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March 13, 2013

Applying for benefits under Obama health-care plan not easy

WASHINGTON — Applying for benefits under President Barack Obama’s health care overhaul could be as daunting as doing your taxes.

The government’s draft application runs 15 pages for a three-person family. An outline of the online version has 21 steps, some with additional questions.

Seven months before the Oct. 1 start of enrollment season for millions of uninsured Americans, the idea that getting health insurance could be as easy as shopping online at Amazon or Travelocity is starting to look like wishful thinking.

At least three major federal agencies, including the IRS, will scrutinize your application. Checking your identity, income and citizenship is supposed to happen in real time, if you apply online.

That’s just the first part of the process, which lets you know if you qualify for financial help. The government asks to see what you’re making because Obama’s Affordable Care Act is means-tested, with lower-income people getting the most generous help to pay premiums.

Once you’re finished with the money part, actually picking a health plan will require additional steps, plus a basic understanding of insurance jargon.

And it’s a mandate, not a suggestion. The law says virtually all Americans must carry health insurance starting next year, although most will just keep the coverage they now have through their jobs, Medicare or Medicaid.

Some are concerned that a lot of uninsured people will be overwhelmed and simply give up.

“This lengthy draft application will take a considerable amount of time to fill out and will be difficult for many people to be able to complete,” said Ron Pollack, executive director of Families USA, an advocacy group supporting the health care law. “It does not get you to the selection of a plan.”

“When you combine those two processes, it is enormously time consuming and complex,” added Pollack. He’s calling for the government to simplify the form and, more important, for an army of counselors to help uninsured people navigate the new system. It’s unclear who would pay for these navigators.

Drafts of the paper application and a 60-page description of the online version were quietly posted online by the Health and Human Services Department, seeking feedback from industry and consumer groups. Those materials, along with a recent HHS presentation to insurers, run counter to the vision of simplicity promoted by administration officials.

“We are not just signing up for a dating service here,” said Sam Karp, a vice president of the California HealthCare Foundation, who nonetheless gives the administration high marks for distilling it all into a workable form. Karp was part of an independent group that separately designed a model application.

The government estimates its online application will take a half hour to complete, on average. If you need a break, or have to gather supporting documents, you can save your work and come back later. The paper application is estimated to take an average of 45 minutes.

The new coverage starts next Jan. 1. Uninsured people will apply through new state-based markets, also called exchanges.

Middle-class people will be eligible for tax credits to help pay for private insurance plans, while low-income people will be steered to safety-net programs like Medicaid.

Because of opposition to the health care law in some states, the federal government will run the new insurance markets in about half the states. And states that reject the law’s Medicaid expansion will be left with large numbers of poor people uninsured.

HHS estimates it will receive more than 4.3 million applications for financial assistance in 2014, with online applications accounting for about 80 percent of them. Because families can apply together, the government estimates 16 million people will be served.

Here are some pros and cons on how the system is shaping up:

• Pro: If you apply online, you’re supposed to be able to get near-instantaneous verification of your identity, income, and citizenship or immigration status. An online government clearinghouse called the Data Services Hub will ping Social Security for birth records, IRS for income data and Homeland Security for immigration status. “That is a brand new thing in the world,” said Karp.

• Con: If your household income has changed in the past year or so and you want help paying your premiums, be prepared to do some extra work. You’re applying for help based on your expected income in 2014. But the latest tax return the IRS would have is for 2012. If you landed a better-paying job, got laid off, or your spouse went back to work, you’ll have to provide added documentation.

• Pro: Even with all the complexity, the new system could still end up being simpler than what some people go through now to buy their own insurance. You won’t have to fill out a medical questionnaire, although you do have to answer whether or not you have a disability. Even if you are disabled, you can still get coverage for the same premium a healthy person of your age would pay.

• Con: If anyone in your household is offered health insurance on the job but does not take it, be prepared for some particularly head-scratching questions. For example: “What’s the name of the lowest cost self-only health plan the employee listed above could enroll in at this job?”

HHS spokeswoman Erin Shields Britt said in a statement the application is a work in progress, “being refined thanks to public input.”

It will “help people make apples-to-apples comparisons of costs and coverage between health insurance plans and learn whether they can get a break in costs,” she added.

But what if you just want to buy health insurance in your state’s exchange, and you’re not interested in getting any help from the government?

You’ll still have to fill out an application, but it will be shorter.

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