Open enrollment for health care coverage next year begins Wednesday amid uncertainty over the future of the Affordable Care Act (ACA). Bexar County residents seeking health insurance under the program known commonly as Obamacare will face a shorter enrollment period and higher prices, with less community outreach and sign-up support.

The Trump Administration shortened the length of this year’s open enrollment to 45 days and reduced by 90% the advertising budget for the ACA. Further, a decrease in funding for programs that assist in enrollment have local health care advocates working overtime to ensure that enrollment rates don’t decrease.

While modest changes have been made to the health care law, attempts by Congressional Republicans to repeal and replace it have resulted in more confusion over coverage than reform, said health care advocates. Still, the health care law remains in effect, and those required to enroll in a plan will face penalties mandated by the law if they fail to do so.

Bexar County Judge Nelson Wolff told the Rivard Report that because the U.S. Department of Health and Human Services cut ACA advertising funding that encourages enrollment, community outreach efforts by stakeholders and volunteers “is most important” for getting uninsured county residents to enroll.

We have had really positive benefits in Bexar County since [the ACA] been implemented,” Wolff said. “We are going to encourage everyone to sign up for those who need this kind of insurance.”

ACA enrollment in Bexar County peaked in 2016, with 121,000 enrolled, and decreased to 113,612 in 2017, according to the San Antonio Metropolitan Health District. In 2010, before the law went into effect, there were 330,000 uninsured county residents.

EnrollSA, Bexar County’s volunteer coalition of organizations that employ certified application counselors to help people enroll in ACA, has been working to enroll San Antonio’s uninsured populations since the ACA became law. Its mission is to coordinate and consolidate the scattered resources going into organizations involved in open enrollment to best reach uninsured communities.

The message that EnrollSA is currently trying to get to uninsured people in Bexar County is that ACA is still the law of the land, said Andrea Guajardo, a volunteer EnrollSA coalition lead who also is the director of community engagement and social responsibility at the University of the Incarnate Word’s School of Osteopathic Medicine.

“Our main focus is on bringing access to care to our community,” Guajardo said. “Our number one message is nothing has changed, nothing has been repealed, nothing has been replaced, and nothing has been rescinded.”

But in previous years, EnrollSA operated with 90 certified application counselors; this year there are just 40.

Guajardo explained that the political rhetoric coming from Washington about Obamacare being replaced or repealed and the cuts in advertising funding have resulted in people being unaware of their options. This makes the job harder for outreach organizations such as EnrollSA.

“What we are hearing from consumers is that they aren’t sure,” Guajardo said. “[They ask] ‘Do I still have insurance? Am I still going to get a subsidy? Is it still a law?’ All of the questions we worked really hard to answer in the first three years are now being asked again.”

Thirty percent of uninsured people are unaware that the ACA exists, and 60% of those already enrolled don’t know when open enrollment is for them to make changes, according to a Kaiser Health Tracking Poll. More than half worry they won’t be able to afford coverage and don’t know that subsidies are still available for those with income that is 100% to 250% of the federal poverty level, which is $24,600 for a family of four.

Eight insurers remain in the Texas marketplace exchange for 2018, although most counties will only have one or two providers. Three insurance providers offer marketplace plans in Bexar County: Blue Cross Blue ShieldAmbetter, and insurance newcomer Oscar Health.

Blue Cross Blue Shield of Texas will continue to provide statewide coverage throughout 2018, with an average 23.6% premium increase. AmBetter, which offers health care plans in 32 Texas counties, has filed for a 21.3% rate increase for 2018.

Oscar, which entered  the Bexar County market in 2017, has broadened its coverage area to include Comal and Guadalupe Counties and is expanding into the Austin area with both on and off-exchange plans. Premiums have increased an average of 15% from last year.

Health insurance plans and prices will be posted on later than normal, and some health insurers will send out renewal notices later than normal as they wait on this information.

Financial subsidies remain available for those who qualify, but only during the open enrollment period.

Metro Health Director Colleen Bridger told the Rivard Report that she formed an ACA stakeholders group as a response to the “devastating cut to resources” devoted to educating consumers and organizations about the ACA.

“We need to rally the troops and divvy up the work that used to be done by 50 staff that we don’t have anymore,” Bridger said. “What we didn’t want was people hearing about the repeal and replace and dismantling and thinking they shouldn’t go sign up.”

The Bexar County ACA stakeholders group consists of 17 organizations including CentroMed, Daughters of Charity Services of San Antonio, Methodist Healthcare Ministries, and the San Antonio Public Library.

Anel Treviño, program manager with Daughters of Charity Services, said that part of working to enroll people in health care coverage is referring them to services that best fits their needs, which in many cases may not be ACA coverage.

“If they don’t qualify, we want to make sure they know about Carelink, CentroMed, [and] Daughters of Charity,” Treviño said. “We don’t want folks being uninsured and not knowing where they can go for their health care.” Open enrollment season provides an opportunity to educate people about their options.

EnrollSA offers online appointment scheduling on its website that matches consumers with the next available appointment with an open enrollment specialist in their area. Appointments can also be scheduled by calling either 2-1-1 or 3-1-1. Enrollment assistance is available at most public library branches and CentroMed clinics, among other locations.

“We all have regular 9-5 jobs, but during open enrollment there is no ego,” Guajardo said of Bexar County’s volunteer enrollment specialists. “We stay here until midnight making sure the last person is served and enrolled if they need help. We are committed to those who need coverage.”

Roseanna Garza

Roseanna Garza

Roseanna Garza reports on health and bioscience for the San Antonio Report.