Agencies help people navigate Affordable Care Act

By Enedelia J. Obregón
Senior Correspondent

Before open enrollment began for the Affordable Care Act, Andrea García of Buda went online to check her options.
Based on a preliminary estimate she made in the health insurance marketplace, getting health insurance will be a lot more affordable under the ACA. 
“I have my hopes up that Obamacare will be better for low-income people,” García said. “Even if we pay $300 or $400 a month, we would still qualify because of our income. If we can get a subsidy or refund, that would be really good.”
Because of problems with the federal exchange –– the only option for Texans –– people have not yet been signed up for insurance coverage. The open enrollment period, which opened Oct. 1, continues through March 31, 2014. Those who enroll by Dec. 15 can begin coverage Jan. 1, the day the ACA goes into effect. Americans who do not have insurance and do not sign up by Jan. 1 face a federal fine. Undocumented immigrants are not eligible for the ACA.
García is the type of person that nonprofit groups such as Enroll America are trying to reach and help. Enroll America asked the Diocese of Austin to help spread the word on the enrollment period, said Barbara Budde, the diocesan director of Social Concerns.
“While the bishops vigorously oppose the mandate that forces all insurance companies to offer birth control, they do want people to have health insurance,” she said. “There is an option at every level of coverage that does not offer abortion, so Catholics can make choices in good conscience.” The ACA offers three levels of coverage.
“It’s important for people to get covered for health insurance,” she said. “We don’t want people to be left out of this opportunity. We certainly want low-income Catholics to know they are eligible for tax credits. We don’t want them to ignore this law or the opportunities that the law affords them to get insurance for their families.”
García is 61 and too young for Medicare. Her husband is turning 65 in April and will be eligible for Medicare. He now has insurance through work.
She has high cholesterol and high blood pressure and has been in the Texas Health Insurance Pool for two years. The Pool is for people with pre-existing medical conditions who could not get health insurance anywhere else. The Pool will end with the implementation of the Affordable Care Act on Jan. 1.
Prior to that, García was on COBRA for 18 months after she stopped working. The Consolidated Omnibus Budget Reconciliation Act of 1985 requires group health plans to offer added health care continuation. Those premiums are paid out of pocket by the insured.
“I was paying $698 a month on COBRA,” García said. “When that was over, no one else would take me. My only option was the Texas Pool.”
Under the Texas Pool, she is paying $538 a month, but her deductible is $7,200.
When she went online for ACA, one insurance company gave her an estimate of $400 in monthly premiums with a deductible of $2,000.
“It doesn’t cover heart disease or cancer, so I’ll need a supplement of about $110 extra,” she said. “It’s still $200 a month cheaper than now.”
In northwest Austin, the Lone Star Circle of Care is one of the nonprofits spreading the word and helping people to see if they qualify.
They also help people sign up for Medicaid or the Children’s Health Insurance Program, said Monica Crowley, senior director of Strategic Communication and Policy for the Lone Star Circle of Care, which has clinics in Austin, Cedar Park, Harker Heights, Georgetown, Hutto, Killeen, Round Rock and Taylor.
Raquel Luna, a certified application counselor with the Lone Star Circle of Care Central Texas, said a big part of their job is to explain the process and the terms. She and other LCCTX employees got federal and state training in preparation.
“We don’t direct them to any plan,” she said. “We just give them information tools and help them sign up.”
According to statistics, about 23 percent of Texans –– 4.88 million –– are uninsured and are eligible. Of those uninsured, 50 percent are Hispanic/Latino and 13 percent are African-American. Those ages 19-34 make up 39 percent of the uninsured and 53 percent are male.
Mimi García, state director for Texas Enroll America, said they have 28 staff members in Texas training groups and organizations on how to navigate the website so they can enroll clients.
“We’re working with a variety of groups across the area –– local churches, food banks, ... Central Health and other groups to get information out,” she said.
Because everyone has different needs –– the elderly don’t need maternity care but care about prescription coverage, for example –– volunteers need to be trained on navigating the system.
“There are different plans that can fit their budget,” she said. “If they are sick now they cannot be charged more. We need to train volunteers to be able to talk about all those things, so they can answer any questions that come up.”
To get help signing up from Lone Star Circle of Care Central Texas call 1-877-800-5722 or visit Help is also available through the national hotline at 1-800-318-2596 or at In Austin, residents can call 211, where callers will be directed to the nearest clinic for sign-up. 
For more information about the Catholic approach to the Affordable Care Act, see Barbara Budde’s column on Page 18.

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