Window on enrolling for insurance closing

Kelley Jenkins of Mansfield talks with Arkansas Department of Health outreach worker DesiRae Hall during a health insurance enrollment fair in Mansfield’s City Hall.

Kelley Jenkins of Mansfield talks with Arkansas Department of Health outreach worker DesiRae Hall during a health insurance enrollment fair in Mansfield’s City Hall.

Sunday, March 23, 2014

WALDRON - Millions of Americans, including thousands of Arkansans, have just more than a week to sign up for health insurance for 2014 or risk paying penalties when they file their income tax returns next year.

Some, including Mike Bolin, 57, of Waldron, say they plan to pay the penalty.

Although he has diabetes and high blood pressure, Bolin, who works for a tour bus company in Fort Smith, said he expects the penalty, along with the full cost of his medical expenses, to be cheaper than buying coverage, even if his premiums are only $150 to $200 a month.

As for the chance that he will have unexpected medical expenses, he said, “There’s not a hospital in Arkansas will turn you away if you’re hurt.

“You can finance that out, and it’s still cheaper than insurance,” Bolin said.

The requirement to have health insurance, taking effect for the first time this year, is part of the 2010 federal health-care law, which also established an annual enrollment period when people who buy insurance on their own, rather than through their employers, can sign up for coverage.

The penalty will be assessed against those who fail to maintain health insurance coverage for more than three months this year.

However, the U.S. Department of Health and Human Services’ Centers for Medicare and Medicaid Services has said it will ensure that the penalty is not assessed against anyone who signs up for coverage during the current enrollment period, which started Oct. 1 and ends March 31, even if their coverage doesn’t kick in until April or May.

For an individual, the penalty for 2014 is generally $95 or 1 percent of the individual’s income above the tax-filing threshold of $10,000, whichever is greater. The penalty amount will be prorated for those who are covered part of the year but have a coverage gap of more than three months.

Those who would have to pay more than 8 percent of their incomes for coverage through their employers or the insurance exchange in their states are exempt from the penalty.

Others exempt from the mandate include members of American Indian tribes, people who have religious objections to purchasing insurance and those who are determined by the secretary of Health and Human Services to have had hardships in obtaining coverage.

Many of Arkansas’ uninsured - adults with incomes of up to 138 percent of the federal poverty level - became eligible for Medicaid coverage on Jan. 1 under the expansion of the program that the Legislature approved last year. Others are eligible for federal tax credits to help them buy coverage.

Medicaid enrollment has surpassed state officials’ expectations, reaching 118,937 as of March 14, but enrollment among those who don’t qualify for the program has lagged.

As of March 10, 29,427 Arkansans who did not qualify for Medicaid had enrolled for coverage through the state’s health insurance exchange.

In its most recent estimate, for 2012, the U.S. Census Bureau’s Small Area Health Estimates program put the number of nonelderly uninsured in Arkansas at 471,902.

The Census figures provide a rough indication of how many of the state’s uninsured might qualify for tax-credit subsidies, which are available to those who don’t qualify for Medicaid and have incomes of less than 400 percent of the poverty level under last year’s poverty guidelines - $45,960 for an individual or $94,200 for a family of four.

To qualify for the assistance, an applicant also must not have access to insurance through another government program or to employer-sponsored insurance that is considered “affordable,” meaning it would cost less than 9.5 percent of his income.

Excluding children in families with household incomes that would qualify for coverage under the ARKids First Medicaid program, the figures show that 175,888 of the Arkansans who lacked insurance had incomes between 138 percent and 400 percent of the poverty level under that year’s guidelines.

So far, enrollment through the insurance exchange, among those who don’t qualify for Medicaid, is less than 17 percent of that number.

On a county level, enrollment - expressed as a percentage of the uninsured in 2012 with incomes that would qualify for subsidies - ranges from more than 30 percent in Desha County in southeast Arkansas to less than 9 percent in Scott County, where Waldron is the county seat.

Bolin said he spends about $40 a month on medical expenses, and he visits the doctor once a year. His wife qualifies for Medicaid because of a disability, he said, and he has a teenage child covered by ARKids First.

Bolin said his employer offered health coverage at one time, but he isn’t sure if it is still available to all employees.

Some Scott County residents don’t qualify for the tax-credit subsidies because they could get coverage through their spouses’ employers.

For instance, Tyson Foods, which operates a plant in Waldron where about 900 of the county’s 11,000 residents work, requires employees to have insurance or provide proof of insurance from another source.

Gary Mickelson, a company spokesman, said coverage is available for less than $50 a month for an individual, and that “affordable family coverage is also available with varying options and premiums.”

DesiRae Hall, an Arkansas Department of Health outreach worker based in Waldron, said some residents are exempt from the federal mandate because they are members of an Indian tribe, which allows them access to tribal healthcare facilities in Oklahoma.

The Census Bureau’s American Community Survey, conducted from 2008-12, estimated that 409 Scott County residents considered themselves at least partly American Indian, including 251 who would also count themselves as being white.

Still, at the Health Department unit in Waldron, Hall said she has been helping about a dozen people each day apply for insurance coverage. Most qualify under the state’s expanded Medicaid program. Eligibility for Medicaid isn’t affected by having access to employer-sponsored insurance.

Hall said she also has helped some who qualified for the tax-credit subsidies.

“We’ll have them leave with tears in their eyes because they’re so happy that they finally get insurance,” she said.

Enrollment through the insurance exchange, among those who don’t qualify for Medicaid, was hampered in October and November by software glitches and other problems with healthcare.gov, the online federal enrollment portal for Arkansas and more than 30 other states.

Arkansans who qualify for Medicaid can apply through the state website access.arkansas.gov. Under the state’s so-called private option, most of those who qualify can sign up for plans on the exchange and have the premiums paid by Medicaid.

While Scott County’s enrollment of those who don’t qualify for Medicaid has been low, with just 64 people signed up as of March 10, its enrollment among those who do qualify for Medicaid was above average as of Feb. 6.

The 494 people who had enrolled as of that date, the latest for which county-level enrollment figures have been released, represented about 49 percent of the 1,012 nonelderly adults who, according to the Census estimate, lacked insurance in 2012 and had incomes of up to 138 percent of the poverty level.

Statewide, the enrollment total of 96,950 represented 46 percent of the 208,831 Arkansans in the same income and age categories.

Desha County had 841 people enrolled, or 84 percent of the 1,000 uninsured, nonelderly adults with incomes of up to 138 percent of the poverty level in 2012.

Idonia Trotter, director of the Arkansas Minority Health Commission, said an outreach worker with her agency has been spreading the word in the county in beauty shops, churches and other places where people gather.

“You have to go where the individuals are,” Trotter said. “We’re making sure that we’re beating the bushes and getting the word out.”

Lawrence Hudson, an agent with Arkansas Farm Bureau Insurance in Dumas, said he’s helped about 50 customers sign up for coverage. About half qualified for Medicaid, while others were eligible for the tax-credit subsidies.

Some already had coverage but were able to find plans through the insurance exchange with lower premiums, he said. Still others decided to stay in nonsubsidized plans that were issued before new requirements took effect under the health-care law on Jan. 1.

Not everyone is eager to sign up, he said.

“You do have some that come by and say, ‘I’m not going to do that anyway,’” Hudson said. “They haven’t gotten fully on board with the government’s health care.”

Front Section, Pages 1 on 03/23/2014