Magazine article Behavioral Healthcare Executive

Health Insurance Enrollment: Navigators to Play Key Role in Obamacare

Magazine article Behavioral Healthcare Executive

Health Insurance Enrollment: Navigators to Play Key Role in Obamacare

Article excerpt

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.

"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 (HHS), 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 marketplaces which will be running in every state. The HHS Center for Medicare and Medicaid Services (CMS) is jump-starting this effort in two ways. In June, it launched a revamped website ( that introduces the national system of health insurance marketplaces to consumers. And, in mid-August, it will announce the award of ACA-funded grants for "navigators" - organizations or people who will help people to select and sign up for health insurance from the marketplaces.

The ACA allotted $54 million for navigator grants, but those funds must cover all 37 states that are not setting up their own marketplaces. That's a pittance compared to what states that are setting up their own marketplaces are spending: Maryland alone, for example, has assigned $24 million in grants to its navigator contractors.

In fact, there isn't enough money for adequate navigator services because many states have decided not to set up their own marketplaces. 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 states that have decided not to set up their own marketplaces - 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, consumers 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" . …

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