.
At the same time, as insurance became more available and affordable, many high-risk patients got coverage and entered the insurance pool. Menkens said there’s another way of looking at the picture, too.
“What happens when they finally get that care and finally they get those preventive services?” she said of high-risk patients who previously might not have been managing their illness. “Health occurs. They’re preventing those illnesses.”
Anderson works at the SVT Health and Wellness Center to counsel patients on health care options, including Alaska Native health care benefits, the ACA, Denali Kid Care, Medicaid, Medicare and the VA. As an enrollment coordinator, Anderson can help guide people in seeing if they qualify for insurance subsidies and how to get health insurance through the exchange. SVT is open to everyone.
“We sit down on these one-on-one conversations — free and confidential,” Anderson said. “We find that, oh, you’re eligible for this. A lot of people walk in and find out ‘I had no idea we had this available for me.’”
Anderson also works with South Peninsula Hospital to help get coverage such as Medicaid for people who have an immediate need for insurance. Expansion of Medicaid brought in 26,000 more people who didn’t have coverage before — including Dax Radtke, a Homer man recently treated for cancer. He said when he got his cancer diagnosis he found out he qualified for Medicaid and had his care covered 100 percent. Anderson also does outreach once a week at the Homer Community Food Pantry and works with clients through Kachemak Bay Family Planning Clinic, the Public Health Center and other nonprofits.
“It’s building a great trust,” Anderson said. “There are great relations with the community.”
Before the ACA, Menkens and Anderson said they had to deliver unfortunate news to patients.
“They would be locked out of coverage because they didn’t have the purchasing power to get a plan,” Menkens said. That changed after the ACA insurance exchanges took place. “All of a sudden, those doors were open. We don’t want to go back to those days.”
Getting more people health insurance also means that hospitals and health care providers don’t absorb the cost of treating uninsured patients.
“More coverage means less uncovered, uncompensated care at facilities across the state,” Menkens said.
Menkens noted that the ACA has three main provisions: Young people can get insurance under their parents’ plans until age 26. People can’t be denied insurance because of pre-existing conditions. There also are no lifetime limits.
The biggest question and concern is “How much is it going to cost?” Anderson said.
That depends on household income and other factors. People seeking assistance from Anderson should bring in tax returns and other financial information. People ultimately sign up for health insurance on their own, but Anderson can walk them through the process. People need an email address to access the online sign-up — but SVT can even provide people with how to do that, and computer access at SVT or places like the Homer Public Library. People can see some of the options and details through a website, getcoveredalaska.org.
Anderson said people sometimes stop her in public with questions about health care.
“They receive tears. They receive hugs. They receive ongoing thanks in the grocery stores,” Menkens said of assistance from coordinators like Anderson. “It’s safe to say our assisters are true gifts to your community.”
Because of what people hear about the cost of insurance, people sometimes discount that opportunities available, Menkens said.
“What we find is when we give it a shot, and especially when they’re sitting down with an expert, they can look at all these particulars,” she said. “With that kind of support, folks often aren’t surprised.”
Sometimes, though, subsidies don’t go far enough, Menkens conceded, particularly with middle- or upper-income families.
“They are now really struggling with the burden of these costs,” she said. “It is extremely unfortunate with those families in the state.”
Petersen said Murkowski has been hearing concerns and praise for the ACA.
“She has heard from a lot of Alaskans on everything and anything on the Affordable Care Act,” Petersen said. “She hears a lot of the problems, but there are good things Alaskans have identified.”
Menkens said she and other health care advocates had a roundtable discussion sponsored by the Alaska Primary Care Association that Sen. Dan Sullivan, R-Alaska, attended.
“We had a very dynamic discussion with the senator,” she said. “We educated him about access and benefits.”
Petersen said that whatever happens with changes to the ACA, Murkowski will “be making sure we’re improving things and not going backwards.”
Meanwhile, the insurance enrollment coordinators like Anderson and Menkens will continue to help people navigate how to get health insurance even in an time of uncertainty about the ACA.
“It’s a shift. There are no easy, quick answers. We are grateful for the gains and we hope to continue that process in Alaska,” Menkens said.
Michael Armstrong can be reached at email@example.com.