Demetrick Brown shells out $120 a month for emergency insurance, the best he can do on the $16,500 a year he cobbles together by juggling a pair of low-skill jobs in fast food and a movie theater.
His Blue Cross and Blue Shield catastrophic policy doesnt cover a single test or procedure until Brown first pays a $5,000 deductible on his medical bills. Brown, 36, is in no financial position to spend that kind of money on doctor visits and routine exams while chipping away at his $4,000 credit card bill and his $3,000 emergency loan for dental surgery.
On Tuesday, Brown, who lives in Cary, will be among more than 1 million North Carolinians who will find out how they will fare under the Affordable Care Act, President Barack Obamas signature domestic policy and a political lightning rod for critics.
Details of subsidized insurance in North Carolina will become available for the first time, ending months of speculation about who will come out ahead and who will take a hit financially.
Tuesday marks the beginning of open enrollment for subsidized insurance, a six-month period to shop for the new policies, which were designed to meet the requirements of the health law. The first deadline is not until Dec. 15 for those who want new policies to be effective Jan. 1, and enrollment runs through March 31.
Like many of the uninsured and underinsured, Brown knows next to nothing about the new health care law. But like many, hes plenty nervous about what it might mean for him.
For one thing, Brown may not qualify for the lowest-cost catastrophic policy under the Affordable Care Act, a far-reaching law that regulates which services insurers must provide, penalizes hospitals for wasteful practices and requires doctors to use electronic medical records.
Im just hoping that, like, I dont have to pay twice as much, Brown said last week during a visit to the storefront in Morrisville that Blue Cross opened recently to sign up new customers. Right now, I gotta pay this credit card off. Thats whats getting to me.
Unlike some states that have embraced subsidized insurance, North Carolina officials elected not to participate in promoting the health law. As a result, the marketing task here will fall to social workers, paralegals, nurses, intake coordinators and volunteers at nonprofit organizations who will help enroll the public.
Marketing the policies
Scores of social service groups and county health agencies have been preparing to start educating the public about the nations biggest health care policy change since Medicare. The complex new law not only provides federal insurance subsidies up to certain income levels, but also carries penalties for those who dont buy insurance.
UNC Health Care, which owns Rex Hospital in Raleigh, plans to hold a public forum on Thursday at Rex Hospital with representatives of Legal Aid of North Carolina; public sessions are also scheduled in Chapel Hill and Siler City the following week.
Two insurers will sell subsidized policies in this state, Coventry Health Care of the Carolinas and Blue Cross and Blue Shield. The public can also consult with independent insurance agents.
Blue Cross, the states dominant insurer, is aggressively recruiting new customers and opening two shopping center kiosks, including one at Northgate Mall in Durham. Blue Cross is also establishing seven storefronts across the state, including the sales center in Morrisville, where Brown dropped by last week for a status update on subsidized insurance.
The Morrisville store is decorated with posters of young adults engaging in risky activities that subliminally beg for an insurance underwriter: an athlete bicycling along a narrow country road, a carefree woman walking the balance beam on a wooden fence, a laughing girlfriend perched atop her beaus shoulders.
Might not hurt to wait
Because glitches are widely expected in the online enrollment software, many North Carolina nonprofit enrollment groups are prescribing a measured dose of procrastination to buy time for the system to work out its kinks. The software will not be ready to accept online applications from small businesses and could miscalculate federal subsidies designed to help people offset their insurance costs.
Some groups, like Legal Aid, are delaying appointments by several weeks and stocking up on paper applications just in case technical problems experienced by other states also cause malfunctions here.
The Benefit Bank of North Carolina, a nonprofit that serves low-income people, is using its own website to estimate potential eligibility for federal insurance subsidies to get people started if the official site, www.healthcare.gov, is not functioning.
Whats more, the navigators, people who have been trained to coach the public on the intricacies of the Affordable Care Act, wont see the insurance plans until Tuesday, and will need time to study the details before they can advise the public on available options.
If there are glitches in the first week or two, its not fatal to anyone signing up for subsidized insurance, said Ralph Gildehaus, who manages the Benefit Bank. You dont get any advantage by enrolling on Oct. 1.
Even as launch day approaches, conservative critics in Congress are threatening to shut down the federal government if the Affordable Care Act is not defunded. Opponents say the law relies on government coercion to force the public to purchase mandatory coverage and micromanages products sold by the insurance industry.
Its basically centralizing control, said Christopher Conover, a health policy scholar at Duke University and at the American Enterprise Institute in Washington. Its not the Soviet health care system, but its moving in that direction.
It ends up being very bureaucratic and stifling, and you lose flexibility and innovation, Conover said. Just think about how long it took Medicare to get a prescription benefit. Private employers had been offering a drug benefit for decades.
Calculating the benefit
According to Obama administration health officials, insurance premiums under the Affordable Care Act will be lower than previously estimated, but North Carolinas will be above the national average. The state will have 51 subsidized health plans in the new insurance marketplace, but most will be limited to specific counties, regions or provider networks.
Still, Brown, a crew member and trainer at McDonalds and an usher and ticket seller at a movie theater, may discover hes better off under the new system.
Brown could pay as little as $50 a month for insurance, after subsidies are factored in, according to an online calculator created by the Kaiser Family Foundation.
On Tuesday, however, hell be able to fill crucial gaps and find out how much hell have to pay for everything else: his deductible, his co-payments and his cost-sharing obligation under the health care law. He will also be able to assess which doctors, hospitals and labs will be covered and excluded from coverage by the policies he is able to afford.
Both Blue Cross and Coventry have released sample insurance rates for individuals aged 25, 40 and 60. The limited information shows that Coventrys rates are lower, by anywhere from $5 to $167 a month, depending on the policy.
But without knowing how the plans compare in other details, such as deductibles or provider networks, its impossible to draw meaningful conclusions. Coventry will offer 25 plans in 39 North Carolina counties, including Wake, Durham, Chatham, Harnett and Orange; Blue Cross is offering 26 plans in all 100 North Carolina counties, but not every plan in each county.
We know there are information gaps we cant fill until Oct. 1, said Jennifer Simmons, the navigator project director at Legal Aid of North Carolina. Those are the fundamental aspects of the whole program.
Im not clear
Navigator groups expect that reviewing plans and filling out an application could take up to several hours and could require more than one consultation.
Mike Kucera, 51, a self-employed landscaper, is anxiously awaiting the release of insurance details. He pays $133 a month for a catastrophic policy from Blue Cross with a $5,000 deductible and wont qualify for a low-cost catastrophic policy under the Affordable Care Act.
The Kaiser subsidy calculator shows Kuceras monthly premiums could double from what hes paying now, even after $146 in estimated monthly subsidies are factored in to offset his premium costs.
But even so, comparing premiums in isolation could be misleading. Kuceras overall insurance costs might end up comparable when calculating other health expenses that are currently not covered by his catastrophic plan but would be covered under a subsidized policy.
Kucera, who dropped by the Blue Cross store in Morrisville last week for an update, said he has mixed feelings about receiving a federal subsidy, having paid his own insurance costs since college.
Im not clear, Kucera said of his insurance prospects. When I walked into the store, they couldnt really give me a whole lot of information until they get the info.
Legal Aid, which is deploying more than 50 navigators statewide to enroll residents, has sent letters about the Affordable Care Act to about 44,000 clients.
The organizations navigators are paralegals and other employees who will set aside 15 to 20 hours a week for consultations with legal clients and with the public on the requirements of the new health care law.
We anticipate that were not going to be struggling to find customers, Simmons said.