Navigators to play key role in Obamacare health insurance enrollment

Not long ago, President Obama soft-pedaled concerns about the Affordable Care Act (ACA) – concerns that two surveys released that month had raised. One, from a national association of actuaries, was that premiums would cost much more than anyone thought. The other, from the Kaiser Family Foundation, was that the vast majority of Americans knew little about how the ACA would actually affect them, and that only 35 percent supported it. For people with health insurance, he said, Obamacare is already in effect, and it will only apply to 15 percent of the population.

“According to Census estimates, nearly 85 percent of the population had some form of health insurance in 2007 and more than two thirds of those people received coverage through an employer,” Mark Weber, spokesman for the Department of Health and Human Services, told Behavioral Healthcare. “Public programs, like Medicare and Medicaid, cover the elderly, the disabled and veterans, along with many children and low-income people.”

The ACA has already affected millions, said Weber. “Because of the Affordable Care Act, 17 million children can no longer be denied insurance because of a preexisting condition, like depression or bipolar disorder,” he said. In addition, more than 6.6 million young adults have been able to go on their parents’ insurance plan “at a critical age when we know behavioral health issues are likely to emerge or progress.” The ACA has also made it possible for more than 71 million people, including 18.3 million children, to get free preventive services including screenings for alcohol abuse and depression.

Despite all this, “there is more work to do,” said Weber.

Getting people enrolled

One of the key areas the Obama administration is tackling next is communicating the plan – especially the insurance exchanges – which will be running in every state. The HHS Center for Medicare and Medicaid Services (CMS) is jump-starting this with ACA money destined for “navigators” – organizations or people who will help people to select and sign up for health insurance. The deadline for navigator grant applications is June 7, and after that, when the awards come out, there will be more information available to the confused masses.

The federal government is allotting $54 million for navigator grants for the 33 states that are not setting up state-run exchanges. That’s a pittance compared to what the 16 states that are operating their own exchanges are going to spend: Maryland alone has assigned $24 million in grants to its navigator contractors, for example. (As of May, Utah remains undecided about its insurance exchange.)

In fact, there isn’t enough money for adequate navigator services because many states have decided not to set up their own exchanges. HHS Secretary Kathleen Sebelius even made fundraising calls to the Robert Wood Johnson Foundation and H&R Block to get help with navigators, Politico reported.

Under the Affordable Care Act, states must establish a “navigator” program to help people learn about their options and to enroll, according to Families USA. Under the law, navigators have five tasks: educating the public about qualified health plans; distributing impartial information about enrollment, tax credits, and subsidies; helping people enroll; referring people who need additional help to another agency that can help with an appeal; and providing culturally appropriate information.

For 27 states that have decided not to set up their own exchanges – which includes marketing them – the federal government has offered to do it for them. Families USA noted that it’s important that consumers get reliable health-plan information from navigators, who will help people understand cost-sharing, benefits, and plan-network limitations. Navigators also need to explain income requirements and help estimate correct tax credits/premium subsidies for those who qualify. Otherwise, consumer will have to repay incorrect tax credits for the subsidies.

Families USA noted that in programs where volunteers already help consumers with health insurance or tax issues, the “enrollment entity” must assume liability for any risks related to the assistance that they offer. The state of California, for example, requires this for groups that contract with its Healthy Family program.

The CMS grants are called the Cooperative Agreement to Support Navigators in Federally-facilitated and State Partnership Exchanges. There is a total of $54 million in these grants. Grantees will receive on-line training in the Affordable Care Act and will answer questions posed by consumers with CMS-scripted language, prompting criticism from one broker interviewed by Behavioral Healthcare: “Canned speeches – just what people need to navigate the exchanges.”

Politics as usual

Republicans opposed to Obamacare are taking advantage of confusion about the law by targeting the navigator grants in particular. Republications say that the navigators could be anyone – even felons – who could “then make off with reams of personal information” such as Social Security numbers, birth dates of family members, income data, and more, The Hill reported May 21. Democrats say that attacking the navigator program is a way for Republicans to derail health care reform, helping it to fail and thus improving their political position for upcoming elections. 

In a hearing held May 21, HHS official Gary Cohen said he didn’t know whether background checks would be performed on navigators or whether they would be required to have a high school diploma.

According to Congressional Quarterly, insurance brokers who are based on the web want access to navigator money as well. But one concern about using internet-based agents and brokers is that they may steer companies or individuals to their own products.

Understanding health insurance coverage is hard enough: navigators and assisters will also be required to explain it to people who may not speak English and who have never had health insurance. If they have behavioral health challenges as well, it will be all the more important to reach out to them and explain the need for insurance.

Small business has been opposed to Obamacare because they are afraid the premium costs will be too high. Some brokers are advising their small business clients to make their workers part-timers (under 30 hours a week) and send them to the exchanges to buy their own health insurance. The ACA does not allow employers to throw full-time workers off of health insurance. Whether part-time workers who currently do not have health insurance will sign up – even with generous subsidies offered by Obamacare – depends on the ability of the navigators and assisters to find these people and get them enrolled.

Footnote: In the 29 states (23 against, six undecided) that are not accepting the federal Medicaid expansion, there will continue to be significant numbers of people not covered by current Medicaid programs whose incomes fall below the 138% of federal poverty level needed to qualify for health insurance on the exchanges. These individuals and families will thus have no recourse for health care. Considering that these people are statistically even more likely to need mental health and substance use disorder services, providing behavioral healthcare to them in non-expansion states will present major new challenges to the field. Stay tuned.