California vs. Arizona: A tale of two health care states

YUMA, Ariz. — At the Sunset Community Health Center, most of the people who were eager to sign up for the new health insurance marketplace when enrollment opened Oct. 1 don’t even bother showing up anymore. They’ve all been advised to wait until early December or to try enrolling on the phone or via snail mail.

“Nobody’s been able to sign up,” said Sylvia Armendariz, an eligibility-outreach worker who helps applicants navigate the process at the center. “Due to the system glitches we’ve had, it’s been unsuccessful for me to access the website ... You try to register and it freezes.”

At the Regional Center for Border Health in nearby Somerton, one person is assigned the task of logging in to the troubled HealthCare.gov federal site every morning and every afternoon to see if it’s finally up and running. So far, every attempt has been thwarted by error messages.

“My first experience was with somebody sitting down to register, and we had to reschedule the visit,” said Yadira Escamilla, a family coordinator and navigator who runs the center’s Women’s Health Clinical Services. “To me, it was kind of embarrassing, but it’s just out of my control.”

But just across the state line in California, more than 35,000 people have signed up for health care mandated by the Affordable Care Act, commonly known as Obamacare. Covered California, the state-run exchange, has generated complaints of long waits but has been largely spared the technical glitches that have brought the federal marketplace to a halt.

And so it goes for residents of the District of Columbia and the 16 states that have set up their own insurance exchanges and those in the 19 states that chose not to participate and left their residents to rely on the federal insurance marketplace. (The remaining 15 states are in a federal-state partnership.) The federal site’s troubles have generated calls to push back the enrollment deadline, something the Obama administration is resisting.

Enrollment is below expectations in most places, regardless of whether the registration process is state or federally run. A recent estimate by a consulting firm puts enrollment in 12 states with their own exchanges at 3 percent of projected 2014 enrollment.

The challenges are greater in states like Arizona that are helpless in the face of technical snafus with the federally run site.

“It would be nice if we had that magic wand,” Armendariz said.

She has tried to process up to 75 applicants since Oct. 1, with no luck and has had to ease their fears of not meeting the March 31 deadline for open enrollment and having to pay a penalty if they don’t get coverage by then.

“They’re afraid,” said Lucy Murrieta, outreach and community-relations manager for Sunset, the largest health care provider in Yuma County, with five clinics in the area. “How do we explain to a lot of people who are bombarded with so much information? There’s so much language within the marketplace. What is a deductible? What is a copay? In Spanish, it’s even worse.”

Depending on an uncooperative system is a huge setback for a state that has about 1 million uninsured people. Groups like Sunset have received funding to organize community forums, many in libraries that provide Internet access for those who don’t have it at home.

Only about a quarter of the 106,000 people who signed up for health care from Oct. 1 to Nov. 2 used HealthCare.gov, Health and Human Services secretary Kathleen Sebelius said Wednesday. The other three-fourths used the state exchanges — 45 percent of them from California.

Javier Ayala, 53, has tried to get on HealthCare.gov from Day One. He tried at midnight. He tried at 3 a.m. He tried just before the morning rush.

“Oh, my gosh,” he said. “It doesn’t work. I got tired with that stuff. As soon as I start typing the name, they cut me off. Oh, my God.”

Ayala gets disability insurance. His two children are covered under Arizona’s KidsCare program for lower-income residents. But his wife, Alicia, who works part-time as an instructional aide for Crane Schools in Yuma, has no coverage, and that’s why he’s still trying to get on the site.

He worries about her, but they both fret about their kids’ losing their insurance because of the changes to the system.

“They’re covered — for now,” said Alicia Ayala , 50. “Who knows? I just hope my kids don’t lose their insurance.”

Navigators — appropriately named advisers who help applicants make their way through the maze of requirements and options created by the Affordable Care Act — are not sitting on their hands while they wait for the website to start functioning. The ACA expanded Medicaid coverage to include people making up to 138 percent of the federal poverty level ($23,550 for a family of four) to cover the gap between those who qualify for Medicaid and those who qualify for subsidies through the health insurance marketplace. The federal government will cover 100 percent of the additional Medicaid costs for three years and 90 percent after that. Last June the U.S. Supreme Court upheld the health care overhaul but allowed states to opt out of Medicaid expansion.

Almost half did.

In Arizona, however, Republican Gov. Jan Brewer fought conservatives in her party and signed a bill that made about 300,000 additional poor and disabled residents eligible for Medicaid.

And that’s why most of the people filing in to community health centers are applying.

Vanessa Vera, at Sunset with her son and nephew, said she qualified before for the state’s Medicaid benefits but her mother did not before. Vera needed to see if Medicaid will now cover her mother.

The center has received 28 applications for the marketplace and 200 for Medicaid, Murrieta said.

The Regional Center for Border Health in Somerton has five family-care coordinators, most busy helping Medicaid applicants. Only eight applications for the marketplace are pending.

“We register them with general information, but when it gets to picking the plan, it freezes,” said Mariajose Almazan, director of community resources and program development.

Some would rather stay without insurance, she said, and pay a penalty.