AUGUSTA — It’s crunch time for health insurance.
People who want to change their health insurance plans or enroll for the first time for a Jan. 1 start date must do so before Dec. 15.
For some, this is an easy process: They like their current plan and their income will be the same in 2016 – they can opt for the passive re-enrollment. They need not do anything.
But for others, it’s a significant challenge. Changes in income, family status and employment can all make signing up for insurance complicated. Mainers are scrambling for help, and a valuable resource has had its funding cut in half.
Consumers for Affordable Health Care is Maine’s go-to advocacy group for handling complicated matters around consumer access to affordable health care. We’re a licensed health insurance agent and a doctor, and CAHC is a go-to resource when clients and patients have problems navigating the health coverage system.
CAHC has been there to assist consumers, navigators, assisters, insurance agents, brokers and health professionals since the rollout of the Affordable Care Act’s health insurance marketplace in 2014. For more than a decade, it has been Maine’s advocacy resource for consumers who need help navigating the health care system.
It has been pivotal for consumers, agents and health professionals alike.
CAHC also assists low-income Mainers in determining eligibility for MaineCare, Maine’s Medicaid program. The nonprofit raises money privately; thanks to a contract that CAHC had with the Department of Health and Human Services starting in 2006, those private funds are matched with federal dollars, essentially doubling the financial resources available to provide badly needed assistance to Mainers.
In June, the DHHS abruptly ended its contract with CAHC without explanation. This couldn’t have happened at a worse time. In the third enrollment season for Healthcare.gov, Mainers need help now more than ever.
Although Healthcare.gov is working much more smoothly than it did in its first year, Mainers looking for affordable health coverage are still facing many challenges as they navigate our health coverage system.
For example, many Mainers who work seasonally, are self-employed or have fluctuating income struggle to estimate their income correctly, and may have to send additional paperwork to the marketplace.
Some may find that members of their family qualify for MaineCare, and will need to apply to the DHHS to get health coverage. In some cases, applicants whose incomes are close to MaineCare levels may have to apply to MaineCare and get a denial before they can move on in their marketplace application.
And here’s where the problem comes in. We often hear from clients and patients who have waited weeks or even months to get a response from the DHHS. Families who call the agency get recorded messages stating that because of heavy call volume, the DHHS cannot take their call today; call back tomorrow. Tomorrow comes and they receive the same message.
This ridiculous runaround forces more people to call the DHHS. Often, to avoid the dead-end phone calls, people must gather all their financial information and plan to spend the day in their local DHHS office instead. Who needs this?
And yet our patients and clients need health coverage in order to get the care they need. Moreover, under the Affordable Care Act, most people must have health coverage, or risk paying a fee at tax time.
CAHC not only helps people comply with the law and navigate the system; it can help the DHHS by screening who actually is eligible for MaineCare before any application even reaches the DHHS. And best of all: If CAHC doesn’t answer the phone when you call, they guarantee a call back within 24 hours.
Why has the DHHS ended its contract with CAHC? As lawmakers and as professionals who help people with their health care and coverage, that is a question we have posed to the DHHS since the beginning of July. We’ve received no response other than, in effect: “We no longer need their services.” Being in the trenches with consumers, we’d argue they need them now more than ever.
And so far, the department hasn’t shown that it can provide these important services – and that means it is violating both state and federal law.
If you are having trouble with your Healthcare.gov application, and you want this problem fixed, please do two things: Contact CAHC for help with enrollment at 1-800-965-7476. And please contact your local state representative and state senator and ask them to support LR 2454, which is a proposal to clarify the state’s obligations.
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