published Sunday, September 29th, 2013

Ready, set — hold on: Affordable Care Act starts Tuesday, but there are hurdles at the starting line

Local and national coverage

UPCOMING EVENTS

Tuesday -- An information session about the enrollment process will be held at the Southside Community Health Center, 100 E. 37th St., from 12:30 p.m. to 1:30 p.m. The public can learn what the new law means for them, documentation needed to determine eligibility, and the assistance available to help navigate the entire process including enrollment sites. It also will offer a tutorial on the categories of the exchange plans.

Saturday -- American Exchange, a broker that specializes in insurance options under the Affordable Care Act, will host its first of several community enrollment events at Liberty Tax, 1213 Dodds Ave., Chattanooga, from 10 a.m. to 3 p.m. This event is sponsored by the Glenwood Neighborhood Association.

WHERE DO I START?

Go online at HealthCare.gov and create a user name to get the process started. Find helpful information from the Kaiser Family Foundation at kff.org.

In the Chattanooga area, find personal assistance at the following locations: Southside Community Health Center, 100 E 37th St.

Dodson Ave. Community Health Center, 1200 Dodson Ave.

Children's Urgent Care, 910 Blackford St.

Erlanger Health System, 975 E. Third St.

Metropolitan Ministries, 1112 McCallie Ave.

Chattanooga Hamilton County Medical Society, 1917 E. Third St.

Homeless Health Care Center, 717 E. 11th St.

Hamilton County Health Department general information, 209-8375

In North Georgia: Primary Health Care Center of Trenton, 13570 N. Main St.

Primary Health Care Center of Rossville, 1430 Suggs St.

Primary Health Care school-based center, Tiger Creek Elementary School, 134 Rhea McClanahan

For months now, Oct. 1 has loomed as the pivotal date for the Affordable Care Act.

Tuesday is the day the health exchanges -- the federally run online marketplaces where people can shop for insurance -- are supposed to go live.

Potential shoppers who have computer access, who are Internet-savvy and have command over tax and income information should be able to log on to the government's main website, HealthCare.gov, and start the enrollment process right away.

But those in the Chattanooga area who need one-on-one help from a counselor will likely have to wait longer than Oct. 1 to sign up.

Government-sponsored Affordable Care Act counselors -- called "navigators" or "certified application counselors" -- are rushing to finish a complex approval process at the federal and state levels before they start helping the uninsured.

The navigators already were subject to federal requirements, but state governments, particularly in GOP-leaning states including Tennessee and Georgia, recently added their own layer of rules that includes background checks. State officials say they are trying to protect citizens from "bad actors" who could have access to very personal information.

Katherlyn Geter, who was hired by Erlanger Health System to head up its enrollment outreach efforts, said her counselors are awaiting state approval and don't expect to have it by Tuesday.

And there's the question of how the main website will function Tuesday when it goes live. Geter has not yet been able to log on, she said.

"It may be the second week before we really get the system down," said Geter. "It's a moving process. Every day we're looking at how we're going to roll out the next process. Every day is changing."

Critics of the law have said that such setbacks and snags are signs of Obamacare's weakness and inevitable failure.

But advocates have said a slew of last-minute rules in Republican states have obstructed the rollout.

State Rep. JoAnn Favors, a Chattanooga Democrat, has decried the state rules from the beginning and said she is still "distraught" about the complications they've created. But she said it hasn't slowed the number of people wanting to volunteer to help eligible people sign up.

"Considering the time frame that we've had to work under, I think we are on target," Favors said.

Others in charge of navigator programs have taken a similar tone, saying there's plenty of time before the March 31, 2014, enrollment deadline.

"The message that I'm trying to get across is that October 1 is the starting point," said Rae Bond, executive director of the Chattanooga-Hamilton County Medical Society, which is offering enrollment assistance. "We still have a long way to go."

Karen Quinn, senior public health nurse with Hamilton County's Homeless Health Care Center, said the population she serves has little to no access to information about the new law.

Her clinic, too, is still going through the approval process for counselors to help with sign-ups.

"We'll do as much as we can through our existing staff, but we'll expand the process as we get through the hiring process with the state and the federal government," she said.

Geter said that even after counselors are properly certified, it may take several visits for a person wanting to enroll to feel confident about signing up. That's why now is a good time for people to start educating themselves.

"Even if the system is up and works really well, we're wanting to urge people to take their time, not rush into this. We want to get this right," she said.

Because of the newness of the whole system, some experts say that the hurdles at the starting line may be a good thing for preventing a bottleneck.

"On one hand, you may take [lack of outreach] as a red flag, a negative sign, of the prospects," said April Wortham, a market analyst with HealthLeaders-InterStudy.

"But on the other hand, it's a new system, it's relatively untested, it's coming together at literally the last minute. Do you really want all those people logging in on October 1?"

NOT QUITE READY IN GEORGIA

Georgia's approval process is more stringent than Tennessee's, requiring navigators to be certified and licensed.

In August, when training requirements were formalized, Georgia Insurance Commissioner Ralph Hudgens told a group of Republicans that his office was doing "everything in our power to be an obstructionist" to the law, according to the Atlanta Journal-Constitution.

Amy Buffington has had to undergo weeks of training and studying and multiple tests and still isn't certified.

Buffington is supervising outreach efforts for the Primary Care Center, which is the main hub for signing up the uninsured in Walker, Dade and Catoosa counties.

She said many people already have called about signing up.

"We just have told people to get back with us, that we are going through the licensing and certification process," Buffington said. "We can't do anything until after that. I would hope it will be in the next week and a half, but it's all dependent on when we get certified."

Still, Buffington remains optimistic about the road ahead.

"People have been very confused about this process, and we are really excited about helping them. We just need to get through it first," she said.

PINPOINTING PRICES

Another missing component is specifics on how much the private insurance plans will cost.

Insurance companies hoping to sell on the exchange still have not received final federal approval for their plans.

Mary Danielson, spokeswoman for BlueCross BlueShield of Tennessee -- the only insurer offering plans throughout the state -- said the company will have an announcement about its rates Monday.

Average rates released Wednesday by the Obama administration indicated that Tennessee's premiums would be among some of the lowest in the nation.

But experts cautioned against making too much of the averages, since prices will be determined by the individual's age, income and other factors.

"I would say they are a very narrow snapshot of what premiums may look like," Wortham said.

She said the first year is already shaping up to be a "trial run" for everyone -- for the government, for consumers, for businesses and for the insurers.

"The insurers are feeling their way through this along with the rest of us," she said. "We don't know yet who is going to enroll in these plans."

Contact staff writer Kate Harrison at kharrison @timesfreepress.com or 423-757-6673.

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