In Rhode Island, an imperfect yet hopeful Obamacare launch

Navigators troubleshoot enrollment, and outreach to the poor remains a pressing concern

Consumers wait at HealthSource RI, Rhode Island's state exchange vendor.
E. Tammy Kim for Al Jazeera America

PROVIDENCE, R.I. — The debt from his wife’s thyroid cancer treatments — $18,000 and mounting — drew Jaime Yepes to the industrial park on Little Royal Drive. On Oct. 2, the day after the full launch of Obamacare, he arrived at the walk-in and call center of HealthSource RI, the state’s health exchange vendor, looking weary, with mussed salt-and-pepper hair and an un-tucked plaid shirt. He sat in a brand-new armchair in a brand-new waiting room, eager to try out America’s great experiment in health insurance.

Yepes, a 49-year-old food-service worker from Colombia, has followed the Obamacare debate via the Spanish news channel Univision. He’d been looking forward to the Affordable Care Act (ACA) and was therefore “frustrated with the [government] shutdown. I thought it was gonna create problems for Obamacare, but I was glad it didn’t.”

He and his wife and four children were hoping to purchase a reasonably priced plan under the ACA, without fear of lifetime caps or restrictions on preexisting conditions. But he waited until the second day: “I didn’t want to go the first day because they wouldn’t know what’s going on.”

At the walk-in center, Yepes was called into a small back room. A woman trained as a health care navigator sat with him at a computer, going through each screening step at healthsourceri.com. “They had to get so much information from me,” he said. “These people have to know what I eat for lunch!” At one point, Yepes had to go home to retrieve some documents he hadn’t thought to bring, like his income tax return and Social Security card.

Yet after three hours with the navigator, Yepes left HealthSource RI without having enrolled or gotten a sense of what a decent plan might cost his family. The system would not process his wife’s green card number, and because he did not have all the information the exchange needed, “They couldn’t give me any information at all about the plans,” he said. This, he found frustrating.

“I’m buying a product, and they have many different products, so why can’t they get that information to me?” His plan now is two wait “two or three months” before trying again. “I think they’ll be in good shape by then.” 

He and his wife and four children were hoping to purchase a reasonably priced plan under the ACA, without fear of lifetime caps or restrictions on preexisting conditions.

Yepes is among the 124,000 uninsured Rhode Islanders -- about 12 percent of the state’s roughly 1 million residents -- that Obamacare hopes to reach. According to Ian Lang, director of marketing and communications for HealthSource RI, the state has put a “heavy focus on small businesses,” a strategy he said could reach 35,000 enterprises and 300,000 people. (Lang developed this approach with exchange director Christie Ferguson, who oversaw Massachusetts’ “universal” health care program.) Although Rhode Island is small and beset by pension woes and an unemployment rate of 9.1 percent — much higher than the U.S. rate of 7.3 — it boasts a high concentration of small businesses and a relatively generous safety net.

Advocates for low-income families are critical of this business-first strategy. They worry that outreach efforts are bypassing hard-to-reach communities and those who have recently lost insurance due to Medicaid cuts, including some 7000 parents earning between 138 and 175 percent of the federal poverty level whose coverage will be discontinued after Dec. 31. (The idea was that this group could be insured more efficiently through ACA subsidies in 2014.)

HealthSource RI plans to reach uninsured and underinsured individuals through a combination of phone, Internet and in-person (navigator) “touch points,” none mutually exclusive. In the first day and a half of the Rhode Island exchange, according to a state spokeswoman, the call center had fielded 2,198 inquiries and 30 walk-ins, and 10,735 unique visitors had come to the website; 1,533 consumer accounts had been created, with 252 applications fully processed.

Among the state’s subcontracted navigators is Liz Auger, a 15-year employee of the non-profit Providence Center, a community health organization. Last week, Auger received three days of intensive training to become a certified navigator before the Oct. 1 launch. Her first client came in on Oct. 2, but due to a technical glitch on the website, she had to deliver verification documents to the call center, about the same time as Yepes’s visit.

She nevertheless praised the ACA, which she expects will cover her uninsured son as well clients who work low-wage jobs in restaurants and construction. “A lot of them don’t have insurance. The ones that make over the [Medicaid] income cap will now get it.” 

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