Pa., N.J. get meager aid to help consumers with Obamacare

Pennsylvania is on course to spend about $2 million to reach out to more than 1 million uninsured residents to help them sign up for coverage in the federal health law's online marketplace in the fall.

Maryland, though, will spend more than 10 times that sum, nearly $25 million, to help far fewer people - about 730,000 uninsured.

"We are envious and jealous," said Laval Miller-Wilson, executive director of the Pennsylvania Health Law Project in Philadelphia, which provides legal assistance and advocacy to the poor.

New Jersey will also spend relatively little on consumer assistance - about $1.5 million - to provide help to about 900,000 uninsured. That works out to less than $2 per uninsured person in both New Jersey and Pennsylvania, compared with about $34 in Maryland.

The support is critical because big health insurance changes are coming Oct. 1, and surveys show few people know about them. Starting then, individuals and small-business employees will be able to go online and buy health policies regardless of their health status, and many will benefit from government subsidies to lower their premiums.

Because Pennsylvania and New Jersey are relying on the federal government to set up their insurance-exchange sites, they won't be getting as much outreach money as more proactive states.

States with some of the nation's highest rates of uninsured residents, such as Florida and Texas, as well as those in the middle, like Pennsylvania and New Jersey, are getting far less federal money per uninsured resident than states with low rates, such as Maryland, Vermont and Rhode Island, a Kaiser Health News analysis shows.

"The spending difference could have a huge impact," said consultant Jon Kingsdale, who helped launch the Massachusetts health insurance exchange in 2006.

The online marketplaces were envisioned to be as easy to use as travel websites like Expedia, but experts say that many people will need help figuring out which plan is best for them and what information they need to get coverage.

Some have never applied for health insurance and may need assistance even to navigate the website, said Sonya Schwartz, program director of the National Academy for State Health Policy.

Others will want to know about subsidies that can help a family of four with an income as high as $94,000.

The exchanges are the key way the law expands health coverage to about 27 million more people by 2016.

That's where people will shop for and enroll in private coverage and see if they are eligible for premium discounts, or for Medicaid, the insurance program for the poor.

"It's a shame that we see states with lower rates of uninsured putting more money into education and outreach than states with higher rates of uninsured," said Deborah Bachrach, a former New York State Medicaid director who is special counsel at the law firm Manatt Phelps & Phillips.

Miller-Wilson said the $1.2 million for Pennsylvania won't go far in a state with 67 counties, particularly in rural areas where the uninsured are harder to reach. He said many people may feel comfortable signing up only if they can do so with personal assistance.

Consumer assistance is only one way that potential enrollees may learn of new insurance options and how to sign up for them. More federal dollars will go to advertising on radio, television, and billboards. And insurers, hospitals, and nonprofit groups may supplement public education efforts in many states.

The biggest reason for the uneven spending on consumer assistance is that when Congress passed the health law in 2010, it assumed most states would run the online marketplaces, and it authorized broad funding for that. As it turned out, only 16 states and the District of Columbia agreed to do so.

The law did not set aside money for the federal government to operate the marketplaces, either alone or in partnership with the states, as it is doing in at least 34 states.

To remedy that, the Obama administration recently moved $54 million from the law's prevention fund to provide money to hire and train people to assist consumers in those states, based on their number of uninsured.

That money will be awarded directly to groups that agree to hire and train people to assist consumers. Those eligible include church groups, local health agencies, community health centers, and chambers of commerce. Applications are due June 7, with awards being made in August.

Two Philadelphia groups expected to apply for the federal navigator grants are Public Health Management Corp., a nonprofit, and Benefits Data Trust, which helps enroll people in government-assistance programs, said Wendy David, associate vice president of the United Way of Greater Philadelphia and Southern New Jersey.

For states that defaulted to the federal government to run their exchanges, "the system is almost set up to penalize you for doing that," David said.

Health advocacy groups in Maryland, meanwhile, are giddy about the 300 consumer assistance jobs expected from the nearly $25 million that the state is putting toward getting people signed up for insurance. A third of that, or $7.9 million, will go to Baltimore-area groups.

Asked about how Baltimore could have more money for consumer assistance than entire states, such as Pennsylvania and New Jersey, Kathleen Westcoat, CEO of HealthCare Access Maryland, laughed.

"Maryland is putting its money where its mouth is," she said.