New Britain – The crowd at the Access Health CT store was so big Wednesday morning that Pedro Lopez decided to put off his plans to buy health insurance there for a few hours.
But when he returned around lunchtime, the store -- run by Connecticut's health insurance exchange -- was still busy, filled with people trying to beat today's midnight insurance sign-up deadline.
It had been more than a decade since Lopez had coverage, and the 43-year-old figured he could put it off a little longer. But as he turned to leave again, a buddy pointed out that if Lopez wanted insurance, he'd have to sign up by Monday.
“I shouldn’t have waited, then,” Lopez said, eyeing the crowd.
It was actually, according to store manager Larease Royes, the day’s slow period.
“Our downtime still consists of 10 people waiting,” she said. The store drew more than 150 people a day last week.
Demand was high in the final days of the first open enrollment period under the federal health law known as Obamacare. Last week, 3,000 to 4,000 people signed up daily through Access Health for private insurance and Medicaid.
Anticipating a rush to sign up today, community health centers, churches, libraries, social service agencies and other organizations are hosting enrollment events, including some that will continue into the night. (The deadline applies only to people buying private insurance; people who qualify for Medicaid can sign up at any time during the year.)
Access Health officials expect to end March with close to 185,000 enrollees, including more than 70,000 in private insurance plans.
Beyond enrollment, big questions remain
Connecticut has earned a reputation as one of the most successful states in rolling out the federal health law, with a website that functioned throughout the enrollment period and overall sign-up numbers that exceeded early goals.
But whether the health law achieves its aims relies on more than enrollment. And as the sign-up period ends, several key questions remain. Among them:
To what extent does the exchange’s membership include people who were previously uninsured, as opposed to people who migrated from other health plans to policies sold through the new marketplace?
How much of a dent has the law made in the uninsured rates among groups that have been less likely to have coverage in the past, such as blacks and Hispanics?
How do the ages and health care needs of the people in the new insurance pools compare with what insurers expected when establishing their premiums, and what will that mean for the cost of next year’s plans?
And, perhaps most significantly, how will the newly insured use their coverage? Will they be able to afford their deductibles and other out-of-pocket costs? Will they be able to easily get appointments with health care providers who accept the exchange plans? And will they begin to use more preventive services, rather than waiting to seek care until they get sick?
'Few and far between'
Rod Yearwood has another question: How many of the people who signed up for insurance will pay their premiums and stay covered?
Yearwood, a West Hartford insurance broker, spent more than three months working in the Access Health store in New Britain. He figures he helped between 450 and 550 people sign up.
Many hadn’t had insurance in years and needed basic preventive services like mammograms.
One recent customer wanted to know if a plan would cover a pre-existing condition. Some people don’t know that the health law prohibits insurers from denying coverage to people with pre-existing conditions, Yearwood noted.
Some older people on Medicare came to the store thinking they had to sign up for coverage (they don’t).
“I’ve seen it all,” Yearwood said. “Young, old, every demographic population.”
With one exception: African-American men, who Yearwood said were “few and far between” at the store. He wishes he knew why.
“I guess these young guys think they’re indestructible, or they don’t need insurance, or it’s not a priority for them,” he said.
Dr. Linda K. Barry, a professor of surgery at UConn Health, also worries about enrollment among young people and minorities. She thinks it won’t keep pace with that of other groups.
“I’ve taken care of the people who wait to the last minute to come to me as a surgeon, and so I’ve seen what it’s like when you don’t have insurance,” she said.
Barry is part of a team that is using social media to try to boost enrollment among young people and minorities. But there’s a drawback to that approach, she noted: It’s hard to gauge if it’s working.
Unreliable data on race, prior coverage status
Although Access Health has data on the age of enrollees -- a third are 55 and older, while 30 percent are younger than 35 -- it has little reliable information about whether enrollees were covered before, and about their race or ethnicity.
The application asks about people’s current coverage, but answering is voluntary, and officials are uncertain how reliable the responses are.
Similarly, the application now asks about race and ethnicity -- it initially didn't -- but the response rate has been low, Access Health Chief Marketing Officer Jason Madrak said.
After the open enrollment period ends, part of the exchange’s focus will turn to market research efforts aimed at learning more about the people who got coverage, and a study of who’s still uninsured and why, Madrak said.
Exchange officials also want their agency to play a larger role in educating people about how to use the coverage.
Trying not to get sick
Lopez, the man debating whether to wait in line to sign up at the store, is eligible for insurance through his job, but he chose not to buy the plan because he said it costs too much and many doctors don't accept it.
His current health plan? “I try not to get sick." Mostly, he hasn’t, although a hernia left him with a huge medical bill.
Lopez’s friend, Gilberto Rodriguez, spent a couple of hours at the Access Health store and signed up for a ConnectiCare plan with subsidized premiums and out-of-pocket costs.
The 62-year-old former machine operator said he has bad legs and can’t work. His only current coverage is a Medicaid “spend down,” meaning that if he spends more than $3,000 on medical care in a six-month period, Medicaid will cover the rest of his care until the period runs out.
He thinks the new plan will make it cheaper to see a doctor and easier to pay for his medications. All he's waiting for, he said, is to get his card in the mail.
“It’s up to God now,” he said.