Obamacare: Who’s still uninsured in CT, and why?

New Britain – Connecticut had one of the lowest uninsured rates in the country before Obamacare, and has been heralded as one of the most successful states in rolling out the health law. But even here, on the eve of the second sign-up period for private insurance under the health law, it’s not hard to find people without health insurance.

Like Mary Ann Fortin, who works down the street from the store operated by the state’s health insurance marketplace in New Britain. The East Hartford woman said she didn’t have the right paperwork with her when she tried to sign up. She’s been uninsured for the past couple years, since dropping a plan that grew too expensive. “Right now I’m healthy, thank God,” she said, crossing herself.

Monique Smith, who was waiting for a bus a block away, doesn’t have insurance either. She did until she lost her job in retail over the summer and picked up a part-time job that doesn’t provide full benefits. She plans to sign up for coverage when the next open enrollment period starts Nov. 15.

The next big effort to sign up the uninsured begins this week with the start of a three-month enrollment campaign. Officials at Access Health CT, the state’s health insurance exchange, hope to enroll about 35,000 more uninsured residents — a quarter of the number of people they estimate are uninsured. It’s an effort that will involve heavier advertising on networks like BET and Spanish-language television, and in-person enrollment help at libraries and other sites in areas where many people still lack coverage.

But experts say signing up the uninsured this time around could be a tougher task than last year, when, according to Access Health’s figures, nearly 140,000 people who didn’t have insurance gained coverage.

For one thing, those who were easiest to reach most likely signed up during the previous six-month open enrollment period. (People who qualify for Medicaid can sign up at any time during the year, but most of the marketing is concentrated around the open enrollment period for private insurance.)

This year’s outreach effort is a fraction of the size of last year’s nearly $3 million sign-up blitz. Although foundations are paying for some community organizations to reach out to the uninsured as a way to supplement Access Health’s efforts, the overall number of people doing outreach will be considerably smaller.

And while some of the uninsured, like Smith, know about the upcoming enrollment period and are planning to get coverage, clinics that treat the uninsured say they’re still busy — and don’t anticipate a big reduction in need anytime soon.

Who is uninsured and why?

Connecticut’s uninsured include:

• People who earn slightly too much to qualify for Medicaid. They can receive deeply discounted insurance under Obamacare, but some find even those prices — and the fees required to get care — too costly.
• Those who are not in the country legally, who don’t qualify for coverage options available under the health law.
• Low-income state residents who immigrated legally within the past five years, who don’t qualify for Medicaid (with limited exceptions, such as for pregnant women) but can’t afford discounted private insurance.
• People who “churn” on and off insurance coverage during the year, such as those whose income fluctuates and move on and off Medicaid.

In addition, many families with mixed immigration status — in which some members are here legally and others aren’t — have been afraid to sign up for coverage, despite campaigns to reassure them that information they provide won’t be used to target their relatives, said Robin Lamott Sparks, senior director of policy and research at the Bridgeport Child Advocacy Coalition, which has helped many people sign up.

Other barriers include mistrust of the government or computers. When a person applies for coverage through the exchange, the system pulls up information about the applicant to verify his or her identity, the way a credit check would, and Lamott Sparks said some people last year were shocked that it had information on their car loans or other financial information.

Many people are eager to get coverage: The Bridgeport Child Advocacy Coalition has been booking appointments for a month.

“We’re surprised by how many phone calls we’re already getting,” Lamott Sparks said.

Still, she expects there are many others who will be harder to reach, who aren’t aware of their options.

“They’re not listening to mainstream TV or they don’t really have the internet at home,” she said. “They’re just not being reached that way.”

A national poll last month released by the Kaiser Family Foundation found that 89 percent of the uninsured were unaware that the next open enrollment period would begin in November. Two-thirds said they knew nothing or “only a little” about marketplaces people can use to shop for insurance if they don’t get coverage through their job, one of the key provisions of Obamacare. And 53 percent of the uninsured didn’t know that the law makes available financial assistance to help low- and moderate-income people buy insurance.

Still, the findings indicated that the uninsured could be reachable: 59 percent said they expected to get insurance. Those who didn’t said they didn’t think they would be able to find a plan they could afford, didn’t want to be forced to buy anything, would rather pay a fine, or didn’t think they needed coverage.

Jim Flood, 61, spent this year uninsured for another reason: He said he can’t afford coverage. The Cheshire resident bought insurance for himself and his wife until this year, when their plan’s price rose from $523 per month to $1,450. Flood, who owns a small manufacturing firm, said he and his wife are above the income limit for receiving discounted coverage through the health law. To keep his wife insured — for $577 a month — Flood dropped his own coverage.

“It’s been a nightmare,” he said.

Flood isn’t a fan of insurance in general, but at his age, he said he needs some sort of coverage. So he plans to try to get insurance for next year.

“I’m going to be paying a fortune,” he said. “I have no idea whether I can pay for it or not.”

Football games and Black-ish

Research indicates that the bulk of those who are still uninsured are minorities and city residents, Access Health Chief Marketing Officer Jason Madrak said.

The exchange is tailoring its marketing efforts to try to reach them. That includes heavier ad buys during NFL football games — which Madrak said draw a lot of black males — and on networks like BET and Spanish-language television, as well as during shows that Nielsen ratings indicate have broad appeal and more viewers of color, like the ABC sitcom Black-ish.

One of this year’s ads features a black man encouraging customers at his barbershop to get health insurance. An ad in Spanish features a woman talking about family, with images of children in the background.

Research on the uninsured indicated that most were aware of the availability of health insurance, Madrak said. But many view it as unaffordable — a perception the exchange hopes to counteract by highlighting specific examples of people who qualified for subsidized premiums that reduce their cost to, say, $30 a month.

People also indicated that they wanted help signing up, Madrak said, and the marketing campaigns will emphasize the availability of help by phone, through brokers or agents, or in Access Health’s stores in New Britain and New Haven, and enrollment centers in Bridgeport, East Hartford, Hamden, Hartford, Meriden, Norwich, Stamford, Waterbury, West Haven and Willimantic. (There’s a list of enrollment centers at the bottom of this story.)

Some of the uninsured had more specific reasons for not having coverage, like saying they didn’t sign up because they had car trouble, Madrak said, or misconceptions: One man thought you need to have a job to get coverage.

And Access Health officials aren’t counting on signing up everyone. Figuring that about two percent of the population will always be uninsured, they set a goal of reaching half the “addressable” uninsured, a figure they estimate at 35,000.

It won’t be immediately clear how well they do. Like last year, the exchange’s application won’t include a question about whether the applicant has had insurance. Madrak said Access Health will continue to do studies on its membership, but didn’t want to add another question to the sign-up process.

More uninsured patients

Organizations that provide treatment for the uninsured aren’t expecting a major drop in demand.

AmeriCares Free Clinics, which has four Connecticut locations, saw a 14 percent increase in patient visits from the 2013 to 2014 fiscal years. In part, that’s because a new clinic opened in Stamford. But even the older clinics in Danbury and Norwalk saw considerable increase in demand, Executive Director Karen Gottlieb said.

“We thought that [demand] might go down at the beginning of the year and then rebound at the end of the year, but that’s not the case,” she said. “We’re getting new patients every single day at our Danbury clinic in particular. Usually more than one per day.”

About 300 of AmeriCares’ patients signed up for Medicaid or private insurance through the exchange — making them ineligible to use the free clinics — but the clinics got another 1,113 new patients in 2014.

And although she wouldn’t mind having her clinics become unnecessary, Gottlieb expects there to still be a need for care for the uninsured.

“I think that as more people get insured, it crowds the uninsured out of their usual source of care,” she said. “So I think that we might see some continued growth for the free clinics. I do think, though, at some point it’ll level off.”

At Malta House of Care, a mobile clinic that provides free care to the uninsured in Hartford, about 450 patients — 10 percent of the clientele — qualified for Medicaid as part of Obamacare since January. But in that time, the clinic gained another 398 patients.

“We patiently await the day when affordable care is available to all,” said Bobbie Bartucca, executive director of the Malta House of Care Foundation. “Until that time, we will remain here to provide care that is not available anywhere else for as long as we are needed.”