New health law keeps LI firms, families busy

New York's exchange has the second highest number of enrollees for health insurance nationwide, according to the latest federal figures, and that figure is likely to grow as Monday's deadline for coverage starting New Year's Day looms.

Despite New York's relative success, Long Island brokers complain that the system is not always easy to use and that they are having a hard time finding reasonably priced insurance with robust networks of doctors for many of their small-business clients.

The U.S. Department of Health and Human Services reported Dec. 11 that at the end of November, 45,513 New Yorkers had selected a marketplace plan, second only to California with 107,087. Nationwide, 364,682 have enrolled, HHS said.

Combining Medicaid enrollees and reporting more days, the New York State Department of Health said that as of Dec. 15, a total of 134,622 New Yorkers had enrolled, including 95,196 who signed up for commercial health plans and 39,426 who qualified for much-expanded Medicaid.

Elisabeth Benjamin, vice president at the Community Service Society of New York in Manhattan, said the five organizations her group subcontracted to help Long Islanders sign up for coverage have enrolled more than 1,000 so far.

And with the deadline "coming up fast," she said, "there's a huge swell in demand."

Benjamin said that the comparative success of New York's marketplace -- a stark contrast to the federal and some state exchanges that continue to suffer glitches -- has made it a "rock star" among advocates and bureaucrats.

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"New York is not only considered a rock star by the federal government but by people who don't work for government," Benjamin said. "We did build it right and they are coming."

Individuals and families have to enroll on New York's exchange by Monday for health insurance that will begin on Jan. 1, although they have until March 31 to sign up without penalty. Small businesses with 50 or fewer employees don't face the same deadline, but brokers said many of their clients have policies that have been canceled because they don't comply with requirements in the federal Affordable Care Act and will expire at the end of the year.

Local offices kept busy"It's a little crazy. We're inundated," said Neil Weingarten, vice president of Conference Associates, an insurance agency in Patchogue. Weingarten said that on a recent Tuesday his office got 800 calls. The day before: more than 700.

"I haven't been busier in my life," said Jack Glanzer, president of The Granite Insurance Brokerage in Garden City. He said two-thirds of his clients have policies that are being terminated. "All these individuals and sole proprietors have to be moved to new policies."

Navigators, contracted and trained by the state to help people use the online marketplace, called NY State of Health, said they are also busy.

"We've done about double the volume of what we did when we had our facilitated enrollment program," said Janine Logan, spokeswoman for the Nassau Suffolk Hospital Council, referring to previous state efforts to sign up people for Medicaid or other state insurance programs.

Logan said that in October, the council's five navigators enrolled 276 applicants, including individuals and families; in November they enrolled 298.

Jennifer Tolbert, director of state health reform at the nonprofit Kaiser Family Foundation, attributes New York's relative success to several factors.

"New York has a long history of providing insurance through programs like Healthy NY . . . so there's a culture of insurance coverage greater than in some other states," she said. "I think it helps that premiums for individuals in the [New York] marketplace are so significantly lower than what people were able to get before . . . And it appears to me there's a large investment in enrollment assisters who are well positioned around the state to reach hard-to-reach populations."

Many brokers are not so apt to praise New York's exchange. They say that the website is still glitchy at times, especially when they try to apply tax credits, and that when they call the state's help line they often can't get someone to answer -- complaints the Health Department said it has not heard elsewhere.

Some also say they are having a hard time finding policies to replace the ones their clients used to have: Either the networks of doctors and hospitals have shrunk or the cost of comparable coverage has gone up. Three insurers are selling insurance to LI's small businesses on the exchange, compared with eight in Suffolk and nine in Nassau for individuals and families.

"If you want to keep your choice of doctors, you get what you pay for," said Kenneth Heard, a broker in Smithtown.

Heard, like many brokers, said he is not comfortable yet using the exchange and has been applying for policies the old-fashioned way -- on paper. The three-page form is faster, he said, and doesn't require the client to give out tax information, needed if the client wants a tax credit. The number unwilling to share tax information is not inconsequential: "It's not a couple of people; it's a lot of people," he said.

Some forgoing subsidiesThe consequences can be stark. "I have one client in Queens who is getting a $600 subsidy per month," Heard said. Another client in Smithtown -- who did not want to reveal his tax information on the website -- will be paying 50 percent more than last year, he said.

Glanzer said he too has had clients who had eschewed a possible tax credit. "It's a natural distrust of the government, I suppose," he said. He said some were worried that if they underestimated their income for 2014 they could end up owing the government more and just didn't want the hassle.

Weingarten said that many small businesses -- as opposed to individuals -- have bought insurance off the exchange and not bothered with the tax credit available for businesses with 25 and fewer employees who earn an average of less than $50,000 a year. "It's a cumbersome process on the exchange," he said. "For many it doesn't seem to be worth it."

Sandra Jean-Louis of the nonprofit Public Health Solutions in Manhattan, the third organization contracted to provide navigators on Long Island, said it has encountered resistance from people afraid that taking a tax subsidy will mean they won't get a tax refund.

"A lot of people rely on their tax return to take a vacation, for instance," she said. "A lot of convincing has to be done to tell them the money would not be affected by subsidies unless your income changes."

For those getting the insurance -- whether a small business or individual, whether using a broker, navigator or going it alone -- the process can seem harrowing, although the resulting coverage might be as good as or better than what they had.

Thomas Kober, a partner at the accounting firm BMKR in Hauppauge, said a notice last month informed him that the deductible for the firm's plan for its 12 employees was being raised from $6,000 to $10,000. Plus the employees would have a 10 percent co-payment after the deductible.

Kober said they contemplated canceling health insurance coverage but didn't "because it's not fair to employees."

Their broker, Karl Washwick of Riverhead, found a cheaper plan -- but it didn't have the employees' doctors. Finally he found a plan with their doctors, "pretty much" the same premiums, a slightly lower deductible but higher co-payments, Kober said.

Financially, he said, "it's probably a wash" compared with the old plan. "But it cost more time and energy and aggravation."

Last month, Vicki Nemarich, 53, an educational consultant from Old Bethpage, showed up at Nassau University Medical Center in East Meadow to meet with a navigator from the Nassau Suffolk Hospital Council. Several days earlier, she had waited in vain at another site to meet with a navigator. Nemarich had had insurance through the state's Healthy NY program -- canceled with the advent of the exchange. The plan cost her $463 a month plus a $2,500 deductible, but getting good coverage, she said, was critical for her and her 19-year-old son, who suffers from Crohn's disease.

Nemarich came with a thick file of documents, including their passports. But when she and navigator Luz Ayala began inputting information, she hit a snag. She didn't have her son's Social Security number on hand. "I wish they had told me I needed this," she said at the time.

When she came back an hour later, the website had been down but when she sat down again with Ayala, it took her application. She learned she qualified for Medicaid, which will cost her far less, although she isn't sure yet whether she will have to pay a small premium.

"It's a burden off me," she said. "I have a really limited income and it [health insurance] was a significant part of my expenses."

Felix Campos, 56, and his wife, Ana, 54, of Huntington Station felt a similar anxiety when they got a letter telling them that their health insurance was being canceled. Although the couple, who run a housecleaning service, paid $1,180 a month and a $20 co-pay, Campos said he was happy with the plan because it included his wife's doctors -- critical, he said, because she had had a heart attack six years ago and brain surgery in 2000.

When contacted last month, he was panicked because, he said, his wife's medical group was unable to tell him which plans it was taking. "Obamacare insurance is not working properly," he said at the time.

But a few weeks later, it was a different story. After going on the website himself and using the "select a doctor" function, he found a plan with his wife's physicians that will cost him -- with a tax subsidy -- $415 a month. "Finally, I got it," he said. "Everything went smooth."