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10.6 Million Got Help Navigating Health Exchanges, Study Finds

By Kerry Young, CQ HealthBeat Associate Editor

July 15, 2014 -- Paid and volunteer workers helped about 10.6 million people navigate the health law's at times complex process of buying medical coverage, a report found.

Consumers in many cases struggled with even some of the more basic jargon of the health insurance field, such as "deductible" and "network service," according to the recent report by the nonprofit Kaiser Family Foundation.

Then, there were the well documented technical glitches with the federal and some state insurance exchanges created by the health law (PL 111-148, PL 111-152). Very often, workers in assister programs spent one to two hours helping each consumer, the Kaiser report said.

"Explaining rules and options to people with limited understanding of the ACA and health insurance took time," the report said, referring to the Affordable Care Act. "So did waits on hold with marketplace call centers and frozen computer screens."

The report drew on a survey of the helpers involved in getting people enrolled in new insurance through state and federal exchanges. These include the Navigator programs that contracted directly with the Centers for Medicare and Medicaid Services to provide free outreach.

The report estimates that a total of about 4,400 assister programs operated nationally during this first enrollment period for the new marketplaces, with an estimated 28,000 full-time staff and volunteers. That suggests that each assister helped more than 370 people on average during the six-month open enrollment period that ran from Oct. 1 through March 31.

The report was is the first nationwide assessment of the number and type of assister programs and the number of people they helped, according to Kaiser. Many consumers needed more help even after enrolling, the report said. About nine of 10 assister programs has been contacted by people with follow-up questions after enrolling.

"Post-enrollment problems range from consumers not having received their insurance card, to not understanding how to use new health insurance or how to appeal a denied claim," the report stated.

The role of these assister programs will continue beyond the initial enrollment period, the report stated. The Congressional Budget Office has estimated that as many as 13 million people could enroll in the marketplaces in 2015, 5 million more than signed up during the first run. There will be work to be done in keeping current enrollees in the program, and also reaching out to Americans who have not yet signed up for health insurance.

"If the first wave of enrollment in 2014 was comprised of those consumers who were the most resourceful and motivated to seek coverage, then investment in consumer assistance will be all the more key in the year to come," the report said.

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