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Nonprofits push to get uninsured covered under Obamacare

| Saturday, Oct. 29, 2016, 10:30 p.m.
An Obamacare sign is seen on the UniVista Insurance company office on Dec. 15, 2015, in Miami.
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An Obamacare sign is seen on the UniVista Insurance company office on Dec. 15, 2015, in Miami.

The federally funded nonprofits that have helped reduce Pennsylvania's uninsured rate to one of the lowest in the country over the past three years face a challenge as individual health insurance premiums spike for 2017: convincing people to keep their plans.

The state Insurance Department approved increases averaging 32.5 percent for next year for individual health plans sold on the marketplace established by the Affordable Care Act, with rates for some plans shooting up far more than they did for 2016.

Groups such as Pittsburgh-based Consumer Health Coalition and Philadelphia-based Pennsylvania Health Access Network plan to call everyone they can who has enrolled in one of the plans to remind them of their options as they receive letters stating their new rates.

“People panic when rates go up,” said Antoinette Kraus, director of the Philadelphia-based group. “They get paralyzed and don't do anything.”

The nonprofits, with about $3 million in federal grants for the fiscal year, will remind people that federal subsidies increase as rates increase, blunting their impact, and that many people can save money by shopping around to find a new plan.

“It's really important to come back and see what your options are,” Kraus said.

About two dozen nonprofits have helped enroll about 412,000 Pennsylvanians for marketplace plans since 2014, the market's first year. Enrollment in those plans and in Pennsylvania's expanded Medicaid program have driven the uninsured rate down to 6.4 percent, the 15th-lowest in the nation, according to the Pennsylvania Insurance Department.

Heading into the marketplace's open-enrollment period, which runs from Tuesday through Jan. 31, the groups are trying to find and enroll the about 800,000 people who lack insurance.

“It's harder to reach those that are left,” Consumer Health Coalition Director Lou Ann Jeremko said.

One of the most difficult demographics to reach, Jeremko said, is the same for Pennsylvania as for the nation: men who are 24 to 32. Latinos and black people have proved difficult to enroll.

This year, the groups will increase outreach at colleges, churches and other places the uninsured naturally go, she said. The nonprofits' enrollment experts, known as navigators, have found those places to be better for enrolling people than events at places like libraries or at health fairs, she said.

Jeremko estimated 75 percent to 80 percent of the people the coalition serves are enrolled in Medicaid. The nonprofit plans to increase outreach to those who are Medicaid-eligible at unemployment offices, food pantries and homeless shelters, she said.

The coalition employs seven full-time, year-round navigators and oversees about $730,000 in grants for four nonprofits reaching 42 counties. This year is the second of three for which the federal government allotted money for enrollment assistance.

The groups check in on the newly insured throughout the year, Jeremko and Kraus said.

Education is a big part of the job, they said. A September survey from UnitedHealthcare, the nation's largest insurer, shows how much it is needed.

The survey found that just 7 percent of the U.S. population showed an understanding of four basic insurance terms: premiums (monthly costs), deductibles (a set amount people must pay per year for health care before the insurer starts paying a portion of the costs), out-of-pocket maximums (amount beyond which the insurer pays all costs) and co-insurance (the percentage of costs an insurer pays for treatment, usually after the policyholder meets the deductible).

The groups this year will remind people that tax penalties for not having insurance have reached their highest levels since the law's passage, costing $700 or more for people who go without insurance for more than two months.

Insurers have said the 2017 increases are needed to bring premiums even with the costs of treating the sicker-than-expected people who signed up for marketplace plans. Pittsburgh-based insurer Highmark Inc. reported it has lost more than $800 million on its marketplace line of business since 2014, when it set some of the lowest premiums in the country.

Pennsylvania Insurance Commissioner Teresa Miller, after capping rate increases at 27 percent for 2016, said she approved the larger 2017 increases to keep insurers from abandoning the market.

The 2017 marketplace plans may be viewed at The site displays plan prices and subsidy amounts for which people are eligible based on age, income and smoking status.

“Your actual premiums are going to vary ... but I think there are going to be affordable options for a large number of Pennsylvanians,” Miller said.

The premium for the second-lowest-cost silver plan, a popular benchmark plan sold on the marketplace, is $236 per month before subsidies for a 40-year-old male living in Allegheny County, according to Centers for Medicare and Medicaid enrollment data. The plan, sold by UPMC Health Plan, has a $1,750 deductible.

For a man making $25,000, subsidies would lower the premium to $142 per month, according to

The state is encouraging the about 153,000 Pennsylvanians who buy “off-exchange” individual plans from a broker or directly from an insurer, rather than from the marketplace, to see whether they are eligible for subsidies on the marketplace. About 111,000 of them might be, according to federal estimates.

Miller said the state has developed videos for its website and a shoppers guide to help people get covered.

Wes Venteicher is a Tribune-Review staff writer.Reach him at 412-380-5676.

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