Advocates advise patience with Mo. health exchange

JEFFERSON CITY, Mo. -- Missouri residents can begin enrolling Tuesday for health coverage offered through a new online insurance marketplace. But patients searching for insurance may want to practice some patience.

Health care advocates say consumers should expect some initial technical troubles. Some of the trained experts intended to help guide people through the application process may not yet be on the job. And while Tuesday marks the launch of the website, people have until Dec. 15 to sign up and still be covered when the insurance policies begin Jan. 1

"There are going to be some glitches. The exchange is not going to be perfect when it opens," said Ryan Barker, vice president for health policy at the Missouri Foundation for Health, a not-for-profit group that's helping promote the insurance marketplace.

"You can go [to the website] Oct. 1, you can check it out, but there's no huge rush that you have to do anything in October. Take your time, talk to friends, get some help" before you enroll, Barker added.

The insurance exchanges in each state are a central component of the 2010 Affordable Care Act signed by President Barack Obama, which requires most people to have insurance by 2014 or face tax penalties. The online shopping sites will allow people without employer-sponsored health plans to compare prices and benefits of individual insurance policies.

People who buy policies on the health exchanges may be eligible for government subsidies that could save them considerable cash. The subsidies aren't available to adults living in poverty because the federal health care law assumed those people would be added to the Medicaid rolls, but Missouri is one of 26 states that have not expanded Medicaid eligibility.

Missouri's Republican-led Legislature also opted against a state-run health insurance exchange. Instead, it referred a measure to the ballot that voters approved last year barring state officials from setting up an insurance exchange or providing "assistance or resources of any kind" to the federal government to implement its own insurance exchange in Missouri.

As a result, there has been little advance publicity in Missouri about the launch of the online insurance site. Although federal officials released some cost estimates for insurance policies last week, details about specific policies and the doctors and hospitals participating in them won't be known until this coming week.

Missouri Lt. Gov. Peter Kinder, a Republican, has urged people not to sign up for coverage on the insurance exchange.

"I would hope there would be a lot of active resistance to the implementation of this law," Kinder said.

U.S. Sen. Roy Blunt, a Republican who wants to repeal Obama's health care law, stopped short of calling for a boycott.

"I'd recommend that people, if they can figure out how to have health insurance, that they get health insurance," Blunt said. But he added: "I think what people are going to find next Tuesday is that the federal exchange is nowhere near ready to do the job."

Some groups that are supposed to help people understand the new website acknowledge they aren't quite ready.

Central Missouri Community Action, which got a grant from the Missouri Foundation for Health, still is awaiting federal approval to serve as a certified application site and is hiring seven staff. The Community Action Agency of St. Louis County also is awaiting its federal certification and has hired about half of the 14 application counselors being founded through the Missouri Foundation for Health.

"We're not really set up for people to even know about us," said Doug Eller, the St. Louis County agency's coordinator of resource development. He added: "We have a steep learning curve."

Yet some consumers are eager to learn more.

Amber Sullivan, a part-time librarian and single mother of two from St. Charles, said her health insurance got canceled about six years ago because she couldn't make the payments. She has gone without insurance since then, racking up an estimated $1,000 of medical debt. She plans to check out the new insurance exchange.

"I'm hoping that I can get insurance for maybe like $100 a month," Sullivan said.

Rebecca Gordon, who runs a small marketing business in Jefferson City, said she has a high-deductible individual insurance policy, and her husband and son are covered under a separate policy. She hopes the new website makes it easier to shop for insurance.

"I'm looking forward to getting possibly better coverage, even if I have to pay a little more," said Gordon, who serves on the board of Missouri Health Care for All, which supports the new federal law.

Though Gordon plans to click on the website Tuesday, she doesn't anticipate enrolling in an insurance plan until later.

"I think a lot of people are waiting to see what will happen. We are, too," said Angela Hirsch, the community services director for Central Missouri Community Action. "I don't know if there will be a mad rush Oct. 1, or if we'll hear crickets."

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