KAILUA–KONA— There are a few days left to enroll for health insurance in 2016, and local providers are worried people will miss their window.
The West Hawaii Community Health Center office should be filled with people who need to sign up for health insurance, the officers said. But on Thursday afternoon there was no one there and the phone hardly rang.
The failure of the Hawaii Health Connector has left many without insurance, and enrollment kokua Deborah Dahlinger believes many of those people don’t realize it. The HHC was a state-based exchange, and its closure means the enrollees need to join the federal exchange. Dahlinger doesn’t want them finding out when they go to the doctor or prepare their returns, she said.
Instead they work to enroll people in the federal insurance exchange. The deadline to register is Sunday.
This is the first year that full penalties for not carrying insurance will apply, up to 2.5 percent of someone’s income.
Their challenge is complicated by the comparatively small number of uninsured people in Hawaii and language barriers.
As a result of the Prepaid Health Care Act, Hawaii has one of the smallest uninsured population in the nation — 8 percent, or about 100,000, according to the state’s insurance commissioners. About 42,000 of those people qualify for Medicare, leaving 58,000 unprotected.
Walter Lanwi, a Marshallese-speaking officer, said the language barrier stops people before they begin. They may ignore reminder letters, he said, because they can’t understand the text.
Even if they do make it to the website, it’s not fully intuitive, the counselors said, without considering if the relevant language is available.
That’s the core part of their job — guiding people through the computer system and the possibilities it opens up for them.
One reason people don’t enroll seems to be fear, said Saray Soto, the Spanish-speaking enrollment officer. They’re concerned that they will select the wrong option or give the wrong answer, she said, so they “step on the brakes” when they hit a problem and do not enroll.
But the work is worth it, the officers said.
“It is literally life-changing for a large number of people,” Lanwi said.
People go from no insurance, or extremely expensive insurance, to something they can use, Dahlinger said. Now they can make a doctor’s visit before a crisis, or get treatment for chronic conditions like diabetes or high blood pressure, she said.
One of her clients was a women suffering from heart problems who had a list of prescriptions that cost $150 a month, she said. After filtering through plans, they settled on a plan that dropped that total to $7 monthly.
The enrollment is a team project and requires information that can be difficult for the poor to gather.
They need a form of ID, Social Security number and an estimate of wages. The last point can be difficult, she said, as many of the people in this bracket have inconsistent payments or payments made illegally.
“I just ask ‘what will you be reporting on your taxes,’” she said.
The enrollment coordinators tried posters, visiting low-income housing and going to cultural events and health fairs. But they’ve had to rely on word-of-mouth to contact the under-served.
The groups they work with are somewhat impenetrable by other means.
That includes the homeless, who are required to have insurance. Their expected low incomes means most, if not all, will qualify for subsidies. Many will get free health care if income is low enough, said Soto.
Another group is young adults. Although they can remain on parental insurance until age 26, they will have to find their own at 27. For some of them, the exchange is the best option.
With the Compact of Free Association, Marshallese living in Hawaii also have to enroll in the program. This has lead to complexities for the group, and they’ve made visits to various low-income areas where Marshallese live.
The final point came when the state Legislature would not vote to pay an additional $28 million. In January 2015, the State Auditor’s Office found that the program was “unsustainable,” at least if it continued to function as it had been.
“The Connector received $204.4 million in federal grants to support the planning and establishment of Hawaii’s state-based health insurance exchange. We found the Connector did not properly procure or administer its contracts and circumvented its own procurement policies and procedures when hiring consultants,” the audit read.
The exchange had to be self-sustaining by 2015. The director told the Legislature they would be spending $12 million a year and making $1 million.
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