Individuals can't afford ObamaCare

LAS VEGAS REVIEW-JOURNAL

The costs of ObamaCare's individual insurance mandate should worry every Nevadan, not just those currently without coverage.

The Silver State Health Insurance Exchange, the state-run ObamaCare brokerage, last week released preliminary 2014 premiums for Nevada's individual insurance market. As opponents of the health care reform law have long warned and feared, they're expensive.

Come Jan. 1, all Americans must purchase health insurance or pay a penalty tax of $95 or 1 percent of their adjusted gross income, whichever is higher. The vast majority of insured Nevadans have their coverage through their employers or unions. Just 15.4 percent of the state's insured currently purchase their coverage through the individual market.

That figure will increase, and not simply because the mandate takes effect in five months. An untold number of employers are expected to drop coverage for their workers as a result of premium increases. Because President Barack Obama has delayed for one year the Affordable Care Act's employer mandate ' a penalty tax on companies that don't offer medical benefits but have at least 50 full-time-equivalent employees ' businesses now have an incentive to dump their insurance.

Plenty of Nevadans who currently have health insurance very well might find themselves in the market for an individual policy by this fall. They won't like what they find.

As the Review-Journal's Jennifer Robison reported last week, today Southern Nevadans can find individual catastrophic policies online for as little as $29 per month. High-deductible PPOs are available for about $83 per month. But ObamaCare piles new coverage mandates and rules on top of ones already in effect, including caps on premiums for older Americans that necessitate higher costs on younger, healthier men and women. As a result, the exchange's catastrophic plans for Southern Nevadans in their 20s start at about $150 per month. A 40-year-old in need of a plan comparable to typical employer coverage can expect to pay up to $300 per month. Plans for rural and Northern Nevadans cost even more.

The rates won't be finalized until Sept. 1, and those who purchase coverage through the exchange can qualify for tax credits to offset some of those costs. But for those working part-time and temporary jobs to get by, and for the young and healthy, even subsidized premiums will be unaffordable. They'll pay the penalty tax and remain uninsured.

Last month, researchers from Harvard University and the City University of New York estimated that about 300,000 Nevadans will remain uninsured after ObamaCare takes effect, a figure that matches the state's own projections. Nationally, the researchers estimate that about 30 million Americans will decline coverage.

Such a lack of participation would send premiums even higher and collapse the exchanges. This design flaw is one reason why the federal government is spending $700 million marketing ObamaCare to persuade Americans to sign up. It won't work. There's no sweetening this lemon.

Repeal and replace this policy disaster.

Silver State Health Insurance Exchange still plagued by problems

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(Courtesy Nevada Health Insurance Exchange)

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Insurance consultant Richard DiGregorio sits at his desk displaying the Silver State Health Insurance Exchange website on his computer Tuesday, Nov. 5, 2013. DiGregorio helps individuals navigate the website to obtain health insurance. (David Becker/Las Vegas Review-Journal)

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By JENNIFER ROBISON LAS VEGAS REVIEW-JOURNAL

Disappointing.

Difficult.

Atrocious.

That's how local insurance brokers describe the first month of open enrollment through the Silver State Health Insurance Exchange. It hasn't been easy to push applications into the system, they say. When they can get through, they're seeing little actual enrollment, as consumers weigh staying with existing plans outside the exchange, or skipping coverage altogether.

If that trend continues, Nevada could see too few young, healthy people enroll, and the exchange might not generate enough revenue to fund itself.

As of Monday, the exchange reported 8,800 completed applications with eligibility for a federal tax credit determined, said spokesman CJ Bawden. Applications aren't the same thing as actual enrollments, when people pay for coverage. Bawden said the agency won't have enrollment numbers until Dec. 16, the day after the deadline to apply for coverage that takes effect Jan. 1. Exchange officials say they're aiming for 118,000 enrollees in the first year.

Local brokers say that could be a tough goal.

The exchange's website, at nevadahealthlink.com, remains the biggest hurdle to the system's success, brokers say. They report frequent error codes, frozen pages and unwieldy questionnaires ' if they can get through at all. Several brokers said it can take two hours to complete a single application if tax credits are involved.

"It seems like they're working on things, but they haven't fixed it yet," said Nathan Udy, president of Omni Insurance Brokerage. "The process has been disappointing. We were told that, effective Oct. 1, we'd be able to help enroll people in the exchange. It's Nov. 5, and we still don't have a functioning website."

The screens are "very redundant, and not user-friendly," added Rick DiGregorio, an independent broker.

And Phil Randazzo, owner of Nevada Benefits, said last week that he has two computers in all of his brokers' offices going at all hours to get through to the site.

"It's hit-or-miss," he said.

Bawden said exchange officials are aware of application problems, and consumers are reporting enrollment times of 30 minutes to two hours. He said the exchange applies patches to its website every Wednesday and Saturday from 10 p.m. to 2 a.m. to correct problems and improve functionality.

"The consumer experience is dramatically different today than it was on Oct. 1 and will continue to improve as new features and tools are added to the web portal over the next few months," he said.

Even when brokers can get through, actual enrollment has proven underwhelming, they said.

Udy said he gets 20 calls a day for coverage, but he's enrolling just one or two people a week. That's because a lot of consumers are merely window-shopping ' looking at premium costs and potential subsidies to compare plan prices and fines for lacking coverage.

Those who actually buy are mostly unhealthy or affluent. Udy said people who buy today often have health issues; DiGregorio added that higher-income shoppers who don't qualify for a federal premium tax credit are also cutting checks today. DiGregorio said he's enrolling about three people a week.

But Sandra Allan, a broker with GLB Insurance Group, said she hasn't enrolled anybody through the exchange. She put together an exchange-based quote for a company with six employees, but the plans she found are all HMOs, and "people don't want HMO plans," she said. The company decided to stick with the coverage it already had.

The exchange "is not worth the effort at all," Allan said.

Not everyone who manages to get new insurance through the exchange is buying private coverage, and that could create its own set of problems.

Randazzo said 80 percent of the calls he gets are from people eligible for the state's newly expanded Medicaid program, which is for the first time accepting childless singles.

The problem with Medicaid enrollment is that brokers don't get paid for guiding people into the program. Randazzo said he's hired two additional people to help with the crush of enrollees, but if they're mostly signing up for Medicaid, he may not be able to cover the added costs. Nor do Medicaid enrollees help fund the state exchange, which earns its revenue by charging 3 percent of premiums on private plans it sells.

Miki Allard, a spokeswoman for the state Division of Welfare and Supportive Services, said it's too early to provide numbers on expanded Medicaid enrollment. She said 5,000 people applied for Medicaid in October, but that includes all qualified applicants, not just candidates for the expanded version. She said the program will begin processing new applications in November for coverage that starts in January. It's looking for 68,000 enrollees under expanded Medicaid from Jan. 1 to June 30.

"The trials we have experienced with the (exchange) system have made this more challenging than we had hoped, but we are still working diligently to bring health care coverage to all who are eligible as quickly as possible," Allard said.

If the exchange can fix its web woes, things may work out. Udy estimated he'd be enrolling 10 to 20 people a day if the glitches disappeared, though he added that some consumers pricing plans today might still decide to opt for a smaller fine for going without.

"We do have a lot of clients who are excited about getting on the exchange," he said.

DiGregorio agreed there's a market for the exchange's plans, if people could actually buy them.

"The coverage isn't bad. They're good plans, and they get people insured," DiGregorio said. "I know the rollout has been atrocious. However, on the other end, it's going to help a lot of people in the next few years. It'll work itself out. It always does. The most important thing is getting coverage for people who couldn't get it previously."