Why People Find Obamacare So Confusing

The bewilderment of prospective enrollees in Texas reflects widespread misunderstandings about the law nationally.
 golbenge (골뱅이)/flickr

DALLAS – A few days before Christmas, Mirna Cervantes bounded through the doors of the Habitat for Humanity office here.

“Am I too late?” she said, rushing toward a fluorescent-lit room where workers sat at long folding tables, pounding away on laptops.

The Habitat building was temporary host to an Affordable Care Act enrollment event held by the Community Council of Greater Dallas, a local nonprofit.

“Some people would rather get help through someone who knows the process,” said Daniel Bouton, who’s a navigator—kind of a professional Affordable Care Act helper—with the Community Council.

In the state with the highest rate of uninsured people, his is a big job. “One consumer I saw hasn’t seen a doctor in 19 years, so he was going to Mexico to get his issues taken care of.” That man, Bouton said, was relieved after navigators helped him sign up for a plan on the federal exchange.

Obamacare scored a small, year-end victory as signups on the exchanges ticked up, with 975,000 people enrolling across the country in the past month alone. But surveys show that many people are still puzzled by the law and wary of the website because of its earlier, shoddy performance. As late as September, six in 10 people told a Washington Post-ABC News poll that they didn’t know what changes the law would bring. In states where the federal government is running the insurance marketplace, such as Texas, only 44 percent of people knew about the existence of the exchanges. In December, 36 percent of people told Consumer Reports that they (wrongly) believe Obamacare allows the government to determine which doctor they’ll see.

In fact, the entire idea of health insurance can be baffling for those who have never had it: A new study from Health Affairs and the Urban Institute reports that just 60 percent of uninsured people understand key concepts related to insurance, such as co-pays, deductibles, premiums, and provider networks.

Scientific polls (and my extremely unscientific conversations with Texans) suggest that despite the administration’s best efforts with bro-friendly ads, Christmas cards, and other get-the-word-out gimmicks, Obamacare remains obscure, scary, and downright befuddling for many.

To demystify the process, many prospective Obamacare consumers are turning to navigators like Bouton.

“I wanted to see someone face-to-face and have my questions answered,” said Cervantes, who is uninsured. “Especially my son, I want him getting routine check-ups and shots, anything he needs."

After talking with Bouton, she had some good news.

“I found out that I do qualify [for the subsidies],” she said. “It’s great to know that it’s a plan that I’ll be able to afford based on what I make.”

The Community Council is one of the local organizations listed on Healthcare.gov as eager to take enrollee questions over the phone and, for the particularly panicked, to make in-person appointments.

Sandra Luz, the Community Council’s lead navigator, said that the group was inundated with two to three times as many calls as usual—sometimes 50 or 60 a day—in the days leading up to December 23, the deadline to enroll in order to start coverage on January 1.

“People were panicking a lot on the 22nd because they were thinking that it was the last day to enroll so they wouldn’t be penalized,” she said. “What I would explain to them was that it was only if they wanted their coverage to start on January 1.”

Luz said many call her after encountering a common Healthcare.gov clog: If consumers don’t enter their names exactly as they appear on their Social Security cards, “the system will stop because it can’t verify the person’s identity,” she said.

Others bring questions about whether their children can remain on the state Children’s Health Insurance Program, or about what happens if they get paid in cash, or what documents they need in order to enroll.

But that’s just the sign-up process. People were also confused about how to use their subsidies (there are three ways), or by which date to make their first payment (states have different deadlines.)

And other visitors were puzzled when they found they fall in the so-called “coverage gap”—the salary span between the point at which Obamacare subsidies kick in and where Medicaid coverage, which Texas has so far opted not to expand, cuts off.

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Olga Khazan is a staff writer at The Atlantic, where she covers health.

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