Approval of the plans is up to the federal government because Alabama's governor decided the state wouldn't create a state-operated health insurance exchange and would leave it up to Washington. The Alabama Department of Insurance's only role is saying whether the plans being proposed by the three companies meet state law, and that review is in progress, spokesman Mark Fowler said.
"The federal government, however, could reject any plan the state might approve as meeting state law," he said.
The federal government is still reviewing the three companies' plans for Alabama.
The federal Affordable Care Act calls for most Americans to have health coverage by 2014. The health care exchanges, or marketplaces, are supposed to help consumers find health insurance when they don't have it through their jobs. The plans are supposed to be offered to the public starting Oct. 1, with coverage starting Jan. 1.
To help people participate, federal tax credits will be offered to consumers with incomes between 133 percent and 400 percent of the federal poverty level. That's up to about $46,000 for an individual and about $94,000 for a family of four, with those at the high end getting little or no subsidy.
Gov. Robert Bentley, a physician, opposes the federal Affordable Care Act and decided Alabama wouldn't create an exchange. That left it to the federal government to create. Bentley said operating a state exchange for Alabamians could cost the state as much as $50 million annually.
Bentley said he has not looked at the companies' plans for Alabama. "I am not participating in that, and I'm not going to be a part of the federal exchange," the governor said.
In Alabama, the companies are proposing plans at a variety of insurance levels, which makes comparisons with existing policies difficult, company officials said. Blue Cross vice president Koko Mackin said the levels are known as bronze, silver, gold and platinum.
The state government has not applied for and has not received any money to promote or educate citizens about the exchange, Fowler said.
President Barrack Obama has awarded $2.4 million in grants to 13 Alabama organizations to help enroll the uninsured. Quality of Life Health Services of Gadsden got the largest grant of $438,841, followed by Mobile County at $299,152 and Franklin Primary Health Center of Mobile at $256,571.
The federal Health Resources and Services Administration said that will allow the organizations to hire a combined 50 additional workers to assist Alabamians.
At Quality of Life, planning and development officer Amelia Wofford said the organization is looking at adding eight employees to educate uninsured citizens about the various plans and then help them enroll in a program. She said there could be as much confusion as surrounded Medicaid Part D did when the pharmacy plan started, but the new hires will help people navigate a difficult system.
"The forms are voluminous, from five pages to 12 pages," she said.
While she hasn't seen the proposed plans yet, Wofford is optimistic that some of the options will be cheaper than buying an individual policy on the open market.
Quality of Life serves 18 counties stretching from Tuskegee to Fort Payne. It hopes to reach 24,000 from its educational efforts and sign up 7,500 in the first year, she said.
Jim Carnes, communications director for Arise Citizens' Policy Project in Montgomery, said the 50 new employees who will help people sign up is far smaller than was initially expected when Obama signed the Affordable Care Act, but Congress did not appropriate as much money as was expected. "This is what Congress has been doing to try to choke off funding for the law," said Carnes, whose group speaks out for Alabama's poor.
Carnes said explaining the options to citizens in Alabama will be harder because the governor chose not to participate in another part of the Affordable Care Act that would have expanded the state Medicaid program to people up to 133 percent of the federal poverty level. That could have added more than 300,000 to Alabama's Medicaid rolls.
Carnes said other states that have created exchanges and expanded Medicaid can tell citizens "come see what's in store for you." Then they can help the citizens enter Medicaid or find insurance, depending on their income. But in Alabama, he said, there will be citizens who aren't poor enough for Medicaid but don't have enough income to buy insurance through an exchange.
"Those folks are going to be left out in the cold," he said.