Missouri health policy enrollment to miss goal

KANSAS CITY, Mo. -- Last-minute efforts across Missouri were expected to boost the number of consumers gaining coverage through the new federal health insurance law, but organizers said they still don't expect the state to hit anticipated enrollment targets.

The Cover Missouri Coalition, which oversees the statewide effort, had expected state enrollment through the Affordable Care Act's online health insurance marketplace to top 100,000 by Monday's 11 p.m. deadline. When the program was rolled out last year, the federal government projected Missouri's six-month enrollment to hover near 120,000.

Missouri is one of 36 states where the online marketplace is being run by the federal government after state lawmakers balked at participation in President Obama's signature legislative effort -- a stance adopted as well by a majority of state voters. Missouri's Republican-led Legislature has also repeatedly rejected Medicaid expansion proposals.

The state also sought to limit the number of insurance counselors, known as navigators, who could help consumers understand a federal government website plagued by early glitches that took weeks to fix. Those technical snags returned Monday, with the healthcare.gov website shut down for nearly four hours in the morning, followed by a shorter midday service failure.

Jay Angoff, a former Missouri insurance commissioner who later helped implement the federal health-care law as a top adviser to U.S. Department of Health and Human Services Secretary Kathleen Sebelius, said the preliminary enrollment statistics in Missouri, while short of the federal target, are a "testament to the demand there is for health insurance." The online marketplaces are for those who don't receive employer-sponsored health coverage or certain residents eligible for workplace plans but looking for better deals.

"Missouri really is one of the most obstructionist states in the nation with respect to the Affordable Care Act," said Angoff, Missouri's top insurance regulator from 1993 to 1998 and now a Washington lawyer. "Can you imagine if there weren't this complete dedication of the opponents, how many more people could have enrolled?"

Deadline-day activities in Kansas City and St. Louis resembled the final, frantic hours of a political campaign, with organized community events to boost enrollment as well as aggressive social media efforts and door-to-door messages not unlike a neighborhood precinct's get-out-the-vote drive. Some advocates were even available to drive their neighbors to enrollment sites, said Ryan Barker, vice president for health policy at the Missouri Foundation For Health.

In St. Louis and Columbia, clinics extended their normal workday hours well into the night, pushing up against the deadline.

At the Samuel U. Rodgers Health Center in downtown Kansas City, the line of federal health insurance clients began forming even before the clinic's doors opened at 7:30 a.m. Monday, said enrollment counselor James Torres. With just three certified application counselors available -- one fewer than normal, because of illness -- Torres called his efforts "basically triage."

"Demand is very high," he said. "And the learning curve is still very steep."

Tatyana Uglova, 59, said she and her husband have been without health insurance since she lost her job as an information technology specialist for the city of Kansas City nearly one year ago. She came to the Kansas City health clinic Monday for some firsthand guidance.

"I tried a couple of times to enroll online," she said. "I don't have a lot of information. The process was a little confusing."

The Cover Missouri Coalition's March enrollment blitz included a series of radio and online ads, parties with live music, free food and advice from tax preparers. In Portageville, coverage coordinator Mona Walls of the Delta Area Economic Opportunity Corp., which serves six counties in the state's bootheel, was planning for a late night.

"We are going to be here as late as we need to," she said.

------

Follow Alan Scher Zagier on Twitter at http://twitter.com/azagier