Helping Missourians navigate the ACA marketplace will likely be a collaborative effort

May 8, 2013

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Many Missourians will likely need help navigating the Affordable Care Act's new health insurance marketplace that's set to go online by Oct. 1, but one analyst says there might not be enough time or federal funding to train those who can help.

A big part of the Affordable Care Act is the creation of 51 online health marketplaces, one in each state and the District of Columbia. It’s a new way to buy health insurance: Starting Oct. 1, consumers will be able to go online and compare the benefits and costs of different federally approved insurance plans – and then decide which one fits them best. 

“A lot of people haven't had to make these decisions before,” said Stan Hudson, a health literacy expert and associate director of the Center for Health Policy at MU. More than half of people already covered by insurance get them through their employers, limiting the number of choices and decisions they have to make before deciding on a plan, Hudson said.

The Marketplace could have hundreds of health insurance plans, said Hudson. Insurance companies are still submitting plans for approval by the federal government, and no one really knows what the plans available in the Marketplace would look like yet.

What's more, a recent Kaiser Family Foundation survey shows the majority of the uninsured population – those who are more likely to buy the subsidized insurance plans in the Marketplace – don't understand the details of the Affordable Care Act, let alone how the law's changes the health insurance delivery. 

To get Americans ready to enroll in the marketplace by Oct. 1, the federal government has begun the very early roll-out stages a Marketplace Navigators program. These Navigators will raise awareness about the existence of the Marketplace, help consumers apply to the Marketplace, then also help them understand the plan options available in the Marketplace.  

The funding opportunity was announced last month. The U.S. Department for Health has said the money will be awarded in August. Hudson said he believes the short gap between awarding the Navigator grant and the opening of the Marketplace likely means the Navigator program won’t be very effective.

“I think there’ll be a lot of growing pains, at least initially, as we formalize these processes and programs,” Hudson said.

In a proposed regulation, the U.S. Department Health and Human Services ruled that Navigators can’t be agents or brokers, nor can they be paid by insurance companies. Other than that, pretty much anyone can apply to get funding grants to become a Marketplace Navigator and get federal training and certification.

HHS has $54 million in grant funding for Navigators in the 34 states. Missouri, which has 799,257 people uninsured, is eligible for $1,332,657 of those grant dollars.

Most people in Missouri’s healthcare advocates circle believe the money won’t be enough to really help consumers in the Marketplace, Hudson said, echoing the concerns of other experts who have called the federal grant money a drop in the bucket.

California, which is creating its own Marketplace, has budgeted $50 million for its Navigators program.

Missouri depends on federal grants for the Navigators program because its voters have prevented state employees from setting up the state’s Marketplace and made it illegal for the state to help the federal government set up the program.

Hudson speculates the limited funding would mean that volunteer groups will have to play a big role in educating the public about the Marketplace. He compares it to when churches and community groups stepped up to help senior citizens enroll for the new Medicare prescription drug program, back in the early 2000s. Hudson said the Navigators program in Missouri will most likely be a collaborative effort of policy groups, nonprofits, trade associations and programs such as MU Extension.

“The people who are aligning from the nonprofit side to apply [to be Navigators] are thinking that way,” Hudson said. “There are lots of entities who are thinking about collaboration.”