Residents across Indiana are treading lightly when considering buying health insurance through the federal health exchange as they move toward a March 31 deadline to enroll.
Nearly 17 percent of the state's population, or 911,674 people, lacks insurance. Most of those residents are required to show proof they've obtained insurance after March to avoid a penalty under the federal health care overhaul law. But the U.S. Department of Health and Human Services says only about 30,400 residents had bought plans through the exchange through the end of December.
The slow rate of compliance reflects early glitches with the signup process, sticker shock over prices offered through the health exchange and a stubborn work ethic in parts of the state with populations that prefer to rely on one another instead of the government, according to those charged with helping people enroll.
The largest numbers of uninsured in the state are in LaGrange and Elkhart counties, both of which have large Amish populations. More than 25 percent of LaGrange County residents lacked insurance, while 21 percent were uninsured in neighboring Elkhart County, according to U.S. Census data.
Patty Gremaux, director of outreach for Elkhart General Hospital, has encountered many of those during visits to sign up residents for coverage through the Healthy Indiana Plan, a state-run plan that Republican Gov. Mike Pence wants to use as the vehicle for a Medicaid expansion. He is in drawn-out negotiations with federal health officials on the plan.
"I saw firsthand that these were hardworking, ethical, 'I'm-not-going-to-take-public-support' Hoosiers," Gremaux said. That work ethic has made many clients more hesitant when considering insurance bought through a government program, she said.
The Amish, who typically shun government assistance, made up a large portion of the work force in northern Indiana's recreational vehicle industry, which collapsed during the recession and propelled Elkhart County to a nearly 19 percent unemployment rate. Though the industry is rebounding, many of its workers still lack jobs or have returned to positions with leaner salaries and benefits.
"It was the first time — maybe in a long time, if ever — that a lot of very hardworking Elkhart County Hoosiers found themselves in a financial situation they had never been in before," Gremaux said.
Other Indiana counties are faring better but have their own challenges.
The extensive new federal requirements have created a groundswell of resentment in areas like Indianapolis' "doughnut" counties, which have the state's highest rates of insured residents. The top three counties with the lowest percentage of uninsured are Boone, Hamilton and Hendricks, according to U.S. Census estimates released in December.
Residents looking for basic coverage are surprised to find out their bills are higher in part because the law requires plans to cover birth control, pre-natal care and other extras that not everyone is looking for, said Sandra Carasquillo, president of Easy Street Insurance in Greenwood.
Carasquillo, who serves many of the communities ringing Indianapolis, said the law is effectively shifting the burden of insurance to the middle class and the benefits to lower-income residents.
Even counties in the middle of the pack are finding it a challenge to enroll residents.
In Delaware County, where 16.8 percent of residents lack insurance, navigators working with Open Door Health Services in Muncie set up shop in a conference room at the Maring Hunt Public Library in late December. Navigator Amanda Deardorff set up a laptop and chairs around a conference table and welcomed residents who had made appointments.
Many expressed shock at the costs of the plans — single adults right on the bubble, just shy of 400 percent of the federal poverty level, can see prices range between $400 a month for a low-end "bronze" plan to $600 a month for the higher-end "gold" plans. That doesn't include the deductibles that must be paid before coverage kicks in.
Valerie Kizer, 59, of Muncie, didn't like the prices but was happy to have insurance.
Kizer, who co-owns Kizer's Carpet Care with her husband, had struggled to get medical coverage after she was diagnosed with multiple sclerosis in 1994.
"When I had a good insurance, say when I was diagnosed with this, when they [insurers] found out about this, they started raising the rates and raised to a point where I didn't have a choice to drop it. And when that happened, nobody would take me. And when they did take me, the insurance was horrible and they wouldn't pay for anything," Kizer said.
The plan Kizer enrolled in through the exchange will cost about $100 more per month than the coverage she lost at the end of the year, but she said she was happy to have insurance that covers treatments she may need.