Confusion abounds on new health care law

The Affordable Care Act requires state exchanges to establish a “navigator” program that will help people who are eligible to purchase coverage through the state health exchange learn about their new coverage options and enroll.

States will be awarded federal grants to award to entities that will provide these services:

Since Health and Human Services’ Secretary Kathleen Sebelius has not yet established standards for the navigator program, it is not clear whether each entity receiving a navigator grant must perform all five functions, or if, for example, a state might provide some navigator grants that are just for outreach and others that are for enrollment.

Source: FamiliesUSA

With less than three months to go before open enrollment begins, many Ohioans still lack the help they were promised to learn about their eligibility and options on the state’s federally-run health exchange established under the Affordable Care Act.

The ACA requires all states to have community-based “Navigator” programs to help people learn about plans offered through their exchanges — essentially online marketplace for health insurance — and about their eligibility for subsidies.

But the U.S. Department of Health and Human Services is still accepting grant applications from prospective navigators and will not release the names of the award winners until mid-August.

Open enrollment begins Oct. 1, and most people will need to be insured next year or pay a penalty. Tax credits may help individuals who are up to 400 percent of the federal poverty level ($94,200 for a family of four in 2013). For some, it will be the first time they have health insurance.

With the deadline approaching, health policy experts and local consumer advocates expressed concerned about consumers falling through the cracks and or not receiving the information they need in time to avoid rushing to enroll at the last minute.

“We’re going to need a lot of folks helping people with health plans,” said Kathleen Gmeiner, project director at Universal Health Care Action Network of Ohio.

Of the more than $50 million in navigator grants to be awarded to federally operated exchanges, such as Ohio’s or exchanges run as a state-federal partnership, Ohio will receive $2.2 million next year to help an estimated 1.5 million uninsured Ohioans learn about the exchanges.

“That’s simply not going to put enough boots on the ground,” Gmeiner said. “The state will receive some additional money for federally qualified health centers that will expand the number of people who can provide assistance, but that will still fall far short of the need.”

Compounding the problem, Gmeiner said, is House Bill 3 that was signed by Gov. John Kasich in April and is to take effect July 30. The state law would restrict navigators to individuals or entities that not only have been certified as an insurance navigators by the state department of insurance but also receive funding under the Affordable Care Act, she said.

“We are concerned that the community organizations, social service agencies, faith congregations, people who are actually in the community will not have contact with people who need to learn about their enrollment opportunities and will have their hands tied in being able to assist people” if they don’t receive a navigator grant, Gmeiner said.

Deborah Ferguson, director of outreach and social services for the Community Action Partnership of the Greater Dayton Area, echoed those concern.

Helping the uninsured

“We service thousands of people during the course of the year, almost all of them low-income and with low literacy levels, and we’re particularly concerned that they might not understand how this new regulation affects them,” said Ferguson, who’s organization has applied for a navigator grant as part of a consortium of community action agencies.

Ferguson said it is “unrealistic” to expect every agency that applies for a grant in Ohio to get one, considering the limited resources allotted to the state. And even those organizations that do receive grant money will be hard-pressed to reach the populations they serve effectively.

“This is not a simple piece of information to share,” she said, referring to the exchanges. “It’s not like telling people you can’t text and drive. This is pretty complicated, and it will take a variety of methods to explain this stuff. But there’s not going to be a lot of money for people to go out and drum up business and offer classes.”

Melodee Shiels, director of Consumer Credit Counseling of Miami Valley, said her organization is considering applying for a navigator grant under the presumption that “Hey, this is something we need to get involved in” because medical bills are one of the leading causes of bankruptcy and the root of many of her clients’ financial problems.

“In addition to unsecured debt (credit card bills), a lot of what we see are medical situations where someone has had some medical issues that led to extraordinary medical bills that they’re doing the best they can to pay, but they don’t have insurance.”

Mary Huttlinger of the Small Business Majority in Loveland said she’s “keeping her fingers crossed” that her organization’s application for a navigator grant is accepted because the small businesses she serves sorely need the help.

“We find that many small business owners aren’t even aware of the basic components of the Affordable Care Act, much less how to apply for coverage on the health exchanges,” Huttlinger said.

The Small Business Majority, which Huttlinger described as a nonprofit small business research and advocacy group, serves businesses with less than 50 employees. They are not required to offer insurance under the ACA but can make insurance available to their employees on the health exchanges through the Small Business Health Options Program.

“We’re currently providing and overview of the program, but the navigator grant would allow us to take it one step further in terms of providing guidance for enrollment and expand our outreach to all of the 5,000 business we reach in Ohio.”