Patient finance counselors Jennifer Carlson (middle) and Lorry Schacht (back) work with a patient to sign up for insurance last week at Bay Area Medical Center in Marinette. EagleHerald/Rick Gebhard
Patient finance counselors Jennifer Carlson (middle) and Lorry Schacht (back) work with a patient to sign up for insurance last week at Bay Area Medical Center in Marinette. EagleHerald/Rick Gebhard
MARINETTE - The country's Affordable Care Act opened a window Oct. 1 for people without health insurance and those who would see changes to their Medicaid eligibility to sign up for new coverage in state marketplace exchanges.

Its unveiling was certainly less than smooth - to say the least.

Adding to the confusion people already had with enrollment, what information was needed to enter the system, and what plan they would eventually choose - the national website was a technical disaster.

Health care providers, such as Bay Area Medical Center and Aurora Health Care, and service organizations, such as the county health departments and other non-profit agencies, started well before October planning for the sign-up needs of people in this community.

John Hofer, BAMC's director of marketing; Brian Gamelin, BAMC fiscal officer; and Mike Finley, project manager, spoke with the EagleHerald recently about the work that has been since July to prepare for Oct. 1.

While BAMC was working with local agencies and providers to ensure that the people who needed to enroll and choose health plans were identified and assisted, it also partnered with other communities in the state of Wisconsin to make sense of what was about to unroll across the country.

Finley sits on an enrollment action council established by the Wisconsin Hospital Association, which meets regularly to discuss the steps being taken to help people get into the system.

BAMC applied for, and became, a Certified Application Counselor Organization, or CACO, which means they can help people navigate the complicated and ever-changing new health care marketplace.

"We see it as our responsibility to help find the health care options (available) for our patients and consumers," Finley said.

It is part of BAMC's mission to provide care to the uninsured and underinsured residents of both Marinette and Menominee counties, said Hofer. "We are taking the role of leader in assisting the community."

The fact that the hospital and other health care providers in the area will be dealing with two different state systems is not new, and it has created its own problems, he said.

"It confounded things that we are dealing with two states - Michigan and Wisconsin - and the federal government," Hofer said.

Once BAMC was established as a CACO, it had to train and certify employees who would sit down with people to help them through the process. One new person was hired, but four employees total received the training to become certified application counselors for BAMC. NorthReach HealthCare, which is a BAMC/Bellin network of clinics, has two CACs.

Other entities may have people on staff to help with the enrollment process, including Aurora, which has been holding weekly information/sign-up sessions at UW-Marinette and has established mobile enrollment hubs around the state of Wisconsin, said Tammy Clausen, Aurora marketing manager.

Agencies and health care providers in the area were invited by BAMC to discuss the issue in early September, and there was a general discussion about what agencies could do to help local people signed up for coverage. "Mike Finley has done a great job in bringing everyone together," Clausen said.

Those agencies included Marinette County Public Health, Twin Counties Free Clinic, NorthReach, The Menominee County Medical Access Coalition and ADRC.

The Affordable Care Act will require people formerly on Medicaid to enroll, and transition them into insurance if they do not qualify. While Medicaid is changing in both states, it may be determined that individuals are still or now Medicaid eligible, and by just enrolling and entering information, the system puts them in contact with their county health programs to establish provisions.

BAMC counselors are setting up appointments with people from either state to go on the national website together. The hospital has worked with the outside agencies and posted information internally to get the message out that there is help available - at no charge.

"We want the community to get a consistent message," said Gamelin.

Aurora is certified to work with Wisconsin residents.

The national site opened Oct. 1, and ran into a flurry of problems, BAMC started taking appointments the second week of October. The new counselors were not immune to the delays and disruptions on the national website - so appointment times were adjusted to account to slower access.

As of mid-November, BAMC's counselors had met with more than 60 people, and helped all of them enroll. About 15 were determined to be eligible for Medicaid, and the remainder walked away with an idea of what health care plans were available, and how much they would receive in tax credits to offset the premium costs, said Lorry Schacht and Jennifer Carlson, patient finances counselors.

People make their own decisions on which plan they will choose, since there is often a lot of information available about the levels of coverage and cost, as well as doctors and co-payments.

"There is no steerage allowed," Hofer said of the work counselors do to help people enroll, set up an email account and enter income and household members' names. That work stops at advising people on plan choices.

People utilizing the counseling though Aurora go through the same process, Clausen said. "There is education at the beginning and people are at all levels of need," she said of the information available as well as computer skills.

Both BAMC and Aurora will offer follow-up one-on-one sessions with people who want to actually chose a health care insurance provider. People can also do that on their own, Finley said.

Finley said BAMC originally planned to meet with people for about 40 minutes on the first visit, but saw that time increase with the computer system delays. "Now, we're setting expectation levels lower - telling people 'we may not get through all this today.'"

Clausen said the outreach to the community has received positive response.

In fact, it takes most people two to three hours to complete the process - which would include choosing a plan - but the time is often spread out over several visits at BAMC or on one's own computer.

Gamelin said that people need to spend time looking at the plans available, since there is more than just cost involved.

"There are finite details - are their doctors and hospital covered (under the plans)?" he said. BAMC can't provide any background on the plans, since the hospital - like everyone else in the country - "didn't know what plans were being offered until the day (the site) opened up."

While the window to sign up on the exchange has been extended to March 31, 2014, people who need their coverage to start Jan. 1 need to sign up and pay their premium by Dec. 15, Clausen said.

Hofer said BAMC doesn't charge for helping people set up their accounts, nor does it benefit from offering the service.

But ultimately, people in the community and the hospital benefit from more people having access to health care - since long-term (chronic) health issues can be better managed and people will not have to turn to the Emergency Room for problems that can be handled at a clinic.

Gamelin pointed out that people can still enroll after the March 31 deadline if they have a life event that changes their eligibility on another plan.

WHAT: Health Insurance Marketplace Signup

WHEN: Oct. 1, 2013 - March 31, 2014

WHERE: Online at (800-318-2596); by setting up an appointment at Bay Area Medical Center, (Wisconsin and Michigan residents) at (715-735-4202); or by contacting Aurora at or calling 877-732-6334 (Wisconsin residents only)

HOW: Appointments at BAMC are free of charge, but are suggested

WHAT TO BRING: Information about annual income (W-2 or paycheck stub) and Social Security numbers of all eligible dependents in the household.