More than 500,000 Indiana residents without health insurance will be able to start buying it Tuesday under the Affordable Care Act, but while some are likely to decipher the federal website on their own with a few computer clicks, others will need so-called "navigators" to guide them toward the right plan.
Although the law that defined President Barack Obama's domestic agenda remains a source of partisan gridlock in Washington, this week marks the rollout of the exchanges where uninsured residents can shop for coverage that most will soon be required to carry.
Indiana was one of 36 states that opted not to run their own exchange, or online marketplace, deferring to the federal government to create it for them. The 34 health plans that will be sold on Indiana's exchange range from less than $100 a month for bare-bones coverage with high deductibles for an individual to close to $1,000 a month for a family of four.
The open-enrollment period for buying insurance through the website (www.healthcare.gov) will run from Tuesday through March 31. Coverage will begin Jan. 1.
But figuring out the system won't be easy for everyone. That's where people like Marla Asberry come in. As lead outreach and health specialist for Open Door Health Services, Asberry is a public insurance broker, or navigator, trained by the state and federal government to help residents choose the right plans.
"It's anybody's guess how that first day is going to roll out," she said.
Asberry and other navigators she works with have already been getting questions about the exchange and are prepared for many more this week. They have spent the past few months completing federal and state training, from learning state insurance rules to helping residents avoid fraud that could crop up with the opening of the exchange.
Republican Gov. Mike Pence has been no fan of the federal health care law — even apologizing last year after equating the Supreme Court ruling upholding it with the Sept. 11 terrorist attacks. However, his new administration has still been working to provide some key backup ahead of the opening of the exchange.
The state has hired, temporarily, 150 new caseworkers to handle an expected spike in residents seeking Medicaid coverage via the "woodwork effect" — an increase of enrollees. The state also has run tests on its phone system to ensure it will be able to handle call volumes.
State and federal officials already have pointed a few obstacles they expect to work through after the exchange is up and running. State officials noted last week that integrating the state's Medicaid enrollment system with the federal exchange online could take another month. National advocates for Hispanic immigrants also pointed out last week that the federal government is behind in rolling out Spanish-language services for non-native speakers.
Anyone earning less than the federal poverty level — $11,500 for a single adult and $23,500 for a family of four — is exempt from having to buy insurance.
Anyone earning up to four times the federal poverty level — $46,000 for a single adult and $94,200 for a family of four — will qualify for federal tax subsidies but have to buy insurance through the exchange to get the federal benefit.
The federal website takes residents page by page through a series of questions about age, employment, earnings and that will be used to determine what plans they will qualify for and how much they will pay each month.
Lucinda Nord, vice president of public policy for the United Way of Indiana, said the application will look almost exactly like it does online now.
"What will be different on Oct. 1 is they can begin hitting 'submit' on their application," she said.