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Feb. 10, 2014
TOPEKA There is an emotional element to Rochelle Bryant’s work that might surprise some people.
“We use a lot of tissue,” she said. “It’s overwhelming for them (many of her clients) to find out they can finally see a doctor, that they can be treated.”
Bryant is one of about 300 or more people across the state working as “navigators” to help people enroll in health plans through the Affordable Care Act’s insurance marketplace.
One of six navigators employed at Wichita’s GraceMed safety net clinic, Bryant said it is common for people she deals with to be overcome with relief or frustration once they go through the enrollment process.
Some become angry or disappointed when they learn they earn too much to qualify for Medicaid but too little to benefit from the federal subsidies available to help purchase private health coverage through the marketplace. In those instances, the clients essentially are informed that they are right back where they started before going through the enrollment process, still lacking coverage.
“We have to tell people that a lot. It’s not a good feeling,” said Juvan Nava, Bryant’s supervisor and fellow navigator at GraceMed. “You can definitely hear the heartbreak and sad stories.”
According to the latest enrollment report from federal officials, 14,242 Kansans had selected health plans through the marketplace between the program’s rocky start Oct. 1 and Dec. 28, 2013.
Various problems are still being reported nationally, but Kansas navigators interviewed by KHI News Service said that for the most part the process is now working relatively smoothly for them and the people they assist.
Thousands more people are expected to have enrolled by the time the rolls close for this year on March 31.
A series of concerted statewide “enrollment events” are planned between March 2 and March 8 by one group, and navigators such as those at GraceMed said they already are “booked out” days and weeks ahead with appointments to see potential enrollees.
They said they expect the work pace will only grow more hectic as the deadline approaches.
“I think we’re going to be chained to our desks — working, working, working,” Bryant said.
The state's 13 federally qualified health clinics, key players in the so-called medical safety net, received federal grant dollars to promote awareness of the marketplace.
As a result, Nava said, his navigator team is “very well known” around Wichita because “our advertising campaign has been a large one,” featuring billboards and radio and TV time.
He said GraceMed had 19,000 uninsured patients last year and “we’ve contacted each one of them,” to see about getting them covered through the marketplace.
Five thousand of the 19,000 have since had some contact with the navigators and of those 600 have been directly enrolled with GraceMed navigator assistance, he said.
Nava said the team has no way to track how many people might have received some information from the navigators and then completed the process on their own at home or elsewhere.
For the most part, he said, the people the team has worked with have been pleased to learn that the Affordable Care Act “is not what they thought it was. It’s easier and much more affordable than they thought. A sigh of relief is what I hear a lot.”
He said the navigators seem to get more traction working one-on-one with potential enrollees rather than with large groups of people.
“Some are successful, some aren’t,” he said of the larger “outreach” events.
Some people are still “hesitant” about enrolling, he said, due to the “negative connotations” attached to Obamacare by Republican opponents of the law and their allies.
There’s also been a strong push to get people enrolled in Wyandotte County. The Enroll Wyandotte effort has largely been underwritten by regional health care foundations but has relied on cooperation and support from the county’s Unified Government and other entities.
The main push there was organized under the auspices of the Community Health Council of Wyandotte County.
Jerry Jones, the council’s executive director, said the group’s goal is to enroll at least 12,000 of the 16,000 people in the county thought to be eligible for subsidized marketplace coverage.
About 100 people have been trained to assist people with the enrollment, he said, and of those about 60 “we know will be actively engaged through the open enrollment period.”
Another group active in the Kansas City metro area is Advanced Patient Advocacy, which is based in Belton, Mo, but also works on the Kansas side, including in cooperation with Menorah Medical Center and Overland Park Regional Medical Center. Both large hospitals are in Johnson County.
Emily Tran of Advanced Patient Advocacy, said among the “biggest challenges” the group’s navigators have faced has been the general lack of public awareness of the marketplace and its coverage options.
She said navigators from the group often encounter “political bias,” particularly when dealing with patients at the Johnson County hospitals.
“They’re not open to learning more, once they know it’s Obamacare,” she said. “And there are huge numbers that just don’t know about it. They are completely uneducated about it,” though the law was first passed in 2010.
Debbie Berndsen is heading the navigator initiative for a consortium led by the Kansas Association for the Medically Underserved, a group that represents the state’s safety net clinics.
Berndsen said her program had 157 certified navigators and 58 more in training by the end of 2013, which was short of the group’s goal of fielding 250 navigators.
She said the program was on target — “at one point we had more than 250” — but the computer glitches and other problems that accompanied the marketplace’s launch caused a number of people to drop out.
“Training was not moving smoothly due to computer problems. Then we lost a few when the marketplace wasn’t working well and some people just realized they didn’t have time in addition to other full-time jobs,” Berndsen said.
On top of the general lack of public understanding of the Affordable Care Act and the marketplace, the navigator system in Kansas and elsewhere around the nation had to come together very quickly in order to meet the law’s deadlines.
For example, the federal grant for the KAMU-led effort didn’t come until August 2013.
“I started Sept. 2 and the marketplace opened Oct. 1,” Berndsen said. “We heard the phrase building the plane while you’re flying it a lot.”
Nonetheless, the consortium now has navigators in every region of the state — though lacks people in more than half of its 105 counties — and has helped thousands of people, including the 2,127 that navigators know completed enrollment with the their assistance.
“We think these numbers are conservative because they don’t necessarily reflect household size,” Berndsen said last week during a “lessons learned” session at the Cover Kansas Summit, which was sponsored by KAMU.
The event, held in Topeka, drew about 80 people from around the state, including 35 navigators, to compare notes. There was considerable discussion of the obstacles already encountered and overcome but also a lot of talk on how to make it all work better and reach more people.
“Navigators in Kansas are my heroes,” Berndsen said. “They don’t give up when something doesn’t work.”
The KAMU consortium is planning a major advertising push in early March as part of its ongoing efforts to get the word out.
"We will be getting billboards up across the state, as well as some advertising through movie theaters and/or radio," said Katrina McGivern, KAMU's communications coordinator. "We just launched a text messaging campaign to help people get more information. Kansans can text 'InsureKS' to the number 69866 for more information."
So what will become of all these efforts and organization once open enrollment closes at the end of March?
Some at the gathering said they would move right into the work needed to prepare people for open enrollment next year. Others have set their sights on elements of the marketplace that got delayed by federal officials or overshadowed.
“Come that time (March 31), it will be SHOP. It will be the small businesses that we’ll be concentrating on,” Nava said.
SHOP is the acronym for the Small Business Health Options Program, a part of the new marketplace open to employers that have the equivalent of 50 or fewer full-time workers.
Employers with fewer than 25 workers can use the program to qualify for federal tax credits.
Under the Affordable Care Act, employers with 50 or more workers are required to offer health insurance or pay a penalty if their employees find coverage through the marketplace.
Employers with fewer than 50 workers are not required to offer coverage but can use the SHOP program, if they want.
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