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In rural Maine, insurance program progresses slowly

Deb Shields is one of a handful of counselors in rural Washington County charged with finding people who will benefit from the insurance marketplace created by the Affordable Care Act and helping them sign up.

Michael York for the Boston Globe

Deb Shields is one of a handful of counselors in rural Washington County charged with finding people who will benefit from the insurance marketplace created by the Affordable Care Act and helping them sign up.

WHITING, Maine — Volunteers handed out 50-pound bags of potatoes and pointed families visiting the church food pantry to crockpots steaming with hot lunch, as Deb Shields drifted between boxes of squash and bags of rice. The cheery 60-year-old waited for her moment.

“If you have any questions about health insurance,” Shields said, sidling up to a man nibbling a baked good, “I’d love to answer them.” The man didn’t need help, he told her. He had Medicare coverage. She moved on.

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Shields is one of a handful of counselors in rural Washington County charged with finding people who will benefit from the insurance marketplace created by the Affordable Care Act and helping them sign up. There are many. Eighteen percent of people here, more than in any other county in New England, lacked health insurance in 2011, according to the most recent census analysis. Yet, the rollout of the federal program here has been slow.

Outreach workers have a lot of ground to cover in a county of about 32,500 people that is more than two times the size of Rhode Island and where some families have limited Internet access. For weeks, they have been holding community meetings in libraries and at health centers, sometimes drawing just one or two people.

Even among the few who have come to her Eastport Health Center office for one-on-one help, Shields has not signed up a single person. She has been thwarted by the near-failure of the federal insurance website. On Tuesday morning, she and a client tried five times to log in to the site before giving up.

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The Obama administration said Friday that it had identified dozens of flaws with the healthcare.gov site and selected a private company to lead repair efforts. A White House consultant predicted most of the problems would be fixed by the end of November.

Still, getting people to enroll in areas such as Washington County may be particularly tricky, said Alan Morgan, chief executive of the National Rural Health Association. Outside of major metropolitan regions, people were less likely to support the federal health law to begin with.

‘Letting everybody flounder like this is just making it worse.’

Deb Shields, counselor on the insurance marketplace 
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Shifting the conversation from a political one to a practical one — showing people their options — takes workers like Shields. But across the country, outreach resources have been concentrated in population centers, Morgan said.

Maine was one of 34 states that chose not to create a state-run insurance program under the law. (Governor Paul LePage, a Republican, also vetoed a bill to expand the state’s Medicaid program with federal funding.) Residents who qualify for the new subsidized plans must purchase them through the federal program.

Without state coordination, a network of social service agencies, health centers, and statewide nonprofits are using federal grants to lead the outreach campaign. Enroll207.com, created by Maine Health Access Foundation, serves as a clearinghouse for information on how to get help.

Michael Gendreau, a spokesman for Maine Community Health Options, one of two insurers selling exchange plans in the state, said the company had not received enrollment figures from the government. Sign-ups may be low, he said, but phone calls and traffic to the insurer’s website indicate that interest is strong.

“A lot of people are window-shopping,” Gendreau said.

Shields said she would like to see the government take its website down and overhaul it, rather than allow people to make so many false starts.

“Letting everybody flounder like this is just making it worse,” she said. But Shields, well-known in the community for her gardening expertise, is optimistic: Like in the garden, she said, “stuff starts tiny, but it blooms into something phenomenal.”

Many Downeast people live by the calendar. They rake blueberries in summer. They fish during lobster, scallop, and sea urchin seasons. They make balsam fir wreaths at year’s end. The work rarely comes with health benefits, but the need is great.

Washington County residents are hospitalized for diabetes, asthma, and other chronic conditions more often than the average Mainer, according to a state public health assessment. More than 1 in 5 people lived below 2011 federal poverty thresholds — about $22,811 for a family of four — the second-highest rate in New England.

In the basement food pantry of a Seventh-Day Adventist church that sits along a stretch of Route 1 flanked by blueberry barrens ablaze in bright red foliage, interest in insurance talk last week was light. Shields filled a plate with zucchini casserole and chop suey and sat down next to Mona Denbow of Lubec, a nearby fishing village.

The 65-year-old was visiting the pantry with a woman she assists as a home health aide. Denbow is on Medicare, too. But, she told Shields, her relatives planned to skip shopping for coverage and instead pay the government penalty for being uninsured, which next year would be $95 per adult or 1 percent of income, whichever figure is higher.

Shields urged her to take some brochures. A woman listening in tucked a stack into her bag of just-ripening tomatoes.

“I think it’s going to be like Medicare was when it started,” Shields told Denbow. “People didn’t want it, but now people don’t want to give it up.”

Denbow said later that she passed information to her daughter, who is uninsured. Before she spoke with Shields, Denbow said, she knew that the law required people to buy health insurance but she didn’t know it offered subsidies for those who couldn’t afford it.

“I don’t think there was enough education onto it,” she said.

Shields repeated a mantra: There is time. Enough to reach more people like Denbow and for the government to fix the website. Dec. 15 is the deadline to sign up for coverage to start in January, but those who enroll by the end of March will avoid the penalty.

Some counselors in the county feel a greater sense of urgency. Winter is coming, and seasonal workers are setting their household budget through spring, said Susan Farley, an insurance counselor with Washington Hancock Community Agency.

“They’re putting fuel in their tanks,” she said. “They’re trying to get ahead on their electric bills, if they can.”

Frustrated with the website this week, Farley started helping clients fill out paper applications to be mailed. But, she said, she does not know when they can expect a response.

The 25-bed Down East Community Hospital in Machias is one of two hospitals in Washington County. It provides about $2 million annually in free care to low-income patients and never receives payment for about $2 million more in services, considered bad debt.

Doug Jones, chief executive, said that bad debt might decline if patients who now have high-deductible insurance plans, which leave them with bills they can’t pay, sign up for better coverage.

Such plans are common in Maine. More than 1 in 3 sold in the individual market had a deductible of $7,500 or higher, according to a 2011 analysis. Some families may have to pay higher premiums for more comprehensive coverage. Others, such as Tom Alford, will see their costs drop significantly.

The 62-year-old retired from book manufacturing and moved last year from Michigan to Cherryfield, Maine. His health plan, with a $7,500 yearly deductible, costs $437 per month, or more than a quarter of his budget, drawn from savings.

“It’s killing me, is all I can say,” he said.

The deductible has kept him from seeing a specialist for hearing loss, he said. Alford expects his premium on the exchange to drop by at least half, and for better coverage. He plans to meet with an enrollment counselor this week who will guide him through the online application, if the website permits.

Chelsea Conaboy can be reached at cconaboy@boston.com. Follow her on Twitter @cconaboy.
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