The benefit options, eligibility criteria and subsidy structures of the Affordable Care Act exchanges that open on October 1 are uncharted waters. The need to explain them to the millions of people, particularly the young and healthy, upon whose participation success will depend, was anticipated. Section 1311 of the Act provides for “navigators” to provide the kind of assistance large employers give their employees as part of their group benefits enrollment process; a task complicated by the sea of confusion and fear created by the ideologues who oppose Obamacare as unworkable government overreach and a denial of the “freedom” to go uninsured.
A primary goal of the ACA is to extend coverage to the nation’s 30 million uninsured. For many of them, enrolling for health insurance will be a new and daunting experience. Navigators are to be trained to standards set by The Centers for Medicare & Medicaid Services to give impartial and accurate guidance assisting individuals in learning about and applying for health insurance in the federally facilitated coverage marketplaces. (45 CFR Part 155, 78 Federal Register No.137, 7/17/2013)
Navigators, who are prohibited from recommending or receiving compensation from insurers, will also provide impartial information to help small businesses and their employees enroll in health plans offered through the new exchanges.
These Navigators will be in-person assisters in marketplaces where the federal government either will be operating or partnering with a state on an exchange. There are federal grants to help support navigator programs for both types of exchanges. The state-run exchanges oversee and award training grants for their navigator programs, having the option of using the CMS rules or developing their own navigator standards.
Now it appears that the efficacy of these programs, crucial to ACA’s success, will be operating on shoestring budgets, with extremely tight time frames and hostile political climates. For example, while Maryland is spending $24 million for 325 navigators, Virginia—which refused to build an exchange, leaving it instead to the federal government—will not have much money for navigators.
As The New York Times reported, “the federal government did not anticipate having to cover the cost of running the insurance markets in 34 states, which is why it has only $54 million – transferred from a fund for public health prevention programs – for navigators in those states. The health care law set aside much more money for states that built their own markets, assuming that most would do so.”
Hopefully the resulting gaps will be filled by organizations, already working with the uninsured, which did not apply for navigator funds but nevertheless can help educate the uninsured about their options. Although not necessarily impartial, insurance agents or brokers looking to sign people up through the exchanges will contribute to the learning process.
Social Security was created in 1935 and Medicare in 1965. In the ensuing years, Congresses, admittedly more bipartisan than the one that passed the Affordable Care Act in 2010, worked out the kinks that inevitably came with these great innovations. Rather than follow that example, the House majority has spent its energies voting 40 times to repeal ACA while the Cruz faction of the Senate minority vaingloriously vows to not support any “continuing resolution that funds one penny of Obamacare.”
That’s partisan politics talking, not public policy because there is no legislative way in Washington to “defund” Obamacare. But, ironically, the states refusing to build exchanges are defunding ACA’s important public health and preventive care initiatives. By forcing Washington to pay for navigators with money earmarked for these initiatives, have ACA opponents at the state level found a way to actualize the defunding strategy?
The political histrionics whirling about Obamacare implementation are creating a centrifugal force that is pulling apart any chance for a rational, constructive attempt to fix the design flaws and remedy the glitches in ACA as previous Congresses did with Social Security and Medicare. That’s no way to navigate uncharted waters.