The healthcare marketplaces that went online this week are really meant for people who don't have employment sponsored coverage . They can get online, shop around, and purchase insurance at a reduced rate from one of the four providers on Indiana's exchange. In Indiana, that's about 888,000 people who are eligible.
Jonathan Prather is self-employed. For two-and-a-half years he has owned a skateboarding shop in Bloomington. He's a lot like most Americans when it comes to what he knows about the Affordable Care Act.
"I don't know that much," Prather said. "I know that I'm applicable. I know that I have to sign up or something don't I?"
How Much You Could Be Fined In 2014
All uninsured Americans have to be covered by 2014 or they'll be fined. It's $95 a year for adults in 2014 or one percent of their income, whichever is greater. The fines increase each year. In 2016, the fees are $695 per person, or 2.5% of a person's income, whichever is greater.
"To me it's kind of been surrounded by mystery," says Prather. "Just bits and snippets from friends or neighbors or whatever. Just random people tell me this is how it's going to work I think or this is when you can do it, we think. Definitely not real coherent."
"It's scary," says Brian Tabor, vice-president of the Indiana Hospital Association, thinking about how few people are informed about the Affordable Care Act. "It's not terribly surprising to be honest. The ACA has obviously been the subject of a lot of political debate and that's not going to end anytime soon and I think all of that and the Supreme Court case. The general discussion doesn't help to give certainty to people."
Folks like Tabor desperately want to see the exchanges work. At the Hospital Association's annual conference this week in Carmel Tabor and his colleagues spent a lot of time talking about their role in getting people signed up.
"The reality is, financially there is a lot riding on this for hospitals," says Tabor.
One of the things the Affordable Care Act did was reduce payments to providers – hospitals being the largest group. In Indiana it's about $4 billion over ten years.
"So what we have here is money that would normally flow to hospitals through the Medicare program is now kind of at risk and is dependent upon people signing up for insurance. So we have a lot riding on getting people signed up as soon as possible."
Hospitals, Nonprofits Work To Sign Up Uninsured
Hospitals are playing a key role in signing up the uninsured. Many have trained navigators - people who can provide counseling sessions and enroll people in the insurance programs.
Federally qualified health workers in Indiana received some funding to do outreach and enrollment, but in large part, it's falling to community groups.
David Meyer is the organizer of ACA Volunteers of Monroe County. He hosted the first training session this week for volunteers.
"People like us, the ACA Volunteers of Monroe County, are trying to step up to the plate and help assist the uninsured in our community to be bale to take advantage of this new tool, the Affordable Care Act."
Meyer is preparing the group of community volunteers to distribute fliers and host informational healthcare fairs.
What Is The Affordable Care Act?
"If you ask somebody what they know about the ACA or Obamacare, it's all about political scorekeeping. It's not about the program or how it will help people or how it will be useful to them," says Meyer. "So of course the uninsured are very confused and uninformed about it."
At libraries across the state, staffmembers have been preparing for months for the exchanges to go live:
Steve Backs is the Adult and Team Services Manager At the Monroe County Public Library. He helps people get the enrollment process started.
"We can get them on one of our public computers. We do this with a lot of different things such as helping people apply for jobs," says Backs. We help them know how to navigate different pages, how to fill out forms. Every time the government comes up with some kind of new plan that is online, we anticipate that people are going to need help figuring out how to navigate these things."
On college campuses, volunteers are being deployed to get young people signed up. Particular attention is being paid to this age group which has been termed "the young invincibles" because they don't have health conditions and they're not worried about getting signed up.
"We need to get them in the system," says Tabor. "A lot of effort is going to be geared towards getting that group to sign up for the marketplace. In the long run it's probably not sustainable if only the sickest Americans sign up for the marketplace."
Back at his skate shop that argument seems to be the thing that touches Prather the most:
"I think healthcare should be for everyone so if I think if me paying a little bit and being able to get insurance and that making it possible for other people to do that as well, I would be into that."
