Affordable Care Act

by Kat Thornton & Megan Hauptman

published October 3, 2013


LIKE THE PROPHESIED YEAR 2000 in old Technicolor cartoons, the age of Obamacare is no longer in the distant future. On October 1, state-run and federal health insurance marketplaces will open. These are cyber marketplaces that aim to consolidate health insurance plans into a user-friendly website so that individuals will be able to find the best healthcare coverage for them based on their employer, income, and premium constraints.

     In Rhode Island, that site is Open the site and you’ll see a big picture of a smiling child, a couple and their infant, or an elderly woman grinning from ear to ear. The design is inviting, easing, comforting—and doesn’t make you think about premiums just yet. “Live healthy and rest easy with the right plan,” the HealthSourceRI splash page encourages. The federal site, which states can use if they opt not to develop their own, is called It’s nearly identical to Rhode Island’s in format. On the homepage there is a ticker counting the days left until March 31, 2014, when open enrollment for health insurance plans comes to a close and individuals will incur a fee if they cannot provide proof of health insurance coverage.

     State healthcare bureaucrats are proud of HealthSourceRI. “Our exchange is actually more advanced than other states,” Health Insurance Commissioner Kathleen Hittner said. It wasn’t necessary for Rhode Island to create its own exchange—states have the option to adopt the federal website. In fact, only 14 states have created their own exchange site to date.

     The website will be anchored by a physical office and call center where individuals, insurance brokers, or employers can phone in questions about health insurance. The center is located along the interstate railroad tracks at 70 Royal Little Drive, near the Stop and Shop and Savers in the north end of Providence.

     In the first hour of opening, HealthSourceRI’s physical office had two visitors sitting in two of the four on-site consulting rooms. Various employees and workers walked around the blue-walled lobby with clean glass tables and padded sea green chairs to fix the window blinds and set up stands for informational brochures. Although the front door misleadingly read, “Optum,” an analytics company formerly housed at 70 Royal Little Drive, inside the metallic sign for “HealthSourceRI” was in plain sight.  That same morning, temporarily crashed, reportedly due to too much traffic (don’t worry, it’s back now).

     The exchange also launched a television ad on September 30. While perhaps not as humorous as the Oregon exchange ads, which rose to online acclaim with their spotlight on young, flannel-wearing guitarists, the Rhode Island ad is nonetheless feisty and “very unique to Rhode Island,” Lieutenant Governor Elizabeth Roberts said. The video shows scenes from the American revolution, a painting of the HMS Gaspee, the ship that John Brown and other colonists burned down in protest of British law, and images of manufacturing plants. The narrator, in a voice fit for a movie trailer, says, “We are Rhode Island, and we have a history of leading the way. Now, let’s do it with healthcare.”




RHODE ISLAND HAS BEEN PREPARING for this kind of healthcare reform for over twenty years, according to Roberts, who was in office alongside former governor Donald Carcieri in 2008 when the Affordable Care Act passed.  

     In 2004, Roberts helped bring about the creation of the state office of the Health Insurance Commissioner. The office, which exists only in Rhode Island, oversees the premiums health insurance companies place on their plans. Each year, the health insurance company proposes their own increase in insurance premiums, and the Health Insurance Commissioner, using cost projections calculated by a team of actuaries, judges whether the increase is plausible and fair to both the customer and the provider.

     The office was created shortly after charges of corruption were levied against Blue Cross Blue Shield of Rhode Island, the state’s largest provider of individual insurance plans. In 2003, John Celona, then a North Providence state senator and the chairman of the Senate Corporations Committee, was charged with accepting bribes from officials at Blue Cross Blue Shield of Rhode Island, CVS, and Roger Williams Hospital. In response, the federal government launched an investigation into broader state corruption. “Operation Dollar Bill,” as it was called, focused on between seven and a dozen (sources vary) local corporations and politicians. The result was a jail sentence for Celona, the dismissal of several executives at Blue Cross Blue Shield and the Roger Williams Medical Center, and a $20 million fine for Blue Cross Blue Shield of Rhode Island (which health care premium hikes would not be allowed to make up for). At the time, the board of Blue Cross Blue Shield was internally nominated. Now, one-third of their board must be publicly appointed, Roberts said.

     In the shadow of state corruption, Roberts said she worked with a group of more than 200 local volunteers to raise support for health insurance reform through community meetings and semi-successful legislative packages (successful items inc luded things that established the “nuts and bolts” of health care reform, like a pay claims database, Roberts said). Carcieri was not in support of healthcare reform, but Governor Lincoln Chafee, who entered the seat of the governor in 2011, gave Roberts and local activists the go-ahead to prepare for the implementation of Obamacare.

     October 1 was “the big expansion of access,” Roberts said. But she said the biggest dates are now behind us, like the law that extended the age that children could stay on their parents’ insurance, and the ban on insurance companies dropping coverage on a person should they develop an illness or have pre-existing condition. The market is open—now only time will tell what customers will do with it.

KAT THORNTON B’14 is shopping for answers.





“MARKETPLACE ISN'T REALLY A WORD that translates well into other languages,” says Channavy Chhay, Executive Director for the Center for Southeast Asians (CSEA), a state-wide organization that provides comprehensive social services to Asian immigrants in Rhode Island. “People hear marketplace, they think about going to a physical market.” Marketplace is the word that many politicians and policy wonks have used to describe the new online health insurance exchanges that opened October 1. “There have been so many names for this new health care,” chimes in Xong Dong, a Program Director at CSEA. “First it was Obamacare, then the Affordable Care Act, then HealthSource. People are confused.”  

     It’s complicated enough trying to understand the intricacies and procedures for enrolling in a health care plan if you speak English as your first language, but language and cultural barriers make the process infinitely more difficult. That’s where organizations like CSEA come in. “We want our community to be enrolled and informed,” says Chhay. “There are a lot of language and cultural barriers [to enrolling in an insurance plan]. Our organization fills that void.”

     Dong and Chhay’s sentiments are reflected in nationwide polling data on general confusion over what exactly is happening with the Affordable Care Act (ACA). There have been so many attempted repeal votes in the House of Representatives that many people believe that the ACA has been vetoed. “We’ve still got more than 40 percent of the American people who think that the law may have been repealed by the Congress or overturned by the Supreme Court or just don’t know,” says Drew Altman, President and CEO of the Kaiser Family Foundation, which has been conducting polls about the ACA since 2010. This general confusion over the politics of the healthcare reforms is compounded by the difficulty of community-level outreach to inform and enroll people in the soon-to-be mandatory health care.




CSEA IS ONE OF 11 COMMUNITY organizations (in addition to eight state health centers) that will provide one-on-one, in-person health care enrollment assistance through a state-sponsored community navigator program. The navigator program, which is funded by HealthSourceRI, is contracted out to and run by the Rhode Island Health Center Association (RIHCA), which operates several low-cost health centers across the state.

     Currently, RIHCA’s eight health centers serve approximately 40,000 uninsured patients, which is a little less than a third of the total estimated 128,000 uninsured Rhode Islanders. All of these 128,000 Rhode Islanders theoretically need to be enrolled on some form of health insurance by January 2014 to avoid a penalty tax, but many people either don’t understand this new mandate or will have trouble enrolling based on language, cultural or technological barriers.

     That’s the impetus for the community navigator program, which seeks to “reach out to all corners of Rhode Island” according to Jane Hayward, President of RIHCA. Partnering with community groups allows RIHCA to take advantage of the organizations’ language skills, outreach abilities, and existing social service infrastructure.

     RIHCA has already begun training employees from the community groups to work as navigators and begin providing services this week. The idea is to teach people with existing community ties about new health insurance options so that they can then counsel the groups they work with and offer one-on-one enrollment assistance. In addition to CSEA, the groups providing this navigator service include the Providence Community Libraries, the John Hope Settlement House (refugee services), Latino Public Radio, Amos House (support services for formerly and currently homeless people), and the Providence Center (substance abuse recovery centers).




SOME OF THESE ORGANIZATIONS serve populations particularly in need of healthcare coverage, many of which will be covered under the Rhode Island Medicaid expansion, which also kicks into action this January. The Affordable Care Act mandates that everyone be enrolled in an insurance plan by 2014, but several exemptions exist—if you are homeless, in jail, recently bankrupt, or living below the poverty line, you are not subject to the tax penalty. In Rhode Island, if you cannot afford to enroll in one of the low-cost insurance options, you most likely qualify for the state-wide expansion of Medicaid. 

     Amos House, off of Broad Street in South Providence, houses a shelter, soup kitchen, and job training programs. “We are in the midst of a community where there is tremendous unemployment and poverty, where many people don’t have health insurance,” Eileen Hayes, Amos House’s President and CEO, told the Independent in a phone interview. One employee from the organization has been trained as a navigator and will soon begin assisting people to sign up for healthcare through HealthSource.  Hayes hopes that the new healthcare options will allow more people who Amos House works with access to preventative care, rather than relying on the Emergency Room as their primary care provider. She sees access to stable healthcare as one of the first steps for people trying to move on to stable housing and employment. “One of the reasons that many people who are homeless can’t get stability in their lives is a lack of access to health care, especially mental health services.”

     Owen Heleen, Chief Strategy Officer for The Providence Center, echoes Hayes’ sentiment: “Getting access to mental health or substance abuse treatment when uninsured is difficult.” He sees the new insurance mandates as “a big win for all of our clients.” Heleen hopes that access to affordable healthcare and the Medicaid expansion will make it possible for more people to afford and enroll in mental health or substance abuse treatment and reduce some of the stigma that many people face. The Providence Center has already sent three employees to be trained as navigators by RIHCA, and is planning on training three more soon; the navigators will move between their 14 service locations throughout the state. 

     Despite his enthusiasm for the new insurance exchange, Heleen wasn’t entirely sure what the future would look like when we spoke on September 30th. “Buying health insurance is complex. The new system allows people to actually compare apples to apples, because the plans have to have common elements, but I am not positive everything is going to work perfectly at nine o’clock tomorrow morning. We all need to be patient.”

MEGAN HAUPTMAN B’14.5 is kind of patient.