Belleville pharmacist Mark Walz isn't about to let life's little frustrations get under his skin -- such as the federal government's Healthcare.gov website suddenly freezing up on him just as he was about to pick out a more affordable health insurance plan for himself before the Dec. 23 deadline.
"With what I've gone through this year, this is just another hurdle in the game for me," said Walz, a diabetic who over the past 12 months has endured shoulder surgery and then operations for two eye cataracts. In February, a surgeon amputated Walz's left leg below the knee, forcing him to spend nearly three months in a rehab unit.
On Thursday, Walz, 54, was seated in the wheelchair he's been using since the amputation.
A few feet away from him, behind a laptop computer in a cramped examining room at the St. Clair Health Department, sat Karen Willcutt, a county health care "navigator."
Since September, it's been Willcutt's job to help county residents like Walz find a new private insurance plan out of the 35 available in the county before the Dec. 23 deadline to get a new health insurance plan started by Jan. 1.
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Walz works part time at metro-east pharmacies and he buys his own health care insurance on the private market.
Notified by his current insurer that his monthly premiums would shoot up by $300, to more than $700, Walz sat down with Willcutt during an earlier session to weigh his options.
Walz went home with a stack of computer printouts. He used them to compare the higher monthly premium costs he'd pay under some plans with the higher co-pays and out-of-pocket costs he would pay with other plans that would charge lower premiums.
Walz crunched the numbers. After finding a new plan under Blue Cross/Blue Shield that would cost about the same as the one he has now, Walz returned to Willcutt's office. Only a few key strokes and clicks of the mouse stood between Walz and his new insurance future.
Everything seemed to be unfolding perfectly. But then a slightly pained look spread across Willcutt's face. She started reading from the screen.
"The message on the computer says, 'Sorry, there is a problem with our system, please log out and try again after 30 minutes.'"
Walz shrugged at the news.
"As long as I can make sure I have coverage before Jan. 1, you know, whatever," he said. "I mean I'm probably not the norm out there. People are probably really frustrated with the system."
With the Dec. 23 deadline approaching, many big questions surround the future of the Affordable Care Act in Illinois, with some of the biggest centering on whether people in the private insurance market can access affordable plans before the deadline -- a huge issue since many of the people will lose their current plans because of rule changes triggered by the health insurance law.
So far only about 365,000 Americans have bought new insurance plans out of the 7 million who need health insurance on the private market. Health care analysts estimate that at least 2.7 million Americans must enroll in the private market in 2014 to make the new plan work.
In Illinois, only about 7,000 people have so far signed up for new health insurance -- less than 30 percent of the federal government's projection for state enrollment by this point. Statewide, there are 1.6 million Illinois residents who lack health insurance.
Another big question centers on how many uninsured people, especially the young and healthy, the so-called "Invincibles," will sign up or decide to pay a small financial penalty.
In St. Clair County, there are nearly 27,000 adults between the ages 19 and 64 without health insurance, or 11.6 percent, according to the latest U.S. Census figures.
In Madison County, there are about 26,500 adults lacking health insurance, or about 11.7 percent of the total, the census data shows.
These figures compare to Illinois as a whole, where 1.6 million adults out of a population of nearly 11 million people lack health insurance, or about 14.8 percent of the total.
So far figures are unavailable for how many metro-east residents have signed up for insurance under the Affordable Care Act or under the expansion of Medicaid, the federally funded health insurance program for low-income people.
Robin Hannon, the St. Clair County Health Department project director, acknowledged that the sign-up procedure can be daunting. There are four classes of plans: with the cheapest being bronze, and the more costly ones moving in ascending order to silver, gold and platinum.
"We encourage them to anticipate what their health care needs will be," Hannon said, ticking off a list of variables, including the cost of their medications and whether their current physicians are in the health networks they would be joining.
"Ultimately, it's their choice, but we help them explore their health care needs," Hannon said.
Toni Carona, the Madison County Health Department director, acknowledged that enrollments have been slowed by problems with the Healthcare.gov website.
"We thought we would be ready to jump right out the gate and begin enrollment," Carona said. "What we realized very quickly is that when the website wasn't working well, we'd have to concentrate a lot of effort on community outreach and education and we've done that since Oct. 1."
Healthcare analysts interviewed said another potential hurdle for the Affordable Care Act hinges on the question of whether people who sign up for new insurance will actually get the insurance they think they are buying.
Already there have been reports of electronic files getting lost on their way to insurance companies or inaccurate information being typed in regarding first-time insurance customers, said Lisa Zwamosky, an analyst with WebMD, a health care website.
"So there are a lot of questions about whether or not that information is going to be in the system in time for people to access their services," she said. "So I think that is potentially some serious customer service problems down the line."
Jim Brasfield, a health policy analyst at Webster University, in Webster Groves, Mo., said the potential mismatch between what customers think they're getting and what they actually get could be the new law's biggest and potentially most difficult to remedy problem.
"Those kind of issues will begin to surface next year, but they seem less fixable because they're not a technical problem," Brasfield said. "They're part of the design of the whole system."
Meanwhile, back at the St. Clair County Health Department, Walz made an appointment with Willcutt to have another go at the Healthcare.gov website and finally get the health plan he picked.
Just before steering his wheelchair outside for the ride home in his Jeep SUV, Walz pondered whether the Affordable Care Act will be a good thing in the long run.
"In a way, yes, I do think it's a good thing," he said. "Because there's a lot of people out there that don't have insurance and who won't go to a hospital. And they get worse and worse."
Contact reporter Mike Fitzgerald at firstname.lastname@example.org or 618-239-2533.