Spooked by the individual mandate?

One reason for last week's survey about the individual mandate is this: it used to be difficult to explain my job to friends. But health care reform, and specifically the individual mandate, has changed that. Now, when I tell people what I do, I end up handing out business cards. People are beginning to understand that they have to do something about health insurance, even if they don't know what or by when. So, what is being communicated about the individual mandate, and who is doing the talking?

Sixty-one individuals in 37 communities across the Commonwealth (click to see them on a map) took our survey. Respondents included people working in hospitals and community health centers, legislators and members of religious communities, community health workers, and staff at community-based organizations and anti-poverty agencies.

This is what they told us: Phone calls come in daily about the individual mandate. Even so, respondents are concerned that many remain unaware that they must get health insurance by December 31 or face a penalty. In most cases, "the public" learned about the individual mandate by word of mouth and from outreach workers' efforts. When someone needs help learning more or enrolling, same-day or next-day appointments are available in the majority of cases, although some sites are scheduling more than a week out.

And by when should people be insured? I purposely didn't ask "when people should be enrolled by" because enrolled means different things to different people, and for different programs. Anne Rosen and I came up with "If your clients are eligible for Commonwealth Care or Commonwealth Choice, by what date are you telling them to have applied, picked a plan, and paid their premium in order to have insurance by December 31?" With this definition, survey respondents said they were telling their clients to be done with all these steps by November 15 to ensure coverage by December 31, but the second runner-up was "by yesterday."

• Click here for a summary of survey results. (PDF)

And the word continues to go out. Yesterday, the MassHealth Training Forum sent out a link to the latest Department of Revenue mailing about the individual mandate. Have any of your clients brought this in yet?

What did I miss? One item not addressed in the survey was the December 31 deadline question: we are required to have proof of insurance as of December 31, yet some plans are likely to start on January 1st instead. Will the penalty apply to these people? This question came up at October's HAN meeting, and James Roosevelt of Tufts Health Plan writes about fixing this potential glitch on WBUR's blog, Commonhealth.