The Baptist Mission Center Clinic serves the uninsured in Oklahoma City.… (Mei-Chun Jau/For The Washington…)
Signing up an estimated 30 million uninsured Americans for coverage under the health-care law is shaping up to be, if not a bureaucratic nightmare, at the very least a daunting task.
While some people will find registering for health insurance as easy as booking a flight online, vast numbers who are confused by the myriad choices will need to sit down with someone who can walk them through the process.
Enter the “navigators,” an enormous new workforce of helpers required under the law. In large measure, the success of the law and its overriding aim of making sure that virtually all Americans have health insurance depends on these people. But the challenge of hiring and paying for a new class of workers is immense and is one of the most pressing issues as the Obama administration and state governments implement the law.
Tens of thousands of workers will be needed — California alone plans to certify 21,000 helpers — with the tab likely to run in the hundreds of millions of dollars.
“I would say the task we face is herculean,” said Denise de Percin, executive director of the Colorado Consumer Health Initiative, an advocacy group that has studied what it will take to staff her state’s navigator program.
Over the short term, some workers may be funded by federal grants, state budgets or private money. But over the longer term, most of the costs are to be covered by the new health-care marketplaces, called “exchanges,” being set up in every state. The money will come from fees that insurers will pay to sell their plans on the exchanges.
Groups such as unions, chambers of commerce, health clinics, immigrant-service organizations, and community- or consumer-focused nonprofits can use the grants to train and employ staff members or volunteers to provide in-person guidance — especially to hard-to-reach populations — and to provide space for them to work.
Added to the logistical challenge is a political one: Insurance brokers in many states are lobbying to prohibit the navigators from giving advice on which plans to choose and to make them liable for their guidance if it results in financial harm.
The brokers, who earn commissions and fees by enrolling people in plans and who might lose business to the navigators, contend that the navigators won’t have sufficient expertise.
“What you don’t want is for our agents to be cut out and to have this force of untrained, unlicensed individuals giving advice with no financial responsibility,” said Ryan Young, head of government relations for the Independent Insurance Agents and Brokers of America, an industry trade group. “Consumers are going to get hammered.”
Under the law, the exchanges must fund enough navigators to ensure that every applicant who needs assistance can get it.
“You have to ask, how many people can one navigator help in one day?” de Percin said. “Well, the people who do this kind of work might spend an hour to three hours with folks. So the answer is not many.”
Colorado Insurance Commissioner Jim Reisberg stunned a recent gathering of state officials when he said that, to be viable, the state’s exchange will need to sign up 150,000 people, or about 800 people a day, seven days a week, over the six months of the open enrollment period, which will run from Oct. 1 through March.
“I don’t know that any corporation would set goals that high, even if they were going into it with the kind of money they have for marketing Coke or Pepsi,” Reisberg said afterward.
Compounding the difficulty, de Percin said, is that many of the uninsured struggle with English or don’t have easy access to the Internet. Others aren’t familiar with concepts like co-payments and deductibles, let alone the subsidies that will be provided for lower-income people or the new eligibility rules for Medicaid.
“If you’ve never shopped for insurance before, it’s just not a simple task. It’s going to be a lot of new information for people,” she said.
A funding Catch-22
Adela Flores-Brennan, head of the navigator program for Colorado’s exchange, said she expects to train “thousands” of navigators and other in-person helpers. But it’s unclear how much of that effort the exchange will be able to pay for.
In a kind of Catch-22, the money must come from an exchange’s operating funds, which will rely on fees from insurers. But those won’t be available until at least Jan. 1, well after navigators must be in position.
States can pitch in during the meantime. But that’s an unlikely option in Colorado, which has stringent rules governing its budget.
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