Getting covered: A local look at the Affordable Care Act

carrie foxhall

Since July, Foxhall has been working with the Walton Community Health Center under a federal grant as a public assistance specialist, educating the community about the health insurance marketplace and helping individuals and families enroll in a plan that fits their needs and budget.

Jennie McKeon | The Sun
Published: Thursday, March 6, 2014 at 03:24 PM.

Since the healthcare.gov re-launch Dec. 1, Carrie Foxhall has successfully signed up more than 300 people for health insurance provided through the Affordable Care Act — or ObamaCare. Those she helps come from all walks of life.

"I helped a local man who was employed in Walton County, his children were insured through Florida KidCare, but to insure his wife through his employer it would bump his policy to a family plan, which was $700 a month," she explained. "So we were able to get his wife's insurance for $100 a month through the exchange."

There are more stories where this came from. Like the woman who had fallen down a flight of stairs and suffered brain damage. Her husband filed for divorce and with alimony as her only form of income, she could not afford health insurance, but had major medical bills ahead of her. When Foxhall found a plan for her, her parents cried with relief.

Another gentleman that came to her was disabled, but could not survive on his disability checks alone so he got a job paying minimum wage ($7.25). However, having a job disqualified him for his disability insurance and he was promptly canceled. He couldn't afford the premiums through his employer's insurance plan. Foxhall got him a plan that cost $150, saving him about $300 a month.

"It is extremely rewarding to help these people," she said. "Most of them hug me on their way out."

 

Getting Covered

Since July, Foxhall has been working with the Walton Community Health Center under a federal grant as a public assistance specialist, educating the community — Walton County and beyond — about the health insurance marketplace and helping individuals and families enroll in a plan that fits their needs and budget.

"I have been crazy, crazy busy," Foxhall said. "Just the other day, I had left my office for three hours and when I came back I had six messages on my work cell phone and 13 on my answering machine."

The DeFuniak Springs-based Walton Community Health Center saw a need for Foxhall through the amount of uninsured patients that have come in to the clinic. The center offers low-cost primary and dental care to anyone whether or not they have insurance.

Foxhall spends approximately two hours with individuals and families to enroll in health insurance policies. Some have never even used a computer prior to enrollment.

"Being a native in this area, I see the need for affordable health insurance," she said. "This region is economically depressed. There are so many self-employed people who can't afford health insurance and even some who can't afford it through their employer."

 

The gap

Nine out of 10 who come for help walk out of Foxhall's office enrolled in a health insurance plan. For those who are denied, she files exemption forms so they are not penalized or appeals the denial. Still, there are some who cannot get the coverage they need.

As Florida was one of the 26 states that did not expand Medicaid coverage, there are still some gaps in providing health care for the uninsured.

Medicaid still covers children and pregnant women, but for individuals who do not meet the income requirements for the health insurance marketplace, they are left with no other options. For example, an individual who makes under $11,490 or a family of four that brings in under $23,550, does not qualify for coverage from the health insurance marketplace.

While the Walton County Health Department and the Walton Community Health Center help provide care to these uninsured, it's still a risky move to go without.

The rate of uninsured Americans has dropped slightly. According to the 2012 U.S. Census, 48 million were uninsured, down from 48.6 in 2011. The same census data shows Walton County's population at 55,043 — 35 percent of which live below 200 percent of the federal poverty level (under those guidelines, individuals who make around $22,980 are 200 percent below poverty level).

Limited access to affordable healthcare affects more than 28.2 percent of county residents (15,852) under the age of 65 who have no type of health insurance coverage. The county is also designated as a Health Professional Shortage Area (HPSA) for primary, dental and mental health services for the low income population. It is also labeled a Medically Underserved Area (MUA) and the low income population is recognized as a Medically Underserved Population (MUP).

Despite varying opinions about the new health care system, Carrie Foxhall says her job is God's work, and she believes it. If it were 15 years ago, she'd be sitting on the other side of that desk.

"I was a single mother and couldn't afford health insurance through my work," she said. "I've been there — I've been sick and could not afford to go to the doctor because it would literally take food out of our mouths. I could've benefited from this program."

 

The Sacred Heart Perspective

The uninsured are just as susceptible to illness. And when they go to the doctor's office or emergency room with no insurance, it leaves some pretty hefty bills to pay.

 "Annually we give $32 million worth of compensated care," said Roger Hall, president of Sacred Heart on the Emerald Coast. "That's just us, it doesn't include Sacred Heart in Pensacola. As a Catholic healthcare system our mission is to leave no one behind."

Healthcare consumes 18 percent of the Gross Domestic Product (GDP) and analysts predict spending could reach 20 percent by 2021.

"Regardless of politics, we need everyone to have insurance," Hall said. "But we need to understand the Affordable Care Act is not about driving down the cost. Even if everyone had insurance, health care is so expensive right now."

Even when the uninsured get help, it's likely they will be back in the hospital.

"We find often that those with health insurance are more compliant with follow-up care post discharge," Hall said. "For a person that comes to the hospital, lacking in funds, having a re-occurrence in illness is very high."

 

One Business Owner's Story 

For business owners, the most difficult aspect of the Affordable Care Act is making sense of the constantly changing law, said Fudpucker's Tim Edwards.

"The number of man hours we have spent trying to understand the law has been magnificent," he said. "And the laws keep changing."

As owner, Edwards has between 400 and 500 employees, a majority of which are seasonal. More than 200 meet the full-time equivalent requirements of the healthcare law.

Edwards has been offering health insurance to his salary employees for more than 20 years. Employees who worked for the company for more than a year and clocked in 30 hours a week, were eligible for insurance. The longer they worked with the company, the less they had to pay in premiums. Once they reached seven years of employment, 100 percent of their premium was paid.

Being proactive, Edwards set to restructure healthcare insurance for his employees before the mandate. He credits help from insurance agents, attorneys and accountants and advises business owners to seek the same assistance.

A noticeable change in the new health insurance system was the premium cost.

"The premiums have risen, but I don't know if that is a result of the Affordable Care Act," he said.

What was a result of the healthcare law is that employers can no longer offer a better deal for insurance for one employee and not another. Even Edwards' 100 percent premium coverage was against the upcoming law. So some employers had to pay more.

"A positive out of the Affordable Care Act is that I no longer take it for granted," he said. "It's a benefit that's no longer invisible."

Despite the headaches and massive amount of time the new law takes, Edwards sees health insurances as a way to take care of the people that help take care of him.

"There is no business in existence, except for self-proprietorship, that doesn't rely on talented employees," he said. "We provide benefits such as insurance to attract and retain talented employees."

 

DON'T MISS THE DEADLINE: Open enrollment for 2014 ends March 31. If you have questions or need assistance signing up for coverage through the Affordable Care Act Marketplace, contact Carrie Foxhall at 892-8040 ext. 1174, 333-4151 or Carrie.Foxhall@FLHealth.gov.  Health insurances companies can also no longer deny coverage based on pre-existing conditions. More than 100,000 people are currently enrolled nationwide in the federally-run Pre-Existing Condition Insurance Plan (PCIP). The PCIP enrollment period closes March 15.

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