Advocates for expanding access to healthcare are turning to local and county government officials for help as they look to close remaining gaps in health insurance coverage.
With Gov. Chris Christie opposed to the Affordable Care Act, Democratic elected officials say local government can be a conduit for publicizing available insurance options and helping residents enroll.
A potential model for local involvement is Jersey City, where Mayor Steven Fulop made promoting access to care through the ACA a priority for his administration. City workers were trained as certified application counselors, which allowed them to help residents enroll through the federal health insurance marketplace, healthcare.gov.
“The opportunity for real change is at the municipal and city level,” said Fulop at a conference on ACA enrollment held in Princeton yesterday.
Planning has already begun for the next open enrollment period, which will begin on November 15. The first period, which officially ended on March 31 but was extended into April, led to 161,775 people signing up through the marketplace. In addition, 142,023 more adults have enrolled in Medicaid.
Enrollment periods are limited for marketplace insurance to prevent residents from only seeking health benefits when they are ill.
U.S. Department of Health and Human Services regional Executive Officer Dennis Gonzalez said there are several ways that local officials can help residents get insurance. They can contact leaders of groups that include uninsured residents to make sure they know about the ACA; support events that promote the law; offer space in public buildings where regular marketplace enrollment sessions can be offered; put links to healthcare.gov on municipal websites; and record messages about the law that can be sent to residents through “reverse 911” phone systems, Gonzalez said.
“I think we actually underestimated how important elected officials can be,” Gonzalez said of federal officials.
U.S. Rep. Frank Pallone (D-6) pointed out another potential avenue for increasing enrollment — coordinating enrollment efforts with other social services, such as allowing residents to apply for insurance when they seek home energy assistance.
Pallone said that enrollment in New Jersey, while “pretty good, could have been better,” at least partly because the Christie administration didn’t spend the $7.67 million it was awarded by the federal government to support the marketplace. State and federal officials couldn’t agree on how the money would be spent, and the state lost the money.
Pallone added that even after years of debate and publicity about the ACA, many residents remain unaware of basic features of the law, such as the existence of subsidies that can greatly reduce insurance costs and the expansion of Medicaid to cover more low-income residents.
He recalled attending a luncheon in January, near the height of attention about the law’s implementation, where a resident told him: “I don’t have health insurance and I wish you would do something at the federal level to provide health insurance,” Pallone said, drawing laughter from a crowd of healthcare advocates. “And it just dawned on me that even with everything we’re doing, people just don’t hear about it.”
Assemblyman Louis D. Greenwald (D-Burlington and Camden) alleged that Christie’s presidential ambitions led to the loss of the $7.67 million. He said primary-care doctors and hospitals, as well as local governments, should work to inform the public about their options under the ACA.
Communications Workers of America Local 1032 staff representative Dudley Burdge said that while New Jersey had a “really good start” with enrollments, “we really need to get down and redouble our efforts and really, I think, get a lot better organized.”
Burdge noted that the rate of uninsured resident who enrolled in marketplace insurance in New Jersey was worse than in neighboring New York, where state officials embraced the ACA, and in Pennsylvania and Florida, where the governors were more hostile to the law than Christie was.
Burdge acknowledged that the state did establish programs to automatically enroll some residents in New Jersey FamilyCare, the state’s primary Medicaid-supported program for low-income residents. But he said the county welfare staffs represented by his union had no new staff members and no additional training to help enroll residents, and that an outdated computer system is hindering efforts.
“Not many other places were like Jersey City — they didn’t get involved in November, they didn’t train all the staff,” Burdge said, adding that many local efforts started too late and “didn’t quite come together.” He said the time before the next open-enrollment period will allow time to plan and organize.
Fulop emphasized that an early start in Jersey City’s efforts put city officials in a position where they could deal with problems as they arose and continue to support the ACA enrollment efforts even when the website wasn’t functioning.
Greenwald added that another important step is ensuring that the state has enough primary-care providers to treat the newly insured residents. He said the Medicaid Accountable Care Organization demonstration project — which aims to target and coordinate care for residents before chronic health problems develop into crises — is a potential model for meeting this demand.