/Playing with folks’ lives’ Obamacare navigators face misinformation, slashed funding and shorter enrollment periods

Playing with folks’ lives’ Obamacare navigators face misinformation, slashed funding and shorter enrollment periods

Wooten, 22 years old, is actively looking for personal insurance to cover her primary and preventive care. She needs a low-cost plan that has a wide network. However, the options available to her are complicated due to her fixed income as a graduate student. Wooten needed someone to help her navigate her options. Wooten was concerned about the rise in premiums and misleadingly calling them “Obamacare” policies that were not part of the federally regulated healthcare marketplace. This is where “health insurance navigators” come in. Wooten created a Healthcare.gov account on her own but realized that she needed assistance understanding terms new to first-time customers — premium, copay and tax credit. The enrollment period is only six weeks, this year for the second consecutive year. She said, “I was just looking at all of it and like, ‘Huh ?’,”. “I needed someone who could tell me which option would be best, between higher deductibles or premiums.” The ACA law mandates that marketplaces set up navigator programs to help people navigate through the various insurance options and the nuances of complex legislation. As Wooten experienced, confusion has been fuelled by the uncertainty caused by politicians’ repeal-and replace rhetoric, reduced funding for the insurance market, and the elimination of the individual mandate penalty. Navigators are there to help people in need by offering one-on-one support. The premiums for 2019 coverage and this enrollment period are stable compared to last year. However, the average increase in a “silver” plan, which typically offers middle-tier premiums as well as deductibles, increased by nearly 60 percent in 2017, when every other Mississippi insurer had left the Mississippi market. Ambetter remains the sole marketplace insurer in Mississippi, making it one of five states that only has one choice on the exchange. In 2019, the average state will have four insurance companies in the United States. Centers for Medicare & Medicaid Services recently required navigators to concentrate on recruiting people without insurance. This was in contrast to their previous focus on cultivating relationships with small businesses, self-employed people, and both insured and uninsured consumers. It was intended that navigators would be a trusted presence in the community, especially for those who don’t have traditional health insurance options. Wooten was introduced to the navigator program by her family. She made an appointment with Marian Talley, Farish Street Baptist Church in Jackson. In addition to helping individuals enroll in coverage, navigators are able to advise consumers about how subsidies will impact their taxes. Wooten will file her taxes for the first time next year. Wooten stated that she would have been without health insurance again without Talley’s assistance, but instead, she found a policy with a low premium and deductible. Wooten is the target consumer for Get Covered Mississippi. It’s one of two federally funded navigator programs that the state targets. This year, navigators have done more with less. The U.S. Centers for Medicare & Medicaid Services have reduced Mississippi’s navigator funding by 79 percent since 2016. Mississippi has more navigator programs than the majority of states. Despite the fact that funds have been reduced from $907,579 to two programs to $187.849, there are still at least one navigator per county. This is unlike three states which have none, and most states that use one navigator across all counties. According to a Kaiser Family Foundation analysis, seven counties in the South Delta have access two navigator programs that allow mobile units to connect to sub-grantee organisations. The Trump Administration reduced navigator funds by half, reduced advertising by 85%, and eliminated the tax penalty that used to incentivize compliance with the individual mandate (which requires individuals to have insurance). Instead of the national narrative that fewer navigators lead to long waits and hard access to assistance, Mississippi navigators say that reduced advertising has actually hurt more than any because it exacerbates their uphill struggle to educate people about the ACA and what their insurance options and subsidies are. And that even though the tax penalty for not having insurance is eliminated, that doesn’t mean the marketplace exchange is dead. Shannin Jones, Get Covered Mississippi navigator, said that some people don’t think about insurance until they actually need it. Jones claims that even though Mississippi’s exchange has only one insurer this year, there is no provider competition. However, her job is to help people access health care. She said, “One option is better that none.” She said, “And it’s tragic that people are missing this avenue to afford and access care without needing to go to an ER.” Mississippi enrollment data shows enrollment has increased by only 2 percent over last year. National enrollment is down 11 percent. According to navigators, people who have enrolled previously in the market know how to renew their coverage online. Re-enrollees often make up the largest percentage of total enrollment. Uninsured people will be the most difficult to reach, as they are often the most difficult to reach. Kathryn Rehner, who managed the University of Southern Mississippi’s navigation program for three years before it was shut down due to funding cuts, said that reaching uninsured or vulnerable groups is difficult. Rehner stated that the Mississippi Health Access Collaborative focused their grant on the southern counties because outreach programs are often overlooked. They were able to meet people right where they are and not expect people to come to them. She said that while community health centers were great at enrolling people who come through, it was not a good idea because you still have the same people. “We wanted to do more than that, and reach parts of the community that weren’t receiving information or interacting with traditional spheres. We created Get Covered Mississippi under Oak Hill Baptist Church in Hernando. They have had a navigation grant every cycle since 2013. Lottie Minor, program director, says that although their funds have been reduced by 84 percent in 2016, the biggest obstacle to their enrollment has been fighting misinformation due a reduction in advertising and marketing budgets. Minor stated that the state’s consumer needs are different. She said that the state is very different from one county to the next. “In some areas, it’s going be education. Just because people are already lower in the knowledge ladder, we need to work harder to educate them.” “In other areas, it could be those who get caught up in the gap. There’s nothing that we can do. “Obviously Mississippi is not a Medicaid expansion State, so that’s something we deal with.” Get Covered Mississippi relies heavily on word-of mouth and connections within its ministry to reach new customers. Minor stated that they have not had to reduce the number of navigators, which was forty, but have relied more heavily on volunteers. Jackson-based My Brother’s Keeper has five navigators who focus on the southwest corner. This enrollment period is their first year as grantees. They travel the state with a mobile clinic to educate the communities about the ACA, enroll options, and general health care. T’Juan Rucker manages My Brother’s Keeper’s navigation program. He said that it has been a challenge because of the misinformation and confusion around policy and administration changes. He said that many people believe Obamacare has disappeared with Obama. It’s there, but people don’t know what it is. Without the mass marketing, it’s almost like you’re trying to sell snake oil. Rucker believes it will be difficult to reach the “new consumers” who are not covered by navigator programs. Renewing coverage was responsible for 63% of all enrollment last year. This means that the majority of enrollment came from people who are already familiar with the system. Rucker states that removing the tax penalty for not having insurance makes it more difficult. Rucker says that no penalty for going without insurance makes it harder. Rucker spoke to a few seniors at a Vicksburg Walgreens sign-up event about Medicare options. However, his ACA enrollment efforts were relegated to phone calls rather than in-person interest. Rucker gained more interest at the next event, but he admits that it takes energy, time, and presence to establish rapport with new areas — particularly the area he is focusing on, where computer literacy and health literacy are low and the uninsured rates high. “They are the hardest to find and convince about the importance of insurance.” Roy Mitchell is the executive director of Mississippi Health Advocacy Program. He agrees that it is too early to predict the final enrollment outcome, but he is skeptical. With all the policy fluctuations, he says no-show enrollment events can be expected. “I’m not surprised. These types of things require outreach. Mitchell stated that it is difficult to compare the results from last year with this year because the sabotage began in earnest in September. “There has been continuous and systematic sabotage, and that’s what the results are, when there have been sign-up events but nobody’s there.” Rucker, navigator, said that navigators must move quickly but also build rapport with communities to be able reach low-income rural residents who may be reluctant but still need the services. He said that some of these people are trying to balance eating and health coverage. “You prioritise what hits first, and hunger hits first.” Mississippians who enrolled in the marketplace last year received the best deal on premiums. 97 percent of them received some financial assistance from the marketplace — the highest percentage in America — which was either a tax credit, or a cost sharing reduction. Their average premium was $66. The 97 percent who receive financial assistance only takes into account those who have enrolled in coverage and doesn’t include those whose income is too low. Without Medicaid expansion, approximately 100,000 of the 350,000 state uninsured fall into the coverage gap and don’t have any options for insurance. According to organizers on the ground, who help people enroll in coverage, the greatest effect of decreased advertising and funds is likely to be felt by those groups that health advocates are trying to reach the most — such as grad students Wooten, who don’t have insurance. Rehner states that navigators have been a major source of education, outreach, and support since the inception of the ACA. Studies show that navigators are not always responsible for large percentages of enrollment. However, their one-on-one support is critical in reaching the most disenfranchised and influencing enrollment decisions. Rucker also agrees. “You need to have boots on ground. “Air strikes don’t work.” Rehner stated that most of those signing up were poor people. He was referring to USM losing funding for its navigation program. “Your health care is so important to you. It’s crucial to have someone sit with you and say it’s OK, to walk you through it, and to tell your eligibility. After funding cuts, USM lost the grant. My Brother’s Keeper wants to continue the work of USM, but they are focusing on specific areas and only one-tenth the budget. Mike Chaney is Mississippi’s insurance commissioner. He estimates that around 70,000 people have signed up so far this year. CMS last count showed that just over 35,000 people signed up in the first month of open enrollment. Last year, enrollment was down by 83,649, from 88,483 in the previous year. The navigators on the ground hope that their efforts to reach Mississippians without insurance will be successful, but they worry about the lack of political support to reach all those who might need it. Rucker says that navigators are now faced with a shorter enrollment period of six weeks and a reduced budget for marketing and navigation. This means they have to do more to reach people and fight misinformation. He said that navigators have 45 days to ensure the public is aware of our services. “To make a real impact on the insurance disparity, you must reach rural people and understand their thinking and communication. Every day counts.” For help enrolling visit Healthcare.gov or call 1-800-318-2596, or local navigators http://mbkinc.org/ and http://www.getcoveredms.org/.