Little Rock For all of the criticism of the on-line tools and what Secretary of HHS Sebelius has now called the “debacle” of the web access for enrollment for the Affordable Care Act or Obamacare, the 800 pound gorilla in the room is still sitting on the digital divide.
First, we have huge numbers of Americans who are not only priced out of healthcare, but also priced out of internet access, more than 25% of all Americans and 43% of all African-Americans for example. Secondly, without experience on the internet that comes with easy and frequent access, and I’m not talking about a once-a-week trip to the library to try to check email or do homework, everything is difficult, which just compounds the problems of a clunky website to start with and intensifies dramatically when it involves something as complex and confusing as choosing health insurance from a bunch of companies and different plans. Admittedly, time is not our friend in getting everyone into the system by December 15th, it’s just not going to happen, but putting that aside, using more paper applications and 800# call center access could end up more effective in recruiting low-and-moderate income families into the system now, especially with the level of intimidation that now exists about the online access.
This became startlingly clear looking at the experience that the State of Arkansas is having in expanding Medicaid participation up to 138% of the Federal Poverty Level. The good news of course is that Arkansas, rare among many Southern states, is in fact running a hybrid state-federal marketplace and is expanding the program and taking advantage of the fact that the federal government is paying 100% of the first three years, unlike Texas, Louisiana, Florida, and a host of others.
Nonetheless according to a report in the Arkansas Democrat-Gazette, the Department of Human Services sent out 145,000 letters to existing food stamp recipients for whom they had income information and therefore already knew they were within the range of 100% to 138% FPL and therefore automatically eligible for expanded Medicaid. Bam! 65138 replied with return mail that they wanted to enroll, which all admit is a phenomenal response to any direct mail piece.
But, now the digital divide does its pernicious work because “…most of those who responded to the initial letter have not responded to a second letter directing them to a state website, insureark.org, where they can complete the enrollment process.” Now, remember we have been fighting Comcast hammer and tong to actually deliver the internet access in central Arkansas and the rest of the country required by the FCC’s approval of their merger with NBC/Universal, but they are foot-dragging and trying to politic their way out of doing real work. Keep in mind as well that Arkansas, Alabama, and Mississippi are the three states at the very bottom for internet access in the country. So, really, are you serious, these low income folks can only get into the Medicaid system in Arkansas if they go online? Duh! In Arkansas, that means that the state will mandatorily assign them a private insurer and they have 30 days to object and change companies, but essentially, everyone must know the obvious, that the state will end up picking the companies period. Even on the general state enrollment for Obamacare through their own access.arkansas.gov website half as many Arkansans have applied through paper applications or phone applications as the internet, proving the same point once again, so essentially for every two who go online, one uses paper or a phone where they are more comfortable. I bet that would be true everywhere and for every state among the uninsured.
There really should be mass distribution of paper applications, even as big and bulky as they are, door-to-door, through health clinics, libraries, driver’s licenses bureaus, hospitals, and any and every place that is willing to let someone pick up an application, get comfortable, and either fill it out, or venture into the wild world of the web. But, of course that’s only if we are really serious about getting full mass participation in the Affordable Care Act. In the meantime by happenstance or design, given the uncertainty and tentativeness with which so many of the uninsured approach the web and their often limited access to it, we should not be surprised that so few are succeeding in making it through the maze, regardless of whether the online system is ready and able.