Jodee Boismier of Bryson City was one resident who signed up for an individual health plan through the online marketplace with the help of a navigator at Swain County Hospital. As a former hospital employee, she was a part of the group plan; but has been uninsured since she left the hospital more than a year ago to open a convenience store in her community.
With the help of navigator Karen Williams, Boismier was able to receive a subsidy and enrolled in an affordable “gold level” policy that she could afford. She said she was glad she went to a navigator to walk her through the time-consuming process.
“Definitely seek a navigator because there is a lot that you need to have explained and the hospital is providing this assistance so you should really take advantage of it,” she said. “There’s a lot involved — copays, deductibles, the gap to consider — so much that has to be taken into consideration.”
While Swain’s uninsured rate decreased by 11 points, surrounding counties saw only a 4- to 7-point difference in a year. The data also showed that overall, the law helped people 18 to 34, women, minorities and people who live in rural areas.
Steve Heatherly, CEO of Harris Regional and Swain County Hospitals, said he could only speculate on the factors that made more Swain residents sign up for health care through the marketplace based on his observations in the community.
“I don’t know all the factors, but on a per capita basis, there were lots of opportunities,” he said. “And the income per capita in Swain is relatively low, so I’m thinking there are proportionately more folks that can benefit from the subsidized rates on the marketplace.”
Jan S. Plummer, marketplace navigator coordinator for Mountain Projects, said it was hard to say specifically why more Swain residents signed up for health care other than that the percentage of people eligible was higher than in other counties.
The unemployment rate is still higher there compared to other surrounding counties. The latest state data from October shows Swain’s unemployment rate at 6.4 percent compared to 4.4 percent in Haywood and Jackson, 5.2 percent in Macon and 4 percent in Buncombe County.
Plummer said Swain is a tier 1 county, meaning it has some of the poorest neighborhoods in the state. The tax subsidies really helped people who live below the poverty line or who were employed in jobs not offering insurance.
“I also think it has to do with having someone there in Swain focused on providing in-person assistance and holding outreach events before open enrollment last year,” Plummer said. “And maybe more people needed coverage because they didn’t have a coverage option through an employer.”
Still time to sign up
Western North Carolina residents have plenty of resources to help them sign up for coverage through healthcare.gov, including health care navigators with Mountain Projects and through certified application counselors at Harris, Swain and Haywood hospitals.
The hospital application counselors and the health care navigators helped people re-enroll through Dec. 15 and are still helping people enroll for the first time. People wanting coverage to start Jan. 15, 2015, had to enroll by Dec. 15, but open enrollment will continue through Feb. 15.
Area hospitals have a vested interest in getting residents to sign up for health care coverage. Heatherly said the hospital is actively helping people sign up for health care because it keeps the community healthier.
“We view it as an important part of being a community health provider,” he said. “There’s lots of data demonstrating folks with insurance lead healthier lifestyles because they get preventative care that they should get. That leads to better health outcomes.”
Having more patients insured also puts the hospital in a better financial position because it can receive more reimbursement from insurance companies and because preventative health measures use fewer resources than emergency care.
“Certainly from a hospital financial perspective, reimbursement is better when patients have a form of insurance — that’s a fact,” Heatherly said. “So this is a financial initiative but also a community service initiative. It’s the right thing to do and the right thing for the hospital financially.”
State policy also has made a difference in how many people are signing up for health care nationwide. North Carolina did not expand Medicaid, which would have made 500,000 more people in the state eligible for coverage.
Heatherly said expanding Medicaid would benefit the hospital and the community it serves. Again, if patients had Medicaid, they would be more likely to see a doctor more regularly and have better health outcomes.
“There are still folks that seep through the cracks and can’t afford the subsidized rates from exchange products, and for the hospital it’s generally better for someone to have Medicaid as opposed to no form of payment source,” he said. “We’re paid a little better from that program then nothing at all.”
Harris and Swain County hospitals have three certified application counselors who can assist people in signing up for insurance either over the phone or in person through February. For more information, call the hotline at 888.982.9144 or 828.686.7355.
Swain County also has two designated navigators through Mountain Projects who still are available by appointment to help people re-enroll or enroll for the first time through heathcare.gov.
Plummer said she and the other navigators were pleasantly surprised to see so many people coming back this year for their help in re-enrolling as well as so many people signing up for the first time. She said many people who enrolled last year were worried because they received a notice that their premium was increasing next year.
However, Plummer said there are more plan options this year compared to last year and the subsidies have increased.
“So people who think their premium is going up this year still may get additional financial assistance,” she said. “Premiums typically go up year to year, but the federal poverty levels have also changed, which means there are higher tax subsidies available.”
Those who signed up last year do not have to see a navigator to re-enroll this year, but Plummer encourages people to call them if they have more questions about how the plans have changed. While the health care website had glitches last year, she said the application was simpler this year and the website was easier to navigate.
To make an appointment with a navigator, call Mountain Projects at 828.452.1447.
Navigating the insurance maze
Certified Application Counselors from the hospital as well as local insurance brokers will be available to discuss coverage options and help attendees select a plan that is right for them.
• 5 to 7 p.m. Thursday, Jan. 15, at Smoky Mountain High School cafeteria, 100 Smoky Mountain Drive, Sylva.
• 5 to 7 p.m. Tuesday, Jan. 20, at Swain County Chamber of Commerce, 210 Main Street, Bryson City.
For more information on either event call 828.631.8924.
• Mountain Projects navigators will be available to answer questions from 9 a.m. to noon Wednesday, Jan. 21 at Joey’s Pancake House in Maggie Valley. They will have computers and navigators onsite to help people sign up for insurance through the exchange.
WNC uninsured comparison
2013: 25 percent
2014: 14 percent
2013: 21 percent
2014: 16 percent
2013: 22 percent
2014: 15 percent
2013: 20 percent
2014: 16 percent
Source: Enroll America