Do you have health insurance?

Carolina Kenny of Greenfield and Peter Kuusisto of Pelham work for Community Health Center of Franklin County as grant funded Certified Application Councilors for the Affordable Care Act. Recorder/Paul Franz Purchase photo reprints '

GREENFIELD - Despite an initial rollout of the state Health Connector under the Affordable Care Act that was marked by glitches and setbacks, the process of enrolling people in health insurance is slowly but surely improving, according to local health care counselors.

For the past year, Peter Kuusisto and Carolina Kenny, of Community Health Center of Franklin County, have been among the ground troops of certified application counselors working to assist people in enrolling in the new health care system. Other counselors are located at Community Action and Baystate Franklin Medical Center.

The certified application counselor program is a requirement under the Affordable Care Act, or 'Obamacare,' for every state health insurance marketplace. It is free and voluntary and administered by the Massachusetts Health Connector, the state's health insurance marketplace, and MassHealth, the state's health insurance for the poor. It is designed to assistant people in applying for, enrolling in or renewing health benefits.

The enrollment process hasn't always been easy since the state launched the Health Connector in October 2013.

From Franklin County's rural disparate geography to its minimal public transportation options to confusing media reports, the Greenfield-based counselors faced many barriers.

The biggest roadblock, however, is that many people are not aware that the new health insurance program exists, Kuusisto said.

'I found myself doing quite a bit of outreach to reach the population and educate them on what actually is going on.'

In the last three months, they say, the counselors have visited 27 different Franklin County events and spoken directly with 450 people.

'I do feel like we are getting a better response because of the outreach we're doing,' Kuusisto said.

Confusion at the state-level with its dysfunctional online health insurance website didn't make things any easier. On Oct. 1, 2013, the state hit the run button on the website and that's when the problems popped up. The site was marred by functional glitches, mainly due to its mandatory interface with a very shaky national database.

'When I started, there would be times I'd submit information to the website. By the end of the application, part of it would be missing,' Kuusisto said. 'You'd have to go back and add the information back in.'

In March, the state decided to scrap the site and informed the website contractor, CGI of Montreal that the $68 million deal was terminated. The contract with CGI expires in September. The state determined that the CGI website would be too costly to fix and instead opted to replace it with new software, called hCentive, written by a Virginia-based company.

The new system must be ready by November in time for the open enrollment period. In case that doesn't happen, the state plans to simultaneously connect to the federal HealthCare.gov insurance marketplace through 2015, Kuusisto said.

The state is under pressure from the Obama administration to fix the technology glitches. The problems are surprising for Massachusetts since it already had the country's first online health insurance database under its original 2006 state law requiring coverage for all residents.

Another ongoing issue with the state program has been its messaging.

The first open enrollment period lasted from October to March. It was geared toward individuals who are not looking for assistance. The problem was that many people who do need assistance or subsidies believed they were unable to apply. Those who need subsidies for health insurance can apply any time, Kuusisto said.

'At the end of open enrollment, there were a lot of media reports on how the end was coming and how people that hadn't enrolled had to do so,' Kuusisto said.

'Unfortunately, people looking to join got that same message. People in need of assistance can apply anytime. We still hear it from people that they didn't know they can still apply.'

Transportation is also an issue in enrolling people.

'The public transit schedule in Franklin County is not conducive (to easy travel to health centers or public access computers),' Kenny said. 'If people want to come from Athol-Orange to Greenfield, it can be hard. There is only one bus in the morning and afternoon.'

These issues are significant, said Cameron Carey, development director at the Community Health Center, because one of the goals of the Affordable Care Act is to promote self-sufficiency.

The technology is meant for people to sign up for themselves. But there are significant barriers to applying when the technology doesn't work and people do not have means to reach a counselor or drive to a local library to use its public computer.

When the system launched last fall, there was also a huge learning curve for counselors and Health Connector staff. Local cosunselors would wait 45 minutes to an hour to speak to someone at the Health Connector, Kenny said.

'Things are slowly but surely getting better,' Kenny said. 'We're able to anticipate things. The system had so many glitches at first it made it more difficult.'

The Health Connector has since hired more staff and geared up counselor training.

'Now, the wait time is no more than five minutes,' Kenny said. 'The quality is better.'

The troubles are not unfamiliar, said Carey.

'It's almost identical to what Massachusetts went through in 2006. It took six to 10 months to iron out the largest issues,' Carey said. 'Things started to improve and fall into place.'

For more information, visit:

413healthhelp.org

or call the Community Health Center at 413-325-8500 ext. 149.

You can reach Kathleen McKiernan at: kmckiernan@recorder.com or 413-772-0261 ext. 268 On Twitter, follow @RecorderKatMcK