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People Without Email Addresses Face Difficulty Enrolling In Exchanges

Oct 02, 2013

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Down in South Texas, health care providers are reporting an unusual problem with the federal marketplace: Many patients don’t have email addresses and, therefore, can’t sign up online.

The Brownsville Community Health Center had 50 people show up on Tuesday ready to sign up for health coverage -- many even brought pay stubs and income documentation -- but not a single one of them had an email address.

"If you don’t include an email address, they won’t let you through," said Christela Gomez, the special projects coordinator and lead certification application counselor at the center. Although the center considered helping people sign up for an email account, Gomez said many weren't comfortable with the idea because they did not have a computer to access the email address later. "Quite a few didn’t even know what an email address was," she added.

The center’s certified application counselors helped the patients fill out paper applications, but they'll have to wait for a written response from the federal government to find out whether additional documentation is needed or whether those applicants qualify for tax credits.

Some of the questions on the paper application were difficult for patients to answer, said Gomez. One man who came in to receive assistance finding health coverage currently works as a truck driver, she said. He earns 30 cents per mile, and his income can range from $50 to $100 a week.

"We didn’t really know how to fill in the income part with him," she said, adding, "We kind of just wrote it in on the side, his situation."

Paula Gomez, the executive director of the center, said her patients are mostly adults who are too young to qualify for Medicare. Although most of her patients have jobs, pay taxes and want to cooperate with the health care system, there are extenuating circumstances like language barriers that make it difficult.

"I'm sure there are pockets like ours all over the country," Gomez said. She added that the federal government should be more flexible and consider the different situations people are facing across the country. "They think in terms of everything that's going on in Washington, D.C., but they don't look at the reality of the rest of the world in the United States," she said.

Ongoing technical difficulties on the new federal health insurance marketplace's website have created road blocks for Texans trying to sign up and review coverage options under the Affordable Care Act.

"We keep getting kicked off the network, but we've screened some patients," said José Camacho, executive director of the Texas Association of Community Health Centers. "People, from what we can gather at the centers, are quite excited."

Although Tuesday marks the beginning of a six-month enrollment period, Camacho said many Texans have already shown up at federally qualified health centers to receive assistance applying for coverage in the exchange. He described one woman who has a master's degree but recently started a job that doesn’t offer health benefits coming to Lone Star Circle of Care in Georgetown seeking help. Unfortunately, glitches on the federal website prevented the certified application counselors at the center from helping the woman create an account and begin exploring her health plan options.

"With any new product launch, there are going to be glitches as things unfold," Marilyn Tavenner, a federal administrator for the Centers for Medicare and Medicaid Services, said on a media conference call. She said that 2.8 million people have visited the federal marketplace since midnight, and more than 81,000 calls have been placed to their call center. "This is Day 1 of a process. We're in a marathon, not a sprint, and we need your help," she added.

Although the federal marketplace will eventually be able to determine whether an applicant is eligible for state programs like Medicaid and the Children’s Health Insurance Program, the Texas Health and Human Services Commission, which oversees those programs, said the federal website isn't yet able to send applicants' information directly to those plans. The agency is encouraging people who think they may be eligible for those programs to apply directly on the state website, Your Texas Benefits.

"This federal glitch could lead to delays in children getting health coverage," Dr. Kyle Janek, executive commissioner of HHSC, said in a statement. "We've let workers in our offices around the state know about this issue so they can make sure families have accurate information."

Sixty-seven federally qualified health centers that are members of TACHC collectively received $10 million to provide outreach, in-reach and enrollment assistance. So far, they’ve trained 230 certified application counselors. Some centers, such as Su Clinica Familiar in Harlingen and Brownsville, recently received certification and will finish training additional counselors in the coming weeks.

After signing himself up on HealthCare.gov around 8:30 a.m. on Tuesday, Carl Dahlquist, a certified application counselor and the outreach and enrollment supervisor at the Gulf Coast Health Center in Port Arthur, couldn’t get back into the system.

"We had a lot more come in today than we’ve had in the last several weeks because today was Oct. 1," said Dahlquist.

While most people wanted some advice and literature to take home and consider, Dahlquist said he used old-fashioned pen and paper to determine the eligibility status of one man. Although the man didn't qualify for coverage in the federal marketplace, Dahlquist said he was eligible for Texas Medicaid's program for the elderly and disabled. Ironically, Dahlquist said the state's website was also down.

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