Editorial: Navigating Obamacare
If you build it, they will come.
So goes an expression forever linked to a movie about a field of dreams and old-time baseball.
But what if you’re talking about something less magical but more momentous, like a new marketplace to sell affordable health insurance over the Internet in a bid to improve U.S. health care? Then the answer isn’t clear.
Will millions of uninsured Americans scurry to a computer to buy health plans in time for a Jan. 1 deadline, when most people will be required to carry coverage or pay a penalty?
That’s the trillion-dollar question. The federal government is expected to invest that amount over the next decade in state insurance exchanges and public assistance programs intended to help low- and middle-income individuals and families who don’t have coverage through their workplace. The Web-based exchanges, scheduled to open Oct. 1, are a central component of the 2010 Affordable Care Act, which aims to reduce the number of uninsured Americans — more than 48 million at the last Census count in 2011.
No one knows for sure how many people will access the insurance marketplaces this year and next. The Government Accountability Office estimated 7 million in 2014, rising to 24 million by 2022. But whatever the number, it’s a sure thing that few will bother to shop around for health insurance if they don’t know the shop is open for business or what’s being sold. That’s where public information, consumer assistance and the all-important “navigators,” or marketplace guides, come in.
All state exchanges are required to provide a call center and personal assistance to help consumers compare coverage options, understand their eligibility for subsidies and enroll in a health plan. There’s a lot to grasp about premiums, deductibles and the tax credits available on a sliding scale to those making up to four times the federal poverty level ($45,960 for individuals or $94,200 for a family of four).
The exchange websites were built to be user-friendly. But an expedition to this virtual marketplace isn’t likely to be any easier for consumers than it was when seniors were introduced to Medicare Part D, the prescription drug benefit.
To limit the potential for mass confusion, the federal government allotted grants to states to train “navigators” — nonprofit community and consumer-advocacy groups that will assist consumers at no cost.
The trouble is, some of the grants have been insufficient. According to The New York Times, the law set aside more funding for states, like Vermont, that opted to build and operate their own exchanges. States that ceded the task, like New Hampshire, have been shortchanged, because the federal government didn’t anticipate covering the cost of running insurance markets in 34 states.
Consequently, Vermont appears to be in better shape than some, having allocated $2 million in state and federal funds to get the word out about the exchanges. More than a dozen agencies, including the Vermont Chamber of Commerce, Bi-State Primary Care Association and community health centers, have been awarded grants to serve as navigators, and enrollment assistance is set to begin in October when the exchange opens.
New Hampshire’s information campaign hasn’t gone as smoothly. The Republican-controlled state Senate, keen to scuttle implementation of the Affordable Care Act, earlier this year blocked from the budget a $5.4 million grant for consumer outreach, as if blocking money for public information about the exchange would somehow make it go away. Health and Human Services Commissioner Nicholas Toumpas was left scratching his head back in June, wondering whether tweets and text messaging would prove effective in reaching the young adult population who make up a large share of the uninsured.
The state is lagging behind, but officials say they may be close to liberating the $5.4 million by directing it to the New Hampshire Health Plan, a nonprofit that provides coverage to those who have trouble obtaining private insurance. And last week, the federal government finally awarded half a million dollars to two agencies working in New Hampshire that will serve as navigators, the Bi-State Primary Care Association and Planned Parenthood of Northern New England.
New Hampshire’s community health centers will also assume an informational role. So, too, presumably, will private brokers and insurance companies selling plans on the exchange, which in the case of New Hampshire is just one to start off, Anthem Blue Cross and Blue Shield.
Even so, the effort in New Hampshire seems too little, too late. Communicating the message to a diverse and diffuse population of uninsured residents takes time, and with the exchange launch a month or so away, time is running out. Accurate public information and one-on-one help are critical if the most sweeping change in health care in 50 years is to have a positive impact on coverage. Merely building the exchange doesn’t guarantee that the uninsured will come to it.