Maryland consumers who want to buy health insurance under Obamacare in the fall will be able to read glossy fact sheets that spell out the law in simple language. Or talk to one of 325 specially trained workers who will explain the intricacies and help them enroll. Or get information via Facebook, Twitter and YouTube.
In Virginia, it’s a different story. People can seek assistance from about two dozen special guides. Or they can go to their state legislators, who might refer them to phone numbers and Web sites operated by the federal government.
The two states have taken vastly different paths although they have comparable numbers of uninsured: at least 844,000 in Virginia and an estimated 800,000 in Maryland.
“Virginia’s approach is totally opposite from Maryland,” said Cindi Jones, who is overseeing Virginia’s implementation of the health-care law.
For people without health insurance in the Washington region and elsewhere, the help they get figuring out the complicated law known as “Obamacare” will depend on where they live, a testament to the uneven way President Obama’s signature legislation is being implemented around the country.
A key test comes Oct. 1, when insurance marketplaces open for enrollment. These marketplaces will be Web sites where people can compare and shop for health insurance coverage effective in January. People will also be able to find out if they qualify for subsidies to reduce their costs or whether they’re eligible for Medicaid, the state-federal program for the poor.
But two months before these systems must be in place, striking gaps in resources and readiness suggest that people will have widely varying experiences in trying to purchase health insurance. And those differences are likely to affect the law’s success, which hinges on millions of uninsured Americans, especially healthy ones, signing up for coverage.
In states such as Maryland, which embraced the law and is building its own marketplace, health officials are getting access to millions of federal dollars to identify the uninsured, bombard them with information and then provide human helpers to guide them through their options. But in places such as Virginia, which rejected the law and even mounted an unsuccessful lawsuit challenging it, the enthusiasm to spread the word and the resources to do so will be much more limited.
In a news conference Friday, Obama noted that Republicans have made it their “holy grail” to prevent people from getting health care under the law. He also acknowledged that “there are going to be some glitches” implementing the Affordable Care Act.
“No doubt about it,” he said. “There are going to be things where we say, ‘You know what? We should have thought of that earlier,’ or ‘This would work a little bit better’ or ‘This needs an adjustment.’ ”
Health and Human Services Secretary Kathleen Sebelius acknowledged in a recent interview that efforts to help consumers have been uneven. “Certainly, it is much more robust in some areas than others,” she said. “Having consumers be able to get information easy to read, easy to understand, answer questions, pull together their financial information and then get ready, may be more challenging in states where there isn’t a really robust outreach effort.” “There’s a really huge difference in the amount of funds for consumer assistance, outreach and enrollment,” said Sarah Dash, research faculty at Georgetown University’s Center for Health Insurance Reform, who is tracking implementation of the law.
Under the health law, states that built their own marketplaces could tap into limitless federal funding. But facing political opposition, only 16 states, including Maryland, and the District of Columbia took on the task.
Because limited funds had been set aside for the states that refused, such as Virginia, the federal government has had to cobble together other resources. As a result, only $54 million is available for community groups in 34 states to train and hire the special workforce known as “navigators” to help with education, outreach and enrollment.
Adding to confusion in the Washington region: Virginia is not implementing a key provision of the law that allows more people with low-to-moderate incomes to be covered under Medicaid. Both Maryland and the District are doing so. That means a greater share of Virginia’s uninsured will need help figuring out what to do.
“We’re going to be struggling to get our message out, and that will be very different from what Maryland and D.C. are putting out,” said Cyndy Dailey, an executive at Northern Virginia Family Service, a nonprofit working on outreach with other community groups.
Getting people signed up
Starting next year, all Americans over 18 must carry health insurance or face a fine. The penalty starts at $95 or 1 percent of income for the first year, and rises to $695 or more annually for an individual in 2016.