MIAMI — As federal health officials work around the clock to fix technology glitches plaguing the website where U.S. citizens can obtain health insurance under the new federal law, many Floridians still have little understanding of how the law works.
Trained counselors are spending the bulk of their time educating people about what the Affordable Care Act is, not signing them up for insurance.
"A lot of people are going to be quite confused and think they can't afford it and aren't going to be eligible," said Robert Blendon, professor of health policy and political analysis at Harvard.
He also worries that people aren't getting the facts in Republican-run states like Florida because state officials aren't invested in outreach.
"The worrisome thing for the [Obama] administration is that those who would be most likely to go through the registration are, of course, the people with the most serious illness. ... For them, figuring out how to get on is really essential to their lives. But the confusion is likely to affect people who don't feel an immediate need to have health insurance," Blendon said.
In other words, the young healthy adults. The success of the law depends on their participation as insurers need enough of them to sign up for coverage to balance out the cost of caring for older, sicker adults.
During a recent visit to a Miami area community health center, many were unaware they might qualify for subsidies to help offset health insurance premiums. A woman about to turn 65 was looking for a plan even though she wouldn't qualify for the exchange because coverage doesn't start until January, when she would be eligible for Medicare. Earlier this month, during a neighborhood canvass in West Palm Beach, some thought they would be automatically enrolled in the plan. One woman thought it applied to food stamps.
Even during those times when the website, healthcare.gov, was working smoothly, many people didn't sign up on the spot. Jodi Ray, who oversees the navigators for the University of South Florida, says it's more than a one-visit process. Most consumers want to compare information on various plans at home and make a thoughtful decision before they enroll.
"Although people can make decisions on the fly and some are comfortable with that, it's not really that kind of process," she said.
The federal government plans to release monthly enrollment figures, likely starting in November. Ray said she suspects December's enrollment figures will be even higher as outreach efforts start paying off and consumers have time to understand the law. Federal health officials estimate that 7 million people would gain coverage in the first year through the markets, including 477,000 in Florida, where roughly 3.5 million lack health insurance.
At Sant La, a Miami Haitian community center, Executive Director Gepsie Metellus has advocated for self-reliance among Haitian community leaders because there might be a lack of Haitian Creole-speaking navigators and because the government's translations of enrollment applications might not be accurate. She gathered a half-dozen pastors, social workers and members of the Haitian-American media in Miami last week to hear the basics of the new health care law, explained in Haitian Creole so they could address their listeners or congregations in their own words. The federal website is translated into Haitian Creole, but Metellus cautioned that not all people who speak Haitian Creole can read it, and that "legalese" that can confound English speakers is even more confusing in other languages where literacy rates may be low.
The community isn't rushing to sign people up either. They're telling people to wait until the website's kinks are worked out and remind them they have until Dec. 15 to sign up for coverage that begins Jan. 1. The enrollment period lasts through the end of March.