By Jane Norman, CQ Roll Call
May 14, 2013 -- When enrollment in the health care law's new insurance exchanges opens in October, the prospects for success will turn on a crucial element: people who actually understand health insurance coverage and can explain it in plain language to consumers.
Many Americans who will be signing up may never have had insurance in the past or aren't fluent in English or might have trouble figuring out which plan will be best for their pocketbook and health condition. They probably will be using computers or paper application forms to enroll in health care coverage through the exchanges, which serve as marketplaces for the purchase of health insurance for individuals and small businesses.
The Obama administration doesn't want them to give up in frustration.
So the states and the Department of Health and Human Services will oversee the training of what's expected to be thousands of paid health insurance experts who will be available to guide Americans through the enrollment process. Counselors working in community health centers or hospitals also will be trained. Advocates are hoping there will be enough helpers to satisfy what could be a deluge of demand from worried and confused applicants. "It's a challenge. It's a huge challenge," Kathleen Gmeiner of Ohio Consumers for Health Coverage said at a recent forum sponsored by the Kaiser Family Foundation.
Here are some questions and answers about who will be helping Americans understand their new choices:
How do "navigators" fit into the system of exchanges that was set up under the health care law?
Consumers will fill out applications either online, on paper or by phone to apply for health insurance through the exchanges. Each state will have its own marketplace and its own set of available health insurance policies; some will be overseen by the federal government and others by states.
Insurance is often hard to understand and everyone has a different situation. So the law created government-paid helpers called "navigators" who will educate consumers about how to apply and assist them through the process. Navigators won't work on commission and they can't favor any one insurer or be paid by insurers.
Navigators may be public or private organizations or self-employed individuals. Eligible groups include unions, tribal organizations, church groups and chambers of commerce. At least one group in every state must be a consumer-oriented nonprofit. They will advise applicants on whether they are eligible for the Medicaid program or whether they might qualify for government tax credits that will help them pay for their insurance.
Navigators are supposed to provide impartial information and guidance to consumers, not tell them which plan to pick.
Are there navigators in every state? Are there other types of helpers?
There will be navigators in the 34 states in which the federal government is running the marketplaces or the state is engaged in a partnership with the federal government. In those states, the Department of Health and Human Services(HHS) is making available $54 million.
The money is allocated based on the total number of uninsured people under the age of 65 in each state, and each state gets at least $600,000. Some experts are worried this won't be enough to reach all the uninsured. Applications are due June 7.
In the 16 states and the District of Columbia that have set up their own exchanges, there will also be navigators—but they may not be fully operational right away. That's because of a funding quirk in the law. Those states receive what are known as federal exchange establishment grants, and that money can't be used to pay for navigator programs.
So, HHS created the "in-person assister" program for those states, to help them beef up their consumer assistance in their first year of operation. States can apply for and use exchange establishment grants for these assister programs as well as state funds. The assisters probably will do many of the same things as navigators.
There is a third category of helpers called "certified application counselors." They are not paid by the government but instead work for community health centers, hospitals or similar institutions, and they would be certified to help with exchange enrollment in those places.
How will navigators and other government-paid helpers be trained? How much will they be paid? What are their qualifications?
Both navigators and assisters will have to complete a Web-based training program that will take up to 30 hours, and they will be certified by passing exams approved by HHS. They'll be trained on respecting people's privacy and on customer service. And they have to pledge to stay free of conflicts of interest.
Those who apply to be navigators will be asked to provide information on their track records of developing and maintaining relationships with employers, employees, consumers, the uninsured and self-employed people, especially those who are low income. They'll also be asked about public education they've conducted in the past.
Applicants for navigator grants are also supposed to demonstrate that they will be able to reach out to people with disabilities and that their services will be accessible to them.
It's not clear what the pay will be, but HHS estimated in a proposed rule that it would average $29 an hour for all staff, from higher-paid senior executives on down. Similarly, it is not yet known how many navigators or assisters there will be, but the number is expected to be in the tens of thousands.
How will people who don't have insurance find advice on how to sign up?
The idea is the helpers will be out in the community actively looking for people to sign up at church meetings, in barbershops, even knocking on doors, according to recent congressional testimony. In addition, the federal government, the states and private advocacy groups such as Enroll America are expected to roll out education programs in July, August and September that will publicize how to find help. Enrollment begins Oct. 1.
Will the helpers be fluent in languages other than English?
There is no firm requirement for fluency in other languages. But the helpers are supposed to know about the cultures in their states and provide information to consumers in their preferred language, either verbally or by translation when necessary. HHS says in proposed rules that interpretation available by telephone may be used, or a family member might be relied on to help. Applicants will be asked about their experiences in working with people with limited English proficiency. There will be a call center and a language line that can arrange to provide answers in more than 150 languages, officials have said.
People who don't have insurance through their jobs often sign up now through insurance agents. Will that change? Will they be required to use a navigator instead?
Insurance agents and brokers who are continuing to actively sell health insurance cannot be navigators or assisters. However, once consumers have been told they are eligible for a tax credit and are ready to pick a plan, the agent can help them select insurance coverage as long as they abide by certain federal and state rules. But agents can't provide any financial incentives to steer people into particular plans. No one will be required to use a navigator.