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With deadline near, ‘Obamacare’ getting its last-minute looks

You have only a few more days to get your “Obamacare” – if you want it.

Monday is the deadline to enroll for coverage for this year on the NY State of Health insurance exchange. So if you don’t have health insurance yet, you have the weekend to figure out whether to sign up, or if you would rather pay a penalty that starts at $95 for the year.

Insurers expect a wave of last-minute sign-ups even though, according to health care experts, New York has already enrolled more people on its exchange – with far fewer problems – than most states.

“We’re especially busy, and I think that’s been true throughout this whole episode,” said Jennifer Nichols, senior director of revenue cycle operations for Kaleida Health. Nichols oversees the system’s navigators, who help people sign up through the state exchange.

For individuals, though, the question of whether to sign up for coverage is a very personal echo of the policy debate that has haunted the Patient Protection and Affordable Care Act since before its passage four years ago.

For “young invincibles” such as Rob Zandrowicz, 33, an agent with Keller Williams Realty and a North Buffalo resident who plans to go without insurance, Obamacare is nothing but a government-imposed cost that’s too much to bear.

“I’m not going to volunteer and sign up just to pay for other people’s health care,” Zandrowicz said.

But for people such as Mary T. Stengel, a 59-year-old freelance writer and editor from West Seneca, signing up is just common sense.

“I’m an excellent example of how the website is not the policy,” said Stengel, who took five tries over as many days to enroll through the state website but now is saving nearly $40 per month on her health insurance. “I’m very satisfied.”

Website in N.Y. ‘works’

States such as New York, which opted to operate their own exchanges, have been signing up people for insurance since last Oct. 1, as has the federally run exchange that operates in states without their own exchange.

The statistics show that New York has fared comparatively well in signing up the uninsured.

As of last week, 342,895 New Yorkers had enrolled in private health plans on the state’s exchange. That’s about 34 percent of the people thought to be eligible to do so.

In contrast, Maryland – which has its own exchange that has been beset by the same sort of website meltdowns that have bedeviled the federal site – has enrolled only about 14 percent of those believed to be eligible for private plans, according to, a website that is tracking the health care law.

“New York deserves a lot of credit for doing it better than just about any other state,” said Dr. Michael W. Cropp, president and CEO of Independent Health. “There was a lot of planning and coordination that went into it.”

Thanks to the pace of early sign-ups in the state, New York State officials said they are on target to meet their goal of 615,000 sign-ups on private plans by 2016.

In addition, 374,312 New Yorkers signed up for Medicaid or other public plans, bringing the state’s total of people enrolled for health care on the exchange to 717,207. More than 70 percent of them did not have health insurance at the time they enrolled, according to the state Health Department.

In other words, in New York, Obamacare has at least made progress toward its goal of delivering health care to the uninsured. At the time exchange enrollment began in October, New York alone had 2.7 million uninsured people – 64,000 were in Erie and Niagara counties.

The Obama administration announced Thursday that it has met its goal, too, of signing up 6 million people nationwide for health care this year, despite the often-balky federal website and troubles on various state exchanges.

In states using the federal exchange and those with troubled exchange websites, enrollment has been slower because in many cases people resorted to applying for insurance on paper, said Rachel Klein, director of organizational strategy at Families USA, a nonprofit health care advocacy group. In New York, problems like those Stengel experienced are comparatively rare.

“The website in New York State works,” Klein said. “That is the key.”

Last chance until fall

And while the federal has rebounded from its early troubles, the Obama administration this week announced that it is allowing some flexibility for those who have tried to sign up for health insurance on the site but won’t complete their application until after March 31. Those people now will be given till mid-April to sign up.

In New York, though, Monday is the hard-and-fast deadline. Except for those in special circumstances – such as the newly married and newly unemployed – the uninsured who do not enroll will not get another chance until Nov. 15, when the next open-enrollment period begins for health care starting in 2015.

While state officials and advocates of health care reform are making a push to enroll as many people as possible by Monday, a number of uninsured are having trouble selecting a plan.

The Kaiser Family Foundation reported last month that 63 percent of the uninsured told pollsters that they knew little or nothing about the exchanges, and that only 24 percent of them were fully aware of Monday’s deadline.

After Monday, if you can’t document that you have insurance for 2014, you face a penalty of $95 – or 1 percent of your income, whichever is greater – that will be collected by the Internal Revenue Service when you do your 2014 taxes.

The penalty, deemed the “individual shared responsibility provision” by the IRS, is set to rise to $325, or 2 percent of your income, for 2015 and again to $695, or 2.5 percent, in 2016.

But there are plenty of exemptions to the penalty, most notably for those who can prove they experienced a “hardship” as defined by the Department of Health and Human Services.

Among those who will end up paying a penalty, many have calculated they’re better off doing that than paying for coverage they don’t believe they need.

Zandrowicz, the real estate agent, doesn’t have a regular primary care physician or a dentist and has been without insurance since early 2013.

The Army veteran is single and healthy, and doesn’t think paying at least $218 per month for coverage makes sense financially. “I’m willing to bite the bullet because it’s $95,” he said.

People such as Zandrowicz are a big problem for Obamacare, which was designed on the premise that by requiring everyone to buy insurance or pay a penalty, the young and healthy would, in essence, subsidize the new health policies of the older and sicker.

Getting ‘peace of mind’

So far, though, local enrollees have tended to be older than desired by the architects of the insurance marketplace.

“The demographic is mixed. It’s skewing toward older, but that isn’t a surprise to us,” said Gregory A. Pasieka, director of health care reform for BlueCross BlueShield of Western New York, who noted that the region’s population is older and that people here already can stay on their parents’ insurance up to age 26.

Of the younger enrollees, some were drawn to the low-cost options of lesser-known companies.

Nick Guy, for example, bought catastrophic insurance from Health Republic for $150 per month, choosing low premiums and higher out-of-pocket costs. The 27-year-old hasn’t needed to use his coverage yet.

“Still happy I have it for the peace of mind, though, in case anything crazy happens,” said Guy, a freelance writer who lives on the West Side.

Yet there’s a downside to those cheap high-deductible plans.

“The proliferation of high-deductible plans has certainly caught some people by surprise, quite frankly, in that you have to pay out of pocket for medical services upfront until they meet their deductible,” said Dr. David P. Hughes, senior vice president and chief clinical integration officer at Kaleida.

The biggest concerns that Consumers Union has heard from exchange customers involve narrow provider networks and difficulties in figuring out whether a particular doctor or hospital is part of an insurer’s network, said DeAnn Friedholm, the organization’s director of health care reform.

“I think it’s been quite a mixed bag. I think there’s no other way to describe it,” Friedholm said of the health care law. “We knew it was going to be hard, and we knew it was going to be a long slog.”

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