Georgians who lack health insurance soon will be able to shop for it on a special website, or “exchange,” set up under the Affordable Care Act.
That is, if they know it exists. And can figure out how to use it. The website will offer a blizzard of health plans from companies — each with different benefits and costs to consider.
That’s why, between now and the exchange’s debut in October, a cadre of “navigators” is supposed to be hired and trained. The idea is that they will understand the exchanges well enough to explain them to the people they’re intended to help.
As with many aspects of the ACA, however, finding and fielding the navigators carries complications and uncertainties.
Local nonprofits and community groups are supposed to hire and employ the navigators, using federal grants that will be awarded later this summer. The federal government sets basic guidelines but Georgia legislators have added their own layer of rules and qualifications that some say complicates the effort.
It’s crucial that the navigators are in place and well-trained, said Cindy Zeldin, executive director of advocacy group Georgians for a Healthy Future.
“There will be a segment (of people) that hasn’t ever had insurance, that doesn’t know what a deductible is, that doesn’t know what a copay is,” she said. “Not everyone may have the level of health literacy and Internet savvy to be able to independently walk through the process.”
A national survey conducted by CVS Caremark last year found that 78 percent of consumers who would be eligible for new health coverage under the Affordable Care Act had never heard of the state insurance exchanges where they could shop.
In Georgia, the exchange website will be run by the federal government. It will cater to Georgians who don’t get insurance through work, such as the self-employed, students and unemployed. The exchanges are a key part of President Barack Obama’s goal of providing health coverage to tens of millions of uninsured Americans.
Health plans sold on the exchanges will take effect Jan. 1.
Zeldin worries, however, that the $2.8 million in grants available to Georgia will fund the hiring of well under 100 navigators. That’s far too few for the nearly 900,000 Georgians who will be eligible to shop on the exchange, said Zeldin, who thinks 400 to 500 navigators are needed.
Groups hoping to hire navigators also fear a new state law requiring the workers to be licensed, pay fees and undergo extra training will thwart their efforts. The federal health law already requires navigators to have 30 hours of training.
House Bill 198, passed by the Legislature in the spring, effectively requires navigators to get 10 additional hours, be state-licensed and take continuing education classes.
“I think after the passage of 198, we have assurances these people are going to be properly educated,” said Graham Thompson, a spokesman for large insurers in Georgia, who supported the bill.
The state Department of Insurance is expected to release detailed job requirements in coming weeks. Navigators will also likely be fingerprinted and undergo a criminal background check, as is required of insurance agents and brokers. There could also be fees for applying, taking the licensing exam and the fingerprinting.
“Navigators will have access to highly-sensitive personal information and criminal background checks will help protect Georgia citizens from bad actors,” state Insurance Commissioner Ralph Hudgens told The Atlanta Journal-Constitution. “They will also be providing insurance advice to Georgians, and the pre-licensing training and examination called for in HB 198 will help us ensure that navigators are qualified to provide that advice.”
More than a dozen states, such as Virginia and Tennessee, have crafted similar legislation adding new regulations for navigators in addition to those already required by the federal government.
Advocates say some state rules are overly burdensome and raise questions about what exactly navigators are allowed to do. For instance, Georgia’s law prohibits navigators from advising whether specific health plans are better or worse for a consumer.
That could hinder navigators from helping consumers narrow their options, said Tricia Brooks, a senior fellow at Georgetown University’s Center for Children and Families.
Many of the laws were pushed by groups of insurance agents and brokers concerned about possible competition, Brooks said. The navigators, however, won’t likely serve the same types of people — mostly uninsured and low-income — that agents do, she said.
“There’s a lot of work to go around,” Brooks said.
The navigator program won’t be enough on its own, Zeldin said. That’s why community groups will also be putting their own resources into outreach.
The Atlanta-based Center for Pan Asian Community Services has applied for a federal grant to hire five navigators but plans to spend its own money on two additional navigators, said Zakiya Sloley, the nonprofit’s director of development. The group will also spend money on outreach and education about the exchange, Sloley said.
“We’re on the eve of full implementation (of the health care law),” Zeldin said. And people who may be eligible for the exchange “don’t know that they could get affordable health insurance.”
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