After years of chatter and debate, some 640,000 uninsured Kentuckians on Tuesday will have their first full look at what the Affordable Care Act — or as it's commonly called, Obamacare — means to them.
State officials anticipate that 308,000 of those will newly be able to sign up to be covered by Medicaid under an expansion of that program.
For the other 332,000, the state's program, called Kynect, will lay out on its website, Kynect.ky.gov, and in its literature the specifics: the rates they will pay, the insurance carriers working in specific regions, the doctors and health care providers who are available to them, and the subsidies and tax breaks available for individuals.
Kentucky's program is gaining national attention both positive and not so positive.
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A story in The Wall Street Journal featured outreach efforts at Hatfield and McCoy Heritage Days in Pikeville and indicated rural Kentuckians are hard to reach because "they have less access to the Internet." NPR's news-quiz show Wait, Wait Don't Tell Me had a segment mocking the name Kynect.
But Gov. Steve Beshear made it clear Kentucky is charging forward. He ended an op-ed piece that appeared in The New York Times on Friday with this line directed to critics and naysayers who hope Obamacare can be repealed: "Get over it ... and get out of the way so I can help my people."
Why is interest in Kentucky's approach to Obamacare so widespread?
The commonwealth is one of 17 states that chose to create its own program, or health insurance exchange, instead of relying on the federal government to create system and set rates for its residents. It is the only state in the South to have a health exchange and an expanded Medicaid program. It is also a state that is routinely ranked as having the poorest health, according to research by the Kaiser Family Foundation, a California-based nonprofit, nonpartisan organization that focuses on health issues.
"Health advocates from across the South are watching to see if it works," said Cara Stewart, an attorney with the Kentucky Equal Justice Center, a nonprofit advocacy group. If it works here, she said, other states might feel the pressure to get more engaged in reform.
At the same time, people who hate the idea of Obamacare are watching just as intently. David Adams, a Kentucky Tea Party activist, said the state's rollout will show the flaws in the basic premise of health care reform, which he said are "disastrous and widespread."
How many users and how to reach them
So there is a lot of noise but what does it all mean?
Because the Affordable Care Act includes the nearly unprecedented requirement that nearly every American sign up for health insurance between Oct.1 and March 31 or face a penalty, even the experts cannot say whether its unveiling will be met with a whisper or a roar.
State officials would not venture a public estimate as to how many people they expect to sign up immediately for coverage.
But a small percentage of people with chronic illnesses who couldn't get private insurance but previously didn't qualify for Medicaid will surely be clicking on the website at 12:01 a.m. Tuesday, Stewart said. She calls them the "desperate and the waitings."
But Stewart has put thousands of miles on her car traveling the state to let some of the 640,000 uninsured in Kentucky know what is available because "there are plenty of people who have no idea that this is happening," she said.
Last week, she said, she met with the head of a rural hospital who wasn't well-versed on the program. She said he has since taken out a full-page advertisement in his local paper and is planing to contact uninsured patients whom his facility has served in the past few years to let them know they may be eligible for Medicaid or subsidized coverage.
According to a recent Kaiser Family Foundation Poll, only 12 percent of the working-aged uninsured targeted by the program are aware signups begin Tuesday,
The state has already spent some of its $4.7 million marketing campaign for 2013. For instance, booths have been set up at the state fair and at local community events.
But Gwenda Bond, a spokeswoman for the state Cabinet for Health and Family Services, said digital ads targeting people ages 18 to 29, who make up 30 percent of Kentucky's uninsured population, are also a significant part of the marketing campaign this year. She said online ads have appeared on websites with a strong appeal to young adults such as the video service Hulu, the celebrity gossip outlet TMZ and the online radio site Pandora. Videos have also been posted on YouTube.
All advertising efforts, launched about six weeks ago, will become more visible after Tuesday, when potential users can actually take action, she said, including ads on buses in Lexington and new kiosks in hospitals, including the University of Kentucky Chandler Medical Center along with bricks-and-mortar standbys such as bus stations.
A call center with 60 employees has been open since Aug. 15 to answer questions, and starting Tuesday, those representatives can help residents enroll. It's expected the call center's staff will rise to 100. People are being certified all across the state to help potential users understand the system and fill out applications. Some 3,400 insurance agents have been certified to do the same. Libraries and health departments are also being enlisted to offer support and outreach to the uninsured.
Is Kentucky prepared?
So, that being said, is Kentucky ready?
As might be expected, Carrie Banahan, executive director of Kentucky's Health Benefit Exchange, said yes.
The technical systems have been tested and although there are sure to be bumps, she said, "we will be ready to enroll people on October 1."
That isn't the case for all of the 17 states that have created their own exchanges, said Jennifer Tolbert, director of state health reform at the Kaiser Family Foundation. For example, Oregon has already announced it will not be ready Tuesday to enroll people.
The Kaiser foundation, she said, has been monitoring how the systems in various states have been developed and tested. Overall, she said, Kentucky "seems to be on track."
As far as outreach and education, she said, Kentucky again seems to be doing pretty well. The state has awarded grants to Community Action Kentucky and the Kentuckiana Regional Planning Development Agency to cover five of the state's eight geographic Medicaid regions.
The fact that the whole state is not covered yet "is certainly an area of concern," Tolbert said, "but the open-enrollment period is going to last for six months so the state has time."
Bond said the companies to serve the rest of the state should be in place soon.
Stewart said that in her position as a health advocate for the poor she is often critical of the state and suspicious of grand plans. She said she has watched the development of the exchange closely.
"I feel OK about everything the Department of Insurance has done so far," she said.
How much will it cost?
There is one significant issue outstanding: Just what are the rates?
Kentucky has not released the full schedule of rates to the public. Instead it has released snapshots of what certain types of people will pay.
Bond said the array of flat rates, or the "sticker price," are not helpful to consumers because the final price a person will pay is dependent on myriad factors: where he or she lives, age, which insurance company is chosen, which level of plan within that company is picked, whether subsidies are available, etc.
Some of the 17 states creating their own programs, including California and Maryland, released their rates months ago, Tolbert said. Some of that had to do with when funding was received and work began, she said. California, for example, started working on its program before the U.S. Supreme Court's decision in June 2012 upholding the Affordable Care Act. Kentucky waited until after the decision to do the bulk of its work. And, she said, in some cases the rates that have been released early have changed significantly.
Tolbert said there are a handful of other states in addition to Kentucky that have not released their rates.
"I am not sure that there is a problem as long as the information is available on October 1," she said.
Consumers, she said, will have until Dec. 15 to decide what plans to pick before the first wave of coverage goes into effect Jan. 1, she said. The state said all the rates will be available on Oct. 1.
There are many unknowns
Glen Mays, a professor of health services and systems research at UK, said the bigger question is: Can the program attract enough people to make the numbers work, whatever they are?
As with all insurance, to be successful, the program must attract a critical mass of people who will use their insurance sparingly to help offset those who have more expensive health care needs.The first people to enter the plan are likely to be those who need health care the most, not the "broad and diverse mix of healthy people and sick people" needed to make an insurance program financially stable, he said.
In some circles, there has been endless debate about health care reform, but he said he agrees with Stewart that there are a lot of people who do not know what is happening and who do not understand what the benefit of signing into the program might be. Many people still falsely think the law was repealed. There is still clamoring that it will be defunded.
Mays said he doesn't see that happening. In the end, he said, the biggest challenge might be convincing individuals that signing up for health care will be of benefit to them and their families.
What that will take and how many people will sign up and when, he said, "we really don't know."
BY THE NUMBERS
$252 million: Federal funds invested in planning and operations through 2015.
$39 million: Estimated annual cost of running the program in Kentucky.
640,000: Estimated number of uninsured people in Kentucky.
15: Percentage of Kentucky's population that is uninsured.
6: Months until the first enrollment period ends. People must be enrolled by March 1, 2014, or face a penalty.
Source: Cabinet for Health and Family Services
A program as expansive as the Affordable Care Act, also known as Obamacare, brings with it a new lexicon. Here are some helpful terms to know.
Kynect: Pronounced "connect," it is the name used by the state for its health insurance program. It is not Kentucky Connect, Kia-Nect or KyNet but just plain "connect." It should not be confused with the Microsoft motion-sensing video gaming software called Kinect.
Exchange: State officials use this term to refer to the entire state-created program, as in, "The health benefit exchange is moving forward in Kentucky." They also use the term to refer specifically to the website Kynect.ky.gov, as in, "The exchange will go live on Oct. 1."
Kynectors: Pronounced "connectors," this term refers generically to a variety of people who have been trained to help consumers understand the process of enrolling. They have slightly different levels of training and are more precisely referred to as "navigators," "in-person assisters" and "certified application counselors."
ACA: In this context, it is the abbreviation for the Affordable Care Act. This may seem simple enough but people also use ACA to refer to the American Counseling Association and other organizations.
Source: Cabinet for Health and Family Services
To sign up for health insurance or Medicaid or to get more information about Kentucky's program go to Kynect.ky.gov or dial 1-855-459-6328.