By Virginia
Anderson October 27, 2017
ATLANTA — Ms. Stella’s,
a home-cooking restaurant in Milledgeville, Ga., serves roast beef, grilled
pork chops, chicken wings and oxtails with 24 sides from which to choose. Last
spring, owners Jeri and Lucious Trawick opened a second restaurant in Eatonton,
about 20 miles away, and Jeri decided to leave her full-time job to help
shepherd the expansion.
But she needed to
update the couple’s health insurance and went shopping on the Affordable Care
Act’s online marketplace. Trawick, 43, who considers herself nearly as skilled with
a computer as she is with a skillet, found the Obamacare website daunting.
“It was not exactly
user-friendly,” she said. Trawick needs specific medications to control her
hypertension, and the section on drug coverage left her “confused.”
She turned to Insure
Georgia, a program funded in large part by federal money to help
consumers enroll in Obamacare. A trained navigator showed her how to compare
policies on the website, look at drug formularies and examine differences in
prices and provider networks.
“I could have done it
without her, maybe, but it would have taken me forever,” Trawick said.
This fall, it will be
different.
Open enrollment for ACA plans,
which begins Nov. 1, has been shortened to 45 days. At the same time, funding
for navigator programs and other support for consumers has been cut dramatically in
Georgia — by 86 percent — and across the country.
The number of
navigators for Insure Georgia, the nonprofit agency that has received the bulk
of federal funding for enrollment efforts in past years, will drop to 21 from
42 last year, said Fred Ammons, chief executive officer of Community Health
Works, the parent organization of Insure Georgia.
There is no
advertising budget to even inform consumers that open enrollment begins. Ammons
said he is concerned that with all the past year’s rhetoric among Republicans
in Washington about repealing and replacing Obamacare, some people may not even
understand that the program is still available.
That could be a
problem in Georgia, which, after seeing increased enrollment in the first three
years of the marketplaces, experienced a 16 percent drop in sign-ups for 2017
coverage. In some rural counties the decline was as much as 36 percent. Georgia
ranks third in uninsured residents, behind only Texas and Florida.
‘Isn’t Obamacare Dead?’
ACA supporters are
concerned that residents in the rural portions of Georgia — which make up about
17 percent of the population — could be most at risk. In recent decades, those
rural areas have fallen behind other parts of the state in income,
educational achievement and in access to health care.
With enrollment assistance
resources so strapped, it will be hard to reach out to rural consumers.
“We had a booth at the
PRIDE festival in Atlanta last Sunday, and someone said, ‘Why are y’all even
here? Isn’t Obamacare dead?’” Ammons said. “And if they think that in Atlanta,
you can only imagine what they think in south Georgia.”
Health economist
William Custer, who teaches at Georgia State University in Atlanta, echoed
those fears about increases in the number of uninsured in rural Georgia.
The effects of less
insurance will be felt hard in those areas, he explained. Nearly half of the
state’s counties, most of them in rural areas, do not have an OB-GYN. Seven
hospitals in rural Georgia have closed within the past four years. Several have
closed their labor and delivery units. If people in rural Georgia lose
insurance rather than gain it, efforts made in recent years by state leaders to
stanch financial bleeding at rural hospitals could be jeopardized, Custer said.
“This is really the
big worry. The problem in Georgia is that we have very different geographics,
very different demographics and very different health care. These changes this
year really seem to be pushing us even more to two Georgias,” Custer said.
‘Let Obamacare Fail’
Much of the cutbacks
and confusion, health care advocates said, follows President Donald Trump’s
disparagement of the law. He campaigned on a promise to “repeal and replace the
disaster that is Obamacare” and announced in July that he would “let Obamacare
fail.” Even though Congress could not pass a replacement bill, the Trump
administration’s changes in timing and funding for enrollment will have an
effect, the advocates charge.
“The most damaging has
been the rhetoric and confusion,” said Laura Colbert, executive director of
Georgians for a Healthy Future, an advocacy group. “Overall, this could be a
bellwether for future years.”
Enrollment Resources
The federal
marketplace English-language website: healthcare.gov
The federal
marketplace Spanish-language website: cuidadodesalud.gov
The federal call
center for consumer questions, available 24/7: 1-800-318-2596
Insure Georgia: www.insurega.org;
1-866-988-8246
And while the need for
insurance is high in the state, Georgia lawmakers have been resistant to the
federal health law. Georgia, like 18 other Republican-leaning states, refused
to expand Medicaid, as the law allowed. The Legislature also prohibited the state
from employing navigators to help enroll consumers.
Ammons, who is from
rural Georgia, said he lies awake at night wondering how to reach people who
need health insurance.
“I don’t know what I
can do to help these uninsured people,” he said, adding that “for a brief
moment, I thought ‘We can’t even do this.’”
That was the night he
learned, in an email, that Insure Georgia’s funding had been cut from $2.3
million to $328,000.
Ammons said he
realized that he would have to lay off full-time employees. He said he also
figured out that he would have to cut back on navigators that Insure Georgia
typically hired short term for open enrollment.
Next, he cut every
non-personnel line item he could, which meant terminating leases and closing
offices. The group found donated space in Vidalia, in central Georgia, and in
Brunswick, a port city near Savannah. But that leaves the southwestern portion
of the state, an especially poor area of Georgia, without a nearby office.
Ammons said that other
nonprofit groups have donated money that will allow Insure Georgia
representatives to travel to 500 community enrollment events across the state.
While Insure Georgia held more than 1,500 community events last year in all of
Georgia’s 159 counties, his goal is more modest this year.
“We want to at least
be in every county with a Walmart,” he said.
Jeri Trawick said she
is worried for herself and for thousands of other Georgians.
To help with
enrollment efforts, the Trawicks on Nov. 6 will be serving something else along
with their homemade food at Ms. Stella’s in Eatonton.
“We’re going to have
an open enrollment event, with a navigator here, from 10 until 6,” she said.
“And I’ll be the first one in line.”
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