It’s hard to believe that the Affordable Care Act (aka Obamacare) just celebrated its third anniversary, and yet many of the big changes that will affect the most Americans—and impact us most profoundly—won’t kick in until October 1, 2013, with more coming on January 1, 2014.
Which doesn't mean that we're thinking about health insurance just yet, or know what to expect: A Kaiser Family Foundation poll conducted in early March 2013 found that 48 percent of those polled said they hadn't heard anything from their state about state-run health insurance exchange, and most Americans said they don't understand how the law will affect them.
But the changes, whether you like it or not, are coming: In October, state insurance exchanges will open in every state, ready to sign up individuals and many small businesses for health insurance that takes effect at the start of next year. The law requires that states make enrollment possible online, by mail, in person, or by phone.
And how will Americans enroll? It starts with a form, a draft of which was quietly released by the Department of Health & Human Services (HHS) a few weeks ago. (You can find it at the CMS.gov site, which runs Medicare and Medicaid, under the form CMS-10440.)
The length of the mail-in “Application for Health Insurance”—21 pages—and some hard-to-follow language have sent many consumers and health advocates into a tailspin. It is worth emphasizing that this version is still very much a draft, and also that the online version of the form is still in development (no draft of that version has been released yet); that is the same version that will be used by people who apply in person or by phone.
Mara Youdelman, managing attorney for the Washington, D.C. office of the National Health Law Program, which advocates for the health rights of minorities and the underserved, says the written application is both complicated and long, because it can be used for up to six people in a household, some of whom may be eligible for different types of coverage such as Medicaid or the Children’s Health Insurance Plan. With the online system, answers will trigger prompts that skip some of the questions, but that’s not possible to do with the written form, says Youdelman.
Sarah Bagge, a health policy analyst for health reform advocacy group FamiliesUSA, also based in Washington, D.C., says that HHS, which will supervise the Affordable Care Act, estimates that each applicant will see less than one-third of all possible questions on the form if they apply online.
FamiliesUSA and the National Health Law Program are among many groups that have submitted recommendations to improve and streamline the written form. “We don't know yet what changes HHS will make,” says Bagge. “They received over 100 sets of comments and are continuing to do consumer testing. Changes will be based on feedback from both of those sources.” Bagge says FamiliesUSA thinks most applicants will use the online application; she bases this educated guess on information from Oklahoma, the only state with an online Medicaid application. According to a recent article in the journal Health Affairs, the state receives 94 percent of its applications online.
Bagge says HHS has not yet released a draft version of the online application form because the agency is still developing the electronic connections that will be needed to sync the information applicants put in and the prompts to send them to the next question or section. For example, when an applicant types in their income, the system searches to see whether they’re eligible for a subsidy. “HHS has done a great job overall of making a complicated eligibility process simple for consumers,” she notes.
Key issues on which FamiliesUSA made comments include suggesting simpler language on a form for employers to help them determine if their employees are eligible for subsidies; using the application to identify more disabled Americans that are eligible for special Medicaid benefits; and offering in-person help with the form for people with limited English proficiency.
Youdelman says advocacy groups know that the process of getting the application form to be comprehensive and simple to use is far from easy. “It really is threading the needle, between making it easy to apply and asking enough questions to get individuals into the right program,” she says, adding that younger people who are comfortable online should be able to get through the process fairly quickly.
While some complexity will remain, every state will offer help for applicants. Expect to see announcements from your state health department by July 1, or even sooner. Keep in mind, though, that a few states, including California, Washington, and Maryland are creating their own forms, which could differ from the national one ultimately released by HHS. Those states would like to use the health insurance form for other state programs such as food stamps and think it will be easier for people to sign up for state benefits if they only have one form to file. HHS, however, must approve the forms the states use, says Mara Youdelman.
Do you think you’ll sign up for health insurance through an exchange this fall? Are you afraid of the form, or do you think it’ll be simple to use?