By Alexandra Olgin, WFAE October 30, 2017
Despite all the
efforts in Congress to repeal the health law this summer and fall, the
Affordable Care Act is still the law of the land. People can start signing up
for health insurance for 2018 starting Nov. 1. But the landscape for that law
has changed a lot.
Take navigators. Those
are specially trained people who help consumers sign
up for coverage. The federal government cut navigator funding by
41 percent. But that’s not an across-the-board cut. Some groups and states are
dealing with far deeper cuts, while others will have dollars close to what they
had last year.
South Carolina and
North Carolina are cases in point. South Carolina’s navigator funding is about
two-thirds less than the state had last year, while most of North Carolina’s
funding is intact.
The Trump
administration has said that it is
rewarding groups that did a good job and cutting off those that didn’t. But the
strategy may have the effect of hobbling navigators who have the most daunting
job signing up people.
“We are between the
rock and the hard place,” said Shelli Quenga, who runs programs at the
nonprofit Palmetto Project, South Carolina’s largest
navigator group. “We know that people in rural areas don’t have as much
internet access. The people who need help are probably in the rural areas, but
we can’t afford [to send navigators there].”
Instead, Quenga said,
she will have to be strategic about where she plans to place navigators.
“It is based on those
areas that are a) more densely populated and b) had a higher level of ACA
enrollment for 2017,” she explained.
That means about
two-thirds of the state’s counties will not have any navigators. Quenga said
she is still planning to help people in those areas by using screen-sharing
technology to walk people through sign-ups. People can always call the federal
call center for help, but that’s not ideal, she said.
Quenga said her
employees really take the time to work through complicated cases. For example,
she said, “lots of people have family members sleeping on their couch. Do you
count that person as a tax dependent or not?”
The answer is
complicated. How much someone gets financial aid is based on his or her taxable
income, which changes with the number of dependents, she said. “Choosing
whether to include that person as a dependent can have big consequences in
terms of your financial assistance,” she said. “The call center is not set up
to run those scenarios for you.”
And with less help
from the federal government, Quenga said, she feels the pressure mounting to
get more people signed up for coverage during this year’s shorter enrollment
period. If she does, there’s a chance her navigator group will be better funded
next year.
The picture is very
different in North Carolina. There, navigator groups had only about 10 percent
of their federal funding cut.
Jennifer Simmons
coordinates North Carolina’s largest navigator program, the NC Navigator Consortium, and
said she’s happy to report there will be someone available in each of the
state’s 100 counties during the six weeks of open enrollment this year.
They’ll help people
like Ilia Henderson, who is 26 and lives in Huntersville, just outside of
Charlotte. She is one of those young, healthy people insurance companies want
and she’s getting ready to sign up for coverage with navigator Julieanne
Taylor.
Last year, Taylor
helped Henderson, a massage therapist and student, sign up for a medical and
dental plan within half an hour for a good price — just over $100 a month. She
looks forward to working with Taylor to find a similarly good deal for 2018.
Simmons said her navigators will be in libraries, public health departments and
even churches around the state.
“We are remaining
really laser-focused on making sure that consumers across North Carolina are
able to get info they need,” she said.
“There are a lot of
people that need renewal services and help in making sure that the marketplace
has their updated information and that the plan that they are in is still the
right plan for their family,” Simmons said. “But we are also trying to reach
new people.”
Last year, North
Carolina had one of the highest enrollments,
with more than half a million people signing up. South Carolina, with about
half of North Carolina’s population, has more than 183,000 people enrolled.
Sabrina Corlette with
Georgetown University’s Center on Health Insurance Reform predicts enrollment
numbers will drop during this open enrollment period.
“It’s just been
decision after decision,” she said, “including this navigator funding cut that
will ultimately lead not to just lower enrollment in the marketplaces but
sicker enrollment in the marketplaces.”
And if that happens,
Corlette said, count on higher premiums with fewer people in the insurance
pool.
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