Idaho's Health Insurance Exchange: Straight Talk 

More Idahoans dialing into Your Health Idaho for less politics, more facts

Loralie Walker likes talking with the public. She'd better, considering the urgency of what she's talking about.

: "On our first day, 10 of us handled close to 500 calls," said Walker. "I got home that day and told my son, who is also a customer service rep for Idaho Power, that I just took 47 calls and I felt like I was run over by a freight train. He said, 'Welcome to my world.'"

But Walker's "world" isn't anything like Idaho Power--as one of 10 call center operators at Your Health Idaho, she's on the frontline of Idaho's health insurance exchange. And Walker is perfect for the job: She's as sweet as pie, smart as a whip and knows how to turn almost any negative into a positive.

"One person's Obamacare is another person's Affordable Care Act," she said with a broad smile. "You know, I come from very conservative roots and I have been very pleasantly surprised at some of the reactions, even from my own family. I was expecting a little more negativity. At times, callers may try to draw us into political conversations, and I've become very good at deflecting that. It's not my role to discuss beliefs or opinions. But that doesn't mean that they don't tell me how they feel. I'm just not going to get sucked into that."

Walker, who along with her call center colleagues is a full-time temporary employee contracted by Your Health Idaho, said the tone of recent phone conversations is dramatically different than when she first started fielding questions in the fall of 2013.

"At the beginning, people were just really confused. I don't think they were ready to start thinking about actual enrollment, and there were a lot of calls where people just wanted to vent," she said. "Now, people are really serious about enrolling."

The Your Health Idaho call center is rather modest: a group of cubicles tucked into a corner of office space owned by the Idaho Department of Health and Welfare off of Westgate Drive in Boise. In fact, just several feet away from the call center, scores of Idahoans were getting assistance from IDHW workers in applying for food stamps, child support or medical coverage for children.

But Your Health Idaho is not a part of IDHW, or any other state agency (they rent the call center space and technology from the state). In fact, in trying to define Your Health Idaho, it's easier to say what it is not. For starters, it's not even a state agency.

"We are an 'Independent Corporate Body and Politic.' That's how the legislation reads," said Jody Olson, Your Health Idaho's director of communications.

Under Idaho law, Your Health Idaho is not an Idaho agency but is deemed by statute to perform an "essential government function" and to serve a "public purpose," and to that end is considered "a governmental entity."

"It's a quasi-government agency," said Alberto Gonzalez, operations project manager.: Additionally, while Your Health Idaho is not classified as a nonprofit entity, it acts like a nonmember nonprofit corporation in that it has "no members or equity owners who are entitled to vote or receive any dividends or distributions during its existence or liquidation." And even though it is not technically a tax-exempt organization, "as a governmental entity, Your Health Idaho is not subject to federal or state income taxation."

And while some Idaho politicians continue their heated debate over who holds the reins of the exchange and how, or even if, it should function, there are increasing signs that Idahoans have moved on from the politics and are now more focused on how they might benefit from the Affordable Care Act.

"Take a good look at those plans in the silver category. That's where the screaming deals are," David Chase, a so-called "in-person assister," told : Boise Weekly : when we attended an ACA workshop Jan. 8 (BW, : News, "Credits, Penalties and Deadlines," Jan. 15, 2014: ). Chase was referring to one of the ACA's four categories--platinum, gold, silver and bronze--that offer plans with higher or lower deductibles and co-pays.: "A lot of families have come to us and said, 'You know, we really couldn't afford insurance before.' But now they're finding affordable coverage," said Gonzalez: Gonzalez and Olson have received ample Idaho feedback on the ACA. Since the bumpy Oct. 1, 2013, launch of the exchange, Your Health Idaho regrouped and decided to hit the road.

"When HealthCare.gov (the federal exchange that Idaho will continue to utilize until the fall of 2014) wasn't working, we decided to pull back our advertising and increase our ground game," said Olson. "We said it would make a lot more sense to travel throughout the state and offer education and information on a one-on-one basis.

: Gonzalez and Olson have barely unpacked their bags in the past 60 days.

"We've done 110 events in every corner of Idaho," said Olson. "So far, we've reached 9,000 people, eyeball-to-eyeball. And we'll have more events all the way through the end of March [the deadline for securing 2014 coverage through the exchange]."

And about that deadline: To a person, everyone : BW: spoke to regarding this story acknowledged that misinformation continues to be spread, particularly about the deadline and penalties. For the record, you can be penalized if you don't have proof of health insurance coverage for three months or more. In the first year, the penalty is $95 per person ($47.50 for children) or 1 percent of your income, whichever is higher. In year two, it doubles. By year three, it's $600 per person ($300 per child) or 2.5 percent of your income.

"But we try not to make that mandate the main driver of our message," said Gonzalez. "You never want to mandate fear."

But perhaps the most difficult conversations that Your Health Idaho call center operators have had to endure is when they talk with Idahoans who are, quite simply, too poor to participate in the exchange.

"And these are people who are falling below the minimum guidelines in order to be eligible to shop in the exchange marketplace, and generally, they're not eligible for Medicaid either," said Walker.

The 2013 Idaho Legislature chose not to expand Medicaid coverage to low-income adults, effective Jan. 1, 2014, and every indication is that the 2014 legislature won't consider it either.

"That's a tough one. It has been the hardest thing," said Walker, who paused for a moment before continuing. "In the very beginning last fall, I was very uncomfortable in delivering that message. But we've gotten to the point where we're able to deliver that message with some compassion. Some people are, quite honestly, devastated. They really thought that this would be the first time that they might be able to get insurance."

Hannah Brass Greer knows the dilemma all too well. As Idaho legislative director for Planned Parenthood Votes Northwest, she spends her days at the Idaho Statehouse, advocating for greater health care access.

"It's an election year," said Brass Greer. "In 2013, the Idaho Legislature faced the possibilities of expanding Medicaid and the creation of an exchange. They chose the exchange, and that was it. They spent their political capital in getting the exchange through."

And since it is an election year, Brass Greer added that health care advocates will remind voters that Medicaid expansion (or lack thereof) is something worth considering when choosing one candidate over another.

"I expect we'll see some of that, especially as all of this relates to the economics of Idaho families," she said.

Meanwhile, Brass Greer's Planned Parenthood colleagues have spent the past several months mobilizing scores of volunteers to go door-to-door throughout the Treasure Valley talking to citizens about the ACA.

"Hi, my name is Jonny with Planned Parenthood. We're talking with folks in your neighborhood about the new health care law," said Planned Parenthood Votes Northwest Field Organizer Jonny Carkin, rehearsing with a team of volunteers. "May I ask if you currently have health insurance?": On an early Saturday morning, a team of volunteers, including retirees, health care professionals, students and recent college graduates prepared to hit the bricks in an effort to talk to residents about the ACA.

"We've been pleasantly surprised," said Carkin. "We've really been able to have in-depth conversations to dispel some of those myths. Door-to-door is much more effective than mailers or robo calls. This is much more reasoned and less controversial. People in Idaho still have a soft spot for volunteers and they're less inclined to be abrasive or rude when you're face-to-face."

Carkin coached the volunteers on the different types of people they might encounter.

"There are the 'chatty supporters' but you really can't waste too much time with them; and then there are the 'chatty opponents' who think you're there to have a spirited debate and have no intention of changing their minds," said Carkin. "But then there are the 'undecideds.' These people are gold, and those are the conversations that we want you to have."

BW: spoke to the volunteers who had varying degrees of confidence for talking to strangers about the ACA.

"I'm a big Planned Parenthood supporter. I always have been," said Steve, a 60-something retiree.

"I'm excited but I'm nervous," said Carol, a 50-something home health care worker.: "I've never gone door-to-door but I'm really not nervous about talking about this," said 19-year-old Sydney, a Boise State student.

"Honestly, I'm more nervous talking to you than I am talking to someone about health care," said 22-year-old Kim, a recent college graduate

: Carkin said that even though the Affordable Care Act has "been at the forefront for anyone who follows politics," he was anxious for his team of volunteers "to de-politicize it." "One of the reasons it's so controversial is because of the opposition and the messaging that they've churned out. I'm sure that you've heard about some of the robo calls warning about death panels," he said. "Our goal is to forget all of that hype and lay out the facts."

Back at the Your Health Idaho call center, Loralie Walker said she's been talking to nearly every demographic.

"A little while ago, I spoke to a 19-year-old and I just off the phone with a 62-year-old," she said. "But the one thing we keep hearing is that they're grateful to be talking to someone in Idaho. And, I think, we can speak very competently about the exchange, versus a call center that is heavily scripted. That's a huge difference."

So far, the average length of a conversation with a Your Health Idaho call center operator has been approximately five minutes. There is very little, if any, hold time to talk to a representative. But things will only get busier with the March 31 deadline looming.: "The time will fly by in the blink of an eye," said Gonzalez. "As the time nears, this is a call to action, and time is almost up. But Idahoans should know that whether it's at the call center or at one of our in-person meetings throughout the state, there are a lot of people who can help."

And more calls won't faze Walker one bit.

"Am I ready for a flood of calls in March? You bet; I like to be busy."

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