Until now, the Affordable Care Act was a massive piece of government
bureaucracy that many American knew little about or didn’t particularly like.
On Thursday, the Obama administration named the organizations, including
one in Palm Beach County, that will become the face of the controversial law.
More than 100 organizations will spend $67 million to hire workers who
will go out into communities and enroll people in health insurance under the
law beginning in October.
The funding is particularly crucial in Florida, where the state is not
spending any additional money to get the word out about the new law or to try
to enroll some of its 3.5 million uninsured residents.
“People have lots of trouble understanding what the law is. The
navigators will be that link,”
said Leah Barber-Heinz, director of Florida CHAIN, a healthcare advocacy group.
“We know that 78 percent of people are unfamiliar with what the
marketplace is, let alone how to shop and compare and contrast the options that
will soon be there for families.”
The hundreds of “navigators” hired could shape how the law is perceived
and bend the cost curve of health insurance. If they can enroll a large
enough segment of the young and healthy, the cost of health care for others
will go down.
The Affordable Care Act prevents insurers from denying coverage to
people who are already sick. If large numbers of older, sick Americans
sign up without healthy people to counterbalance them, health insurance
premiums could skyrocket.
The Legal Aid Society of Palm Beach is one of eight organizations
receiving $7.8 million to reach out in Florida. The society’s grant of
$446,783 will allow it to target consumers in Palm Beach, Martin, Okeechobee,
and Hendry counties.
The organization’s focus will include “urban and rural communities that
are racially, ethnically, linguistically, culturally and socioeconomically
diverse.” It’s audience is 270,000 people in those counties who have no
health insurance and who are under the Medicare eligibility age of 65.
“This was something that was near and dear to our hearts,” said Robert
Bertisch, the society’s executive director. “We see what happens to
people when they don’t have coverage. Most of our clients who need help
with their bankruptcy, one of the reasons (they file) is they have medical
debts they just cannot pay for.”
The organization already works with clinics to identify patients who may
have a legal issue, such as mold in an apartment that is causing a child’s
asthma.
The group proposes to: hire five navigators; participate in 60 community
events across four counties; enroll 3,000 people; produce five multilingual
Public Service Announcements.
Health and Human Services Secretary Kathleen Sebelius announced the
grant awards on a conference call during a trip to the University of South
Florida’s College of Public Health in Tampa.
The agency is prepared to enroll millions of American – some for the
first time – in less than two months, she said.
“We’re on schedule with providing consumers with tools online, on the
phone and in person, to get the coverage they need,” she said. “And we’ll
be ready October 1.”
Through the website healthcare.gov, people can enroll on their own. They can call a help line for
phone assistance. That’s where the navigators come in.
The state’s biggest counseling push will come from the University of
South Florida program, called Florida Covering Kids & Families. The
nonprofit received $4.2 million. It will work with up to 10 partners to
help consumers and small businesses enroll. It will also have educational
activities to promote the insurance exchange, also known as a marketplace,
where consumers can sign up for insurance online.
Other organizations receiving grants in Florida include the Epilepsy
Foundation of Florida; Advanced Patient Advocacy, which works in 21 states to
help educate and enroll uninsured consumers; the Pinellas County commission;
the National Hispanic Council on Aging; and Mental Health America; which will
target people with behavioral disorders.
This counselors hired by these organizations will spend 20 to 30 hours
in training, be required to pass a test and be expected to follow rigorous
privacy and data standards.
Florida Attorney General Pam Bondi was one of 13 attorneys general who
sent a letter Wednesday saying HHS “failed to adequately protect the privacy”
of American who use counseling services associated with the health care
law. They argued that agency rules do not require background checks or
list any disqualifying criminal acts that might prevent a counselor from being
chosen.
“We are absolutely focused on privacy and security standards at the
department,” said Chiquita Brooks-LaSure, deputy director of policy and regulations
at HHS’ Center for Consumer Information and Insurance Oversight.
Organizations will begin hiring counselors immediately. Training
is scheduled for later this month.
‘Navigators’ to help state residents get Obamacare by Laura Green
in The Palm Beach County Post on August 16, 2013.
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With open enrollment for uninsured individuals
to buy health coverage under the Affordable Care Act set to begin in less than
two months, research is mounting that shows consumers don’t understand health
insurance, let alone key aspects of the landmark health law.
The
studies are troubling, researchers say, particularly when there are going to be
more options for coverage. That could mean millions of consumers may not make
the best choices when benefits are available to them under the new law, which
will begin offering subsidized benefits on exchanges for individuals.
The
open enrollment period, which will run October through March of next year, will
allow consumers ample time to evaluate their coverage that is set to begin Jan.
1, 2014. They will apparently have their work cut out for them, according to an upcoming study in the Journal of Health Economics.
“It
is strange, in my opinion, that the insurance market has evolved so, that so
few individuals understand the fundamentals of the medical insurance plans they
are insured under,” says George Loewenstein, the Herbert A. Simon
University Professor of Economics and Psychology at Carnegie Mellon University in Pittsburgh in a
statement accompanying a study he led in the September issue of Journal of Health Economics.
Researchers
looked at two surveys of Americans between the ages of 25 and 64 who have
private coverage. Among their findings, researchers uncovered that just
14 percent of respondents had an understanding of the most basic insurance
concepts of “deductible, copay, co-insurance and out-of-pocket maximum.”
Such
so-called cost-sharing is key to knowing what kind of benefits to choose and
how much the consumer’s share of the tab will be.
“Insurance
plans incorporate all sorts of incentives designed to encourage customers to
make specific types of decisions,” Loewenstein said. “What is the likelihood
that they are going to respond to these incentives if they can’t understand the
most basic elements of plan design?”
The
study comes in the wake of other polling and research showing Americans don’t
know much about the Affordable Care Act. For example, a poll earlier this year by Gallup said two in five uninsured Americans are unaware they
have to buy coverage or face a penalty.
Health
care experts like Helen Darling, president and chief executive officer of the National Business Group on Health, a business
coalition that includes some of the nation’s largest employers, said she isn’t
surprised people don’t understand the requirements of the health law.
“It
is complicated, talks about topics that most people don’t understand and has
been ‘demagogued’ which adds to the confusion,” said Darling, in a statement to
Forbes. “Also, it is a mistake to communicate some things too early because
people get confused if they learn about something before they need to and
before they can act on something. It is also not surprising that most people
report that they can’t afford health insurance and especially those who are
uninsured.”
Some
believe the confusion will lessen and consumers will become more educated as
health insurance companies begin to ramp up their advertising. The Blue Cross
and Blue Shield Association, for example, which represents companies like Wellpoint
and Anthem, and Walgreens have
already launched a marketing campaign.
Other
health insurers like Aetna, Humana and UnitedHealth Group are also readying
health benefit offerings on exchanges. Many observers think they, too, will
launch educational and marketing campaigns.
Darling
said she hopes the roll-out of the health law’s “public exchanges will tie
together in easily accessible ways what
is available for individual or small employers, including some slightly more
affordable options, the requirements of individuals to buy insurance with
federal subsidies and the employer shared responsibility requirements.”
“As
the economy picks up and there is more evidence of that, health insurances could
become an important competitive benefit in the US labor market,”
Darling said. “Just as most large employers believe that they need to provide
good health insurance to recruit and retain the top talent they need to
prosper, as smaller employers do better, they will get that message too.”
Americans Don't
Understand Insurance, Let Alone Obamacare, Research Shows by Bruce Japsen at
Forbes.com on August 10, 2014.
_____
Now, as a “Navigator,” you’ve been tasked with
becoming so expert in this topic that you can help others comparison shop for
and purchase health insurance.
A
good place to begin is with the ACA’s requirement that every health plan offer
a uniform “Summary of Benefits and Coverage” (SBC) as well as a glossary of
insurance terms.
Presently,
every health plan provides policyholders with a “Summary Plan Description”
(SPD) or similarly-titled document which sets forth the terms of the health
plan.
A
typical SPD can be upwards of 100 pages. An example is the 115-page Collier County Employees Health Plan
SPD. Take a look at this document (briefly)
at http://www.abpmtpa.com/
ccg/pdf/2003021-SPD.pdf
INSERT
Most
health plans also supply policyholders (or prospective customers) with a five-
to 10-page summary of benefits outlining the basic terms of the policy.
Before
the ACA, however, there was no standardization to these summaries of benefits –
making comparison shopping for health insurance difficult, if not impossible. The ACA requires that every health plan offer
a “Summary of Benefits and Coverage” (SBC) following a template created by the
Department of Health & Human Services (DHS).
The
ACA also requires that every health plan offer the uniform glossary of terms
used in these SBCs.
As
a Navigator, you’ll have these definitions memorized and translated into even plainer language – with examples – for
people comparison-shopping health insurance on the “Exchanges” also known as
“Marketplaces.”
_____
Here’s
an example of a new SBC. This is the
Summary of Benefits and Coverage for the Daytona State College employee health
plan:
Thus,
a Daytona State College employee comparison-shopping health plans would …
