Urban Llama

The year coming to a close this evening never really did slow down for me, so it seems fitting that 2014 had a particularly hectic ending.

Much of the polarization 2014 held had to do with my work at the Kentucky Health Benefit Exchange (KHBE). As part of the Cabinet for Health and Family Services, KHBE is the administrative agency for Obamacare in Kentucky, which is known as “kynect.” Considering the animosity that a vast majority of residents in this border South red state have for President Obama, the Affordable Care Act doesn’t exactly poll well around here, particularly if you point out that kynect actually is Obamacare. Still, with Kentucky ranking in the bottom of several of the most severe health rankings, such as tops in smoking and cancer deaths, once kynect initially came online in October 2013, the results in the first year were the best in the nation, with over 521,000 residents enrolling in kynect.

That first open enrollment period lasted six months, October 2013 through March 2014. Due to the technical problems Healthcare.gov had nationally with its website, and the huge number of folks responding at the deadline, a special enrollment period was convened for two additional weeks to accommodate those trying to enroll but who encountered technical issues or couldn’t get the assistance they needed.

The idea was that things would calm down once open enrollment concluded, but it didn’t play out that way. In fact the caseload at KHBE increased, as glitches in enrollments created issues for many hundreds of clients, and the insurance company that took on the lion’s share of the private enrollments with kynect was not prepared to efficiently handle the array of issues that came with such a large number of first-time enrollees. Just establishing the proper protocol to address all the people having issues with their insurance through kynect took time and multiple revisions. Some clients have cases that are still being worked out a year later as the second open enrollment period is underway.

So the success and national accolades that came to Kentucky for kynect at the close of the first open enrollment period in April 2014 turned into an all-hands on deck triaging of problem cases to get folks’ insurance working the way it should. As that situation became more manageable in September, there was no escaping that the next open enrollment would start in six weeks. In addition to updating information for 2015 and finalizing improvements to the kynect website, KHBE was also in the process of designing a new mobile application, to allow anyone with a smart phone to access certain information to facilitate answering questions about kynect. Also, a retail store was to be opened in Lexington’s Fayette Mall. It was a one-stop shop, staffed with KHBE staff, insurance agents and kynectors. We could take applications and get you enrolled right there.

Both were huge undertakings, and the retail store, which opened Nov. 13, in time for the beginning of the second open enrollment period on Nov. 15, has since been a huge drain on staffing, especially with having to be open for extended holiday hours.

There is no way of getting around that a tremendous amount of pressure came with all of this. Trying to keep all the balls up in the air as everyone involved worked incrementally to finalize what needed to be completed by Nov. 15 made sleeping hard. The hours and seven-day work weeks were grueling.

Not to mention the political backdrop. Kentucky was the state with the hottest Senate race in the country, as Mitch McConnell, the 30-year incumbent and sitting Senate Minority Leader, was running against Sec. of State Alison Lundergan Grimes. Sen. McConnell has not been bashful about wanting to remove Obamacare “root and branch.”

The possibility was there for Sec. Grimes to perhaps reap the reward of the over 521,000 Kentuckians who did embrace the Affordable Care Act. Because when you cut through all the rhetoric, kynect allowed those who may have pre-existing conditions to have the option of getting comprehensive health care coverage without being turned away or charged more. And with the program being based on income and family size, the vast majority applying would receive tax credits and possibly other discounts to offset the monthly premiums, or qualify for expanded Medicaid, which comes free of charge.

In the end, even though McConnell backed away from his “root and branch” blanket statements and tried to distance kynect from being a form of Obamacare, the incumbent wiped the floor with his Democratic challenger. The results from the election came a week before the second open enrollment began. This victory for the Republicans made me feel like we had work to do in terms of better explaining kynect to the public. One of the big components for kynect to remain viable is that we need to keep bringing uninsured individuals into the program, particularly those eligible for private plans or Qualified Health Plans (QHP). What couldn’t happen was we get into this second open enrollment and we don’t at least meet the number of private enrollments secured in 2014.

That was the backdrop as November arrived. KHBE has kynectors in all 120 counties that can provide free assistance with taking applications and completing enrollments, plus kynect-certified insurance agents blanket the state, who can recommend to clients what insurance plan will work best for each individual’s specific situation. They all needed to get re-trained and updated on changes to the kynect system as well.

And then it began, generally without quite the fanfare that accompanied the first enrollment period, but that is how it should be. Many folks were already in the system, so we were not starting from scratch. The folks on Medicaid re-certify on the anniversary of their previous enrollment, so a large majority of that population did not require assistance at this time. It’s those qualifying for private insurance that we needed.

While open enrollment runs from November 15, 2014 through February 15, 2015, for those wanting health coverage beginning January 1, 2015, you had to have your application completed and plan picked by December 15. Health insurance isn’t exactly what you want to think about at Christmas, but it has to get done.

The retail store in Fayette Mall has proved more popular that ever expected. It has up times and down, but you need the necessary staffing in place to be prepared. And those are long shifts. There is something about being in the mall atmosphere. It’s like working on stage. Folks come to the mall to get things accomplished. When people come to the kynect store they expect to get what can be a rather complicated process completed right then and there. That is a whole other level of pressure. Each time a client would come to my work station I prayed the system would be working properly, that I would know the answer to the questions asked and could get this person’s case fixed.

As December arrived my 2-year old daughter, Isabella, came down with a nasty illness that was going around at daycare. She was out for a week, and promptly passed her lovely illness along to daddy. With the December 15 deadline looming I fought this thing off with a potent cocktail of over-the-counter medications. I worked the second shift at the retail store on Dec. 15, which I knew would be insane, and it didn’t disappoint. Then I called off sick for the rest of the week and went to the doctor.

With all the hours I was pulling Christmas had not remotely been properly addressed, and that is a problem when you have kids aged 2, 10 and 11. Hell most things in my personal life had been pushed to the side for much of the year. I was hoping I could make amends over the last two weeks for some of that time I was missing in action, and I did to a certain degree, but then my family needed to take an unexpected trip to Detroit.

It’s a long story, but my partner, Maia, was previously married to a man in Portugal. The 10 and 11-year old we have are hers from that marriage. The 11-year old, Gabriel, has been doing a semester abroad in Portugal, since June he has been gone and needs to come home. The other back story to this lovely year is that Maia’s former husband has been diagnosed with a rather aggressive form of cancer, and he can’t fly Gabriel back to the States as planned, so Maia and her 10-year old son, Jacy, need to fly over to get Gabriel and spend some time with their Portuguese family in early January.

In getting those travel plans arranged it was discovered that Jacy’s passport had expired. To get a new one turned around in the necessary time for them to travel, all minors must be presented in person at a U.S. Passport issuing office. Both parents are supposed to be there as well, but that couldn’t be facilitated obviously. This required the Portuguese consulate to become involved to supply the necessary documentation to the passport office for why Jacy’s dad could not be present.

So on the afternoon of December 22 everything was finally arranged. We just needed to drive to Detroit with the 2 and 10-year olds and be there for a 11:30 a.m. appointment on December 23. The only hitch was we needed UPS to deliver the consulate documents before we could leave. Turns out they arrived in Louisville, but were mistakenly sent to Kansas City. The documents made it all the way from Portugal, and were 50 miles from our house, then sent 559 miles the wrong way. After Maia had a heated conversation with a supervisor at UPS it was promised that the documents would be put on a plane in Kansas City and sent to Detroit, but we would have to get them from a sorting center once there. This meant we had to drive to Detroit with our fate not in our hands. We needed UPS to get this right or we were screwed.

We didn’t get out of the house until after 5PM. It’s a lovely drive straight north through Cincinnati, Dayton, Toledo and then Detroit. Even in the dark this is a hideously ugly drive. I know most of what it looks like in daylight, but was surprised how ugly it seemed in the dark. We finally got to bed around 3AM. As it turns out UPS was as good as their word, and by mid-afternoon on Dec. 23, we had successfully completed our business in Detroit. It was Christmas Eve by the time we arrived back in our driveway, but we did it.

And kynect has done what it needed to do as well. After the Dec. 15 deadline had passed, it was found that over 101,114 Kentuckians had newly enrolled or re-enrolled in Obamacare, surpassing our numbers in the first month last year and outpacing our total private enrollments from the previous year. Once we go back to work on Monday, six weeks remain in the current open enrollment period. There is speculation that a considerable number of folks needing health care coverage will be looking to get enrolled as the deadline nears. That is going to make for a fast start to 2015 most likely.

It has been a really hectic and busy year, but my family had a lovely Christmas once we were off the road. I owe Maia, the kids, my folks, Maia’s folks and Maia’s sisters an enormous THANK YOU. Everyone helped pitch in while I was out doing kynect and I could not remotely dial in to the everyday situations that make up life in a household. I’m sorry for that and other things that have transpired this year that are my fault. Particularly I owe Maia a huge THANK YOU! I’m seeking a better balance between life and work in 2015. On the plus side I was finally able to get my 2012 and 2013 income tax returns processed this week. Miracles do happen.

Happy New Year everyone!