SALISBURY — Without a central source of information in North Carolina on Obamacare, local agencies are rushing to fill the void and spending hundreds of hours on training and public education, mostly at their own expense.
Novant Health Rowan Medical Center will host an information session and enrollment event from 3 to 7 p.m. Nov. 14 at the Civic Center for people who are uninsured, purchase their own health insurance or want to understand the current health insurance marketplace options through the Affordable Care Act, also known as Obamacare. The event is a collaboration between the hospital, Rowan County Health Department, Department of Social Services and local insurance brokers.
The Affordable Care Act mandates that every American, with some exceptions, have health insurance by March 31, 2014.
While states that are promoting Obamacare received federal grants for outreach and enrollment, North Carolina did not set up its own state-run health exchange and turned down millions of dollars in federal assistance for promotional activities.
“The states that agreed to participate have more resources and a more organized approach, while we are sort of left to scramble,” said Dari Caldwell, president of Novant Rowan. “It’s unfortunate.”
Caldwell said she was disappointed that North Carolina also declined to expand Medicaid, which leaves about 500,000 poor residents in the “gap.” They don’t qualify for Medicaid, but they also won’t qualify for a subsidy through Obamacare to help pay for health insurance because they don’t make enough to meet the federal poverty guideline.
Many people in the gap will discover their dilemma when they try to enroll in an insurance plan on the federal marketplace, an online health insurance shopping website serving 36 states. The marketplace opened Oct. 1 and has been riddled with errors and delays, with no accurate count on how many people have actually been able to sign up for health insurance. People also can enroll by phone.
Caldwell said she hopes people will be able to enroll online Nov. 14 at the Civic Center, but that will depend on how well the site — www.healthcare.gov — is working.
The hospital is spearheading the event after Caldwell said she attended many meetings about Obamacare hosted by different groups throughout Rowan and wondered if the groups were talking to each other. Caldwell said she also needed to know how to direct her employees.
“We were struggling to get information about what was happening and what can we tell patients and staff and doctors,” she said. “… It became obvious that we do not have a smooth way of handling this in our community.”
A team of community leaders began working together.
The only Rowan County agency that received federal dollars to help enroll people is the federal qualified health center in China Grove, said Krista Woolly, executive director for the Community Care Clinic of Rowan County. Woolly’s clinic has been accepted as a certified application counselor, a volunteer position, and will help people navigate the marketplace and sign up for insurance, she said.
Novant Rowan received no money and has been using its own resources to train the hospital’s financial counselors and patient access staff about the marketplace.
So far, uninsured patients at the hospital aren’t talking much about trying to enroll, which concerns Caldwell. Many are probably eligible for subsidies that would bring down the cost of health insurance significantly, she said.
“This is a huge change, and the ongoing challenge is going to be to connect with people who might be eligible and make sure they have the opportunity to get insurance,” Caldwell said.
Most Americans buying insurance on the exchange will qualify for a tax break. People who earn between 100 and 400 percent of the federal poverty level — $62,040 for a couple or $94,200 for a family for four, for example — will qualify for subsidies that will offset the cost of buying health insurance.
Average premiums in North Carolina for a mid-range health insurance plan under Obamacare are $369 a month before tax breaks are applied. That’s higher than the national average of $328 a month, the U.S. Department of Health and Human Services said.
The cost of coverage is higher in North Carolina where only two insurers — Blue Cross and Blue Shield of North Carolina and Coventry Health Care of the Carolinas — are selling plans on the exchange. The cost is lower in states with more competition, according to a federal study.
Because North Carolina is part of the federal exchange, applicants for health insurance first must see if they qualify for Medicaid. That goes through the Department of Social Services, where six additional temporary workers are processing applications, Director Donna Fayko said.
Most people who don’t have health insurance by the March deadline will face penalties, beginning at $95 per year in 2014 and jumping to $695 in 2016, although the government will not penalize people in the gap for not having insurance if they would have been covered by the Medicaid expansion.
“We are concerned about people choosing the fine and not buying the health insurance,” Caldwell said.
Many people may not realize they qualify for a subsidy, she said. It appears that people who don’t make enough money to file an income tax return can’t be penalized, since the penalty is deducted from tax refunds.
“We are anticipating still a large number of folks who will remain uninsured, and we will still need to be concerned about them receiving health care,” Caldwell said.
Novant Rowan already has felt cuts from the Affordable Care Act, she said. The law reduced the hospital’s Medicare reimbursement by 22 percent during the past two years to help fund a pool to expand Medicaid.
When North Carolina did not expand Medicaid, that money went to states that did expand the program, Caldwell said.
Despite the confusion and frustration surrounding the federal marketplace, Caldwell said she sees a silver lining.
“It has been very invigorating to see all these agencies working together to address the needs of our community,” she said. “We will be a stronger, healthier community because of it.”
The Nov. 14 event will feature speakers at 3:30 and 5:30 p.m. and trained staff from 3 to 7 p.m. People who plan to sign up for an insurance plan at the event should bring with them:
• Social Security numbers or document numbers for legal immigrants
• Birth dates
• Pay stubs, W-2 forms or wage and tax statements
• Policy numbers for any current health insurance
• Information about any health insurance you or your family could get from your jobs
Under the Affordable Care Act, insurance plans must cover a wider range of services and cannot turn away applicants based on prior illnesses, also called pre-existing conditions. Plans offered through the marketplace will provide coverage for:
• Doctor’s visits
• Hospital care
• Maternity care
• Emergency room care
• Prescriptions
While walk-ins are welcome at the Civic Center, pre-registration is encouraged. To register, call 1-800-335-4921 and choose option 3.
The health department will have representatives in attendance, along with local brokers including Snow Benefits Blue Cross Blue Shield.
The hospital also will offer wellness screenings including a cholesterol check and blood glucose check.

Contact reporter Emily Ford at 704-797-4264.