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ND groups spread word about health exchange amid dismal enrollment

By Kyle Potter

Forum News Service

FARGO — James Nichol, a Blue Cross Blue Shield of North Dakota representative tasked with explaining the ins and outs of the Affordable Care Act to North Dakotans, had a tough room here Monday afternoon. It’s been that way across much of the state, he said.

The skeptics in the crowd of about 80 in a Ramada Plaza and Suites ballroom muttered their disapproval and asked political questions. One man declared the health care law, commonly called Obamacare, unconstitutional.

With the help of more than $1 million in federal grants, a handful of health organizations are trying to spread the word and — eventually — get North Dakotans enrolled in health insurance through the new federal marketplace. Nichol and Blue Cross have spent much of the month touring the state for sessions like Monday’s forum.

Insurance officials say the well-publicized website woes of, the new federal marketplace where Americans can shop for coverage, are a big factor in the dismal statewide enrollment so far — just 20 North Dakotans have purchased insurance since the marketplace went live Oct. 1, according to company figures. About 68,000 North Dakotans don’t have health insurance, according to U.S. census estimates.

But health officials say there’s another obstacle: With state leaders taking a hands-off approach to the implementation of the health care law, community health clinics and so-called professionals called navigators across the state are on their own to spread awareness about the new exchanges and fight what they call “misinformation” about Obamacare.

“There is a void that was out there in the state. People are hungry for information,” Nichol said.

Little state involvement

Gov. Jack Dalrymple and North Dakota lawmakers decided not to set up their own exchange, instead letting the federal government run the show — and foot the bill. Those marketplaces, which route health insurance shoppers to providers that offer plans that qualify for the various rules and regulations, are a crucial part of the Affordable Care Act.

Several states elected to chip in with some exchange work, but North Dakota is one of 19 states that took a completely hands-off approach — with one exception. Dalrymple and the Legislature expanded Medicaid to cover as many as 32,000 additional North Dakotans.

In an interview last week, Dalrymple called the state’s decision to have the federal government run the exchange “one of the best decisions we’ve ever made in state history.”

Other states may be promoting the new exchange like neighboring Minnesota, which runs its own marketplace called MNsure. In North Dakota, organizations like the Family HealthCare clinic in Fargo feel like they’re responsible to fill in the gaps.

“There’s definitely room for doing more for the people of North Dakota,” clinic Chief Executive Officer Patricia Patron said.

Patron’s clinic received a $105,000 grant from the federal government, which went to hiring two full-time employees to aid in enrolling the clinic’s low-income patients for health insurance through the federal marketplace. Community health centers like Family HealthCare generally serve uninsured and low-income populations — some of whom may qualify for Medicare coverage and others with higher incomes who could receive subsidies from the government to purchase health insurance on the exchange.

Four North Dakota community health centers received a total of $329,000 — the second-lowest among the states — in federal funds to boost awareness and help people get enrolled. The Community Health Care Association of the Dakotas received another $144,500 for similar efforts throughout North Dakota and South Dakota.

“We’re doing a lot of work to debunk myths that are out there,” said Sam Kundinger, Family HealthCare’s chief business development officer.

Another $600,000 went to two groups of navigators, who focus more on outreach and education about the marketplaces. Of that, $186,000 was awarded to a group that targets American Indian populations throughout the Dakotas.

North Dakota Insurance Commissioner Adam Hamm said that though the Insurance Department has links to on its website, it’s not his job, or the state’s job, to promote the federal exchange.

“North Dakota made a decision not to have a state exchange or to partner with the federal government. The exchange is the sole responsibility of the federal government,” Hamm said.

Dalrymple emphasized that North Dakota is “doing everything that is required and expected” with the federal government and the new health care law.

The basics

As the top dog of 17 navigators in North Dakota, Neil Scharpe says they have two duties: making people aware of the federal marketplace and how it works, and helping people sign up.

The technical problems that have plagued the federal marketplace since it went live Oct. 1 have made the enrollment piece slow going, said Scharpe, who is based out of the North Dakota Center for Persons with Disabilities at Minot State University.

Educating North Dakotans has been going better, he said, but it’s difficult “when we are asked specific questions, and can’t give really specific answers because we aren’t the system.”

Many of those specific questions were posed to Nichol at Monday’s Blue Cross informational session, and he had his answer ready: “It depends.”

Nichol outlined the variety of insurance plans Blue Cross offers through the federal marketplace, each with different coverage levels, deductibles, out-of-pocket maximums and premium monthly payments.

Sanford Health and Medica also are selling insurance on the exchange.

North Dakotans making between 138 percent and 400 percent of the federal poverty level — currently $23,550 for a family of four — are eligible for federal subsidies. Part of the Affordable Care Act expanded Medicaid up to 138 percent of the poverty level. No Medicaid recipients will be eligible for subsidies.

Customers have until March 31 to sign up in order to avoid tax penalties, but Nichol stressed the Dec. 15 deadline for North Dakotans who need health care coverage effective Jan. 1.

Blue Cross Blue Shield of North Dakota is encouraging customers to wait “several weeks” until the technical problems on the federal website are sorted out. Nichol acknowledged the dismal enrollment numbers in North Dakota — just 14 had enrolled in Blue Cross Blue Shield plans through the exchange as of early last week.

“I have a feeling that in a few weeks, things will look better,” Nichol said.

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