Health

Sharon Bush spent 30 minutes on Tuesday helping a client sign up for an email account. The email address is a necessary step in signing up for health insurance through Healthcare.gov.

Bush didn’t realized that the email requirement for the federal exchange would take up so much time.

“In southeastern Kentucky, there are a lot of people who don’t have and/or use technology,” Bush said. “[The client] is a grandmother in her early 60s, and she just said, ‘I have two granddaughters and they use it a lot.’”

Bush works in Manchester, Kentucky, at Grace Community Health Center, where she helps people sign up for health insurance. She’s a former Kynector, a person paid by the state to assist people with enrollment. She helped people last year find health insurance through Kynect and is now helping people sign up on the federal exchange at Healthcare.gov.

In early October, Gov. Matt Bevin was given approval by the federal Centers for Medicare and Medicaid Services to dismantle the state-based insurance portal, Kynect, leaving Kentuckians searching for insurance to go through the federal portal, Healthcare.gov.

Nov. 1 marked the first day of open enrollment for health insurance. And because none of the enrollment information from Kynect transferred over to Healthcare.gov, the more than 100,000 people who were signed up for coverage on the state-based exchange now have to re-enroll.

Healthcare.gov requires an email address to sign up, or people can call the federal help center. But Bush didn’t know that until Tuesday. She said after helping her client set up an email address, they sat for 45 minutes while the website was down.

“It just kept spinning and spinning, and you could tell the server was busy,” Bush said.

In the end, they had to reschedule for next week. Bush, who primarily helps Kentuckians sign up for coverage in Leslie, Clay and Laurel counties, figures the server might not be so busy then.

“Southeastern Kentucky people are kind people, and they’re not always in a hurry as people in urban areas,” Bush said. “If I’d been in a metro area, those people might not have been as understanding about coming back another day. So if it was going to have to happen, it’s probably better it happen to me than someone else.”

Widespread Issues

The issues Bush ran into in Manchester also caused problems across the state, including in Louisville, where Susie McConkey tried to enroll a client.

McConkey is vice president of business development for agent services at AgentLink, a company that acts as a go-between for insurance brokers — who don’t sell specific kinds of insurance — and clients. The agency will likely enroll 10,000 people before open enrollment ends Jan. 31, 2017.

McConkey said she fears that some brokers might give up using the site out of frustration.

“We anticipate, even though this is day one, some people are going to try and give up,” she said. “And the more difficulties, if the Healthcare.gov is down more, we need to be in a position to help them.”

In previous years, brokers and nonprofit enrollers like Bush could go on the Kynect site on behalf of clients to enroll them. But Healthcare.gov doesn’t allow for that. Consumers either have to do it themselves, or brokers can use a web-based entity — purchased software, like what AgentLink had to buy — that interfaces with Healthcare.gov and allows them to enroll people.

The software is expensive, so many health insurance brokers across the state have chosen to send their customers to AgentLink.

McConkey said one of the big issues facing enrollees is the limited doctor networks.

Anthem BlueCross Blue Shield is only offering a health maintenance organization plan — traditionally used to hold down costs — to over half of Kentucky’s counties. And Anthem is the only remaining insurance provider offering plans in all 120 counties.

Many insurers have pulled out of the exchange because they say they lost too much money on those plans. Anthem is switching most of the state to HMO networks partially in an effort to stop losing money.

“The big issue is that you’re not covered outside the network, McConkey said. “In a PPO [Preferred Provider Organization], you can go outside the network and it might cost more. The only thing offered in Jefferson County is an HMO.”

McConkey said she knows of one client in Louisville who will not be able to see her doctor in Jeffersonville, Indiana, anymore because they are not in network.

The window for open enrollment runs through through Jan. 31. For coverage starting Jan. 1, 2017, consumers must sign up by Dec. 15, 2016.

Lisa Gillespie is WFPL's Health and Innovation Reporter.