---- — DES MOINES, Iowa (AP) — After years of debate and preparation, the launch day of the biggest new social welfare program in a generation has arrived. Starting Tuesday, uninsured Iowa residents will be able to use the new online marketplaces created under President Barack Obama's health care law to compare and buy health insurance plans.
About 264,000 Iowa residents under 65 without insurance could benefit from the law, but just how many people will immediately participate is hard to know. While Iowa is not a state where political opponents of the law are trying to aggressively impede implementation, state officials said there is still work to be done to explain the law to the public. And not all the education, assistance and marketing efforts will be fully ready in Iowa on day one.
"It's really a massive undertaking to educate Iowans. I think we have a lot of work ahead to educate people about the options on the exchange," said state Sen. Joe Bolkcom, a Democrat from Iowa City who supports the law and has worked to inform his constituents about the new program.
The exchange will be available Oct. 1, with coverage starting Jan. 1 at the earliest. Under the law — which seeks to reduce the number of Americans without health insurance — individuals are required to have health insurance from their employer or purchase it. Those who don't buy insurance will pay a penalty next year.
Iowa has agreed to a partnership exchange with the federal government, which means that the website and the technical infrastructure will all be handled by federal authorities. The state vetted and approved the insurance carriers that will be featured on the exchange and has been holding informational sessions around the state to let people know about the law.
Those shopping for benefits in Iowa will be able to choose from between at least two insurance carriers, both selling plans that offer a range of premiums, deductibles and co-pays. Some people using the exchange will qualify for subsidies to help cover the cost.
Projected premium costs are expected to be lower in Iowa than in many other states. Before tax credits that will provide an up-front discount for most buyers, the premium price for a mid-range benchmark plan will average $287 a month in Iowa, according to information released by the Obama administration earlier this week. That's lower than the national average of $328 monthly.
"I think compared to other rates we've seen, we shape up pretty competitively, said Iowa Insurance Commissioner Nick Gerhart.
One question mark in Iowa remains the planned expansion of low income health care. The state is seeking a waiver enabling the state to receive more federal Medicaid money for the proposed Iowa Health and Wellness Plan, a new health insurance program that would cover as many as 150,000 residents. The plan would cover some people on a new state-run program, while others would get private plans on the exchanges, with the federal dollars paying the premiums.
But so far, the state has not received federal approval. Gov. Terry Branstad has said federal officials have questioned the plan because it includes some small premiums, though they could be waived for meeting health goals or due to hardship. Still, officials remain optimistic the program will be in place well before Jan. 1, when coverage would begin.
"The actual coverage doesn't begin until January. I think we will come to a conclusion on that," Bolkcom said.
Getting the word out to residents about the exchanges remains a challenge. Federal grant money was recently approved for a marketing campaign in Iowa, but given state contracting rules, the earliest anything would hit the airwaves would be December, said Gerhart.
"We are supplementing what the federal government is doing on outreach," Gerhart said.
Other pieces of the process won't be completely ready by Oct. 1. Three medical organizations received federal grants to hire people in Iowa to serve as Navigators, who are people specially trained to help consumers find their way through the new health insurance system. Most of those Navigators will not be ready to go Tuesday.
Denise Hotopp, vice president of organizational integrity for Visiting Nurse Services of Iowa, said her organization would hire three full-time and between three and five part-time navigators using $257,142 in federal grant money. She said the three full-time people would start training next week, with a goal of being fully trained and certified by Oct. 7. The part-timers might not be in place until early November.
"We will go wherever community demand requests it. We will be making contact with libraries, community centers," Hotopp said.
Shelby Cloke, a spokeswoman for Planned Parenthood of the Heartland, which is hiring five navigators in Iowa with $214,427 in grant money, said they hoped to have them all in place in several weeks. A third grant recipient, Genesis Health System, did not return a request for comment.
Meanwhile, advocacy groups are also working to fill in the information gaps in Iowa. Anthony Carroll, associated state director for advocacy for AARP Iowa, said he was doing events around the state, talking to people about the law.
"This isn't about promoting it. What we're trying to do is educate people," Carroll said. "There's a huge vacuum of people who want to know what the law means."
Looking ahead to Tuesday, Gerhart stressed that it was going to take some time for this process to work.
"People need to take their time. It's just the first day," Gerhart said.