The Challenge of Helping the Uninsured Find Coverage

August 14, 2013
Author: ABBY GOODNOUGH | New York Times
http://www.nytimes.com/2013/08/15/us/politics/the-challenge-of-helping-the-uninsured-find-coverage.html?_r=0

OAKTON, Va. — Cyndy Dailey held a job fair at her nonprofit agency here last weekend, with a major caveat: she did not yet know if she could hire.

Like many organizations across the country, Ms. Daily’s agency, Northern Virginia Family Service, is hoping to win a federal grant to help uninsured people in the state sign up for coverage under President Obama’s health care law. With the money, she hopes to hire at least a handful of “navigators” — a new category of worker created under the law to educate consumers about new health insurance options and, starting in October, to walk them through the enrollment process.

Navigators are seen as crucial to the success of the law. As the Jan. 1 deadline approaches when most Americans will be required to have health coverage or pay a fine,  navigators are supposed to explain away confusion and fear among the legions of uninsured, helping them understand how new health insurance markets will work and whether they will qualify for subsidies to help with the cost of coverage.

But as the navigator effort gets under way across the country, it is clear that their impact will vary from state to state, with wide discrepancies in how much will be spent to hire and train navigators and how many people they will be able to reach. Many will be operating on shoestring budgets, with extremely tight time frames and hostile political climates.

“There’s definitely going to be a tremendous difference, not only in navigators but also in marketing funds,” said Andy Hyman, senior program officer at the Robert Wood Johnson Foundation. “So what we’re going to have to see in states with fewer funds is a lot more ingenuity.”

Maryland is spending $24 million on a program that will soon dispatch 325 navigators and assisters around the state. Colorado is investing $17 million on 400 “coverage guides,” and New York is spending $27 million on a similar effort.

But in states like Virginia, which declined to build their own insurance markets under the law and ceded the task to the federal government, navigators will not have much money to get the word out. The Obama administration has promised up to $54 million for navigators in the 34 states where the federal government is setting up all or part of the markets. The grants are to be awarded Thursday.

In Virginia, up to $1.4 million will be distributed to navigator groups, which may include nonprofit community organizations, trade groups, chambers of commerce, unions and other public and private entities.

“It is what it is,” Ms. Dailey said about the comparatively tiny budget for navigators in her state. “All we can do is make our best effort.”

Her agency has asked for $495,000, about a third of the total navigator funds allocated for Virginia. That would cover the equivalent of seven and a half full-time navigators (some may end up working part-time), computers and other equipment for them to do their jobs, informational materials, marketing, and continuing outreach events in five counties.

The federal government did not anticipate having to cover the cost of running the insurance markets in 34 states, which is why it has only $54 million — transferred from a fund for public health prevention programs — for navigators in those states. The health care law set aside much more money for states that built their own markets, assuming that most would do so.

To fill in the gaps, other organizations will also be working to get the word out and helping people sign up for health plans through the new markets. About 1,200 community health centers around the country, which provide medical care for the uninsured, have received a total of $150 million in federal money to help with outreach and enrollment. Virginia’s health centers received $2.5 million.

In addition, many groups that did not apply for navigator funds will nonetheless help educate the uninsured about their options, connect them with navigators or point them toward the new insurance markets.

Insurance agents or brokers may also help people sign up for coverage through the markets; insurance companies selling plans through the markets will also play a role. Northern Virginia Family Service plans to enlist a network of partner organizations, many of whom already work with the uninsured, to help with outreach and enrollment or provide space and other resources.

“Other local groups may have funding or be in a position to get volunteers to do some of this work,” said Christine Barber, a senior policy analyst at Community Catalyst, a consumer advocacy group. “Everyone is anxious to know who the navigators are so that other groups can partner with them, know who to refer people to, know how to flesh out their coalitions and their outreach.”

Navigators, who will also help small businesses and their employees learn about and enroll in health plans offered through the new markets, cannot recommend any particular health plan or receive compensation from an insurance company. They will get at least 20 hours of training and take a certification test.

Opponents of the health care law have nonetheless questioned whether navigators will know enough to help consumers understand the complexities of insurance coverage, and whether they can be trusted with the personal data that consumers will include in applications for coverage.

Ms. Dailey said her agency planned to run background checks on navigators and have them sign off on ethics policies, adding, “We will do a good job because we have all these protocols in place.”

Once the federal grants are awarded, recipients will have to move quickly to hire and train navigators and set their outreach plans in motion. Judy Robinson, whose small nonprofit group in Charlottesville, Va., hopes to win a grant to hire three navigators who would team up with at least a dozen volunteers, said she was excited about the possibility despite the pressure.

Ms. Robinson said her group, the Jefferson Area Board for Aging, was already getting calls from uninsured residents seeking information about the new insurance market.

“I’m a planner, I like to anticipate things, so it is a little hard for me,” she said. “But I’m just going to try to let go, go with the flow of it and not be upset not to have it all in place.”

Ms. Dailey said her “contingent-upon-award” job fair for navigators last weekend drew about 20 people, including retirees, recent college graduates and people with compelling personal stories about health care and insurance.

“My hope would certainly be that we could do fast-track interviews,” she said. “I think I have a good pool of folks.”

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