As a divided Congress tied itself in knots over health-care funding -- effectively shutting down the U.S. government -- the Affordable Care Act continued to enter the lives of Alaskans Tuesday with the opening of the online insurance market place.
Enrollment began on the internet portal, but not without glitches. In some places, people could finally see prices for a variety of health plans. In Alaska, the federally-run online marketplace barred individuals from navigating past the initial information input screens and viewing specific health plans for most of the day.
Still, health officials remained optimistic at a morning news conference at the Alaska Native Tribal Health Consortium headquarters, saying anything new is bound to have startup issues.
"Let us not report that it took 40 minutes for someone in Ketchikan to get through the call center; let us not report that the site crashed in Washington; let us not report that someone got lost on the site four times," said Susan Johnson, Northwest Regional Director of the U.S. Department of Health and Human Services. "Instead, let us report that millions of people -- almost 140,000 Alaskans who are uninsured -- for the first time have health (insurance)."
In the Pacific Northwest, where states created their own marketplaces, and around the country, it was more of the same: lots of interest frustrated by technical problems on websites. In some cases, the problems were attributed to unprecedented user volumes for a government website; in others, like in Washington state, officials reacted with shrugs, a six-hour shutdown and a reboot, unsure what had gone awry.
In Oregon, where the state's marketplace, Cover Oregon, has been promoted with folksy tunes and videos that have gone viral, officials acknowledged they were resorting to paper applications. They predicted CoverOregon.com would be fully functional by the weekend.
The Hartford Courant reported that Connecticut's on-line marketplace functioned well enough for 167 applications to be processed. One applicant, a third-year law student at the University of Connecticut, said it took only 20 minutes on-line to find out he was eligible for Medicaid -- and free from paying any premium at all, unlike his University of Connecticut student policy, which cost $2,400 a year.
Plan prices are based on a person's age, location, tobacco use and if he or she is applying for individual or family coverage. This means insurance companies cannot base coverage or premiums on gender or preexisting health conditions.
The first enrollment period will end on March 31, but to get insurance by the opening date of Jan. 1, a person must enroll by Dec. 15.
In Alaska, there are 34 plan offerings from two carriers on the state's federally-run marketplace, Johnson said. To help Alaskans sort through the plans and health-care jargon, federal grants have been given to two navigators -- the Alaska Native Tribal Health Consortium and United Way of Anchorage. Other agencies will have certified counselors to assist Alaskans with their questions and insurance applications, and private brokers like Enroll Alaska have certified agents as well.
The tribal health consortium will cover rural Alaska. Valerie Davidson, senior director of legal and intergovernmental affairs for the consortium, said her agency has one navigator officially trained and about 20 "in queue."
"You're not alone, we're here to help," she said.
United Way of Anchorage, the other navigator agency, has been making appointments with potential enrollees, said Sue Brogan, a United Way vice president.
Davidson said most Alaskan Natives will be exempt from signing up for insurance because of coverage provided by the U.S. Indian Health Service or its contractors, but they must apply for this exemption through the marketplace. Davidson still advised Alaska Natives to browse available plans and log into the portal to see if they qualify for Medicaid or are interested in plans that offer expanded coverage.
She also sent a message to young people -- sign up. For the system to work, it's critical that young, healthy individuals enroll.
"If you're riding your snowmachine or you're riding your mountain bike or you're out on the river and you have a catastrophic incident, you may find yourself needing insurance," Davidson said. "So the time to act is now."
Brogan said United Way will focus its energies on Anchorage, Juneau and Fairbanks to help people navigate the marketplace.
"So given this task at hand, we can expect that it's going to be a typical Alaskan experience -- a road experience -- with a few bumps here and there and maybe some potholes, but we are certainly going to be working together to make sure that our families and neighbors can get the coverage that they're eligible for," she said.
Stefanie Burich is currently completing her training, a series of online modules and tests, as a navigator. She previously worked as a trail guide and with an acupuncturist before being hired by United Way. Burich is scheduled to start assisting interested applicants at the YWCA Alaska next week.
Burich is from Berlin, the capital of the country with the oldest universal health care system, dating back to the 1880s.
"Coming from Europe, that's (health insurance) just a given for us, so I've seen the benefits," she said.
Jon Zasada, director of development and marketing with the Anchorage Neighborhood Health Center, said his group of certified application counselors saw six people interested in the marketplace Tuesday. But due to website malfunctions, none were able to sign up.
For the community health center, more patients with health insurance means an increase in its sustainability and revenue, which will help insure treatment for patients down the road, Zasada said.
"What I've been telling folks is, we're dedicated to serving the uninsured and underinsured, but we need a diverse mix to remain viable and provide that care," he said.
Zasada said that every insured person helps underwrite the care costs for two uninsured. Currently, he said just under half of the center's 14,000 patients do not have insurance.
Alaska health care officials advise newcomers to take it slow and shop around at healthcare.gov.
"Relax into all this newness," Johnson said.
Meanwhile on Capitol Hill, a Republican-controlled House and Democrat-controlled Senate continue to butt heads over the health-care law and its individual mandate that requires all Americans to have health insurance or face a tax penalty.
In response, Johnson said she echoes much of President Barack Obama's concern that now is not the time to battle over the Affordable Care Act, which has been a law for over three years.
"I think that there's not a climate for considered discussion about improvements when you play brinkmanship," Johnson said.
Reach Tegan Hanlon at firstname.lastname@example.org or 257-4589.
Need marketplace assistance in Alaska?
Health Insurance Marketplace:
Alaska Native Tribal Health Consortium
907-729-7777 or 855-882-6842
United Way of Anchorage
2-1-1 or 1-800-478-2221