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September 29, 2014 - Kim Moore [see other posts]

Navigating the Marketplace

Getting Ready to Enroll Thousands

The second open enrollment period for the health exchanges created under the Affordable Care Act is coming. Beginning November 15th and continuing through February 15, 2015, Kansans without health insurance (and having a few other qualifications) can look to the federal marketplace for coverage options and possible subsidies to make the coverage affordable. During the first open enrollment period, 57,000 Kansans secured health insurance through the marketplace. The ACA penalizes most Americans who do not have health insurance coverage (there are several exemptions from the penalty). The penalty is the greater of $325 or 2% of household income in 2015; and in 2016 the greater of $695 or 2.5% of household income.

Many of those approaching the marketplaces are unfamiliar with insurance. They have worked in places which don't offer coverage or offered it at very high employee premiums preventing a realistic look from lower-paid employees. Many never dreamed they could afford health insurance. Terms like deductible, co-payment, networks, and co-insurance are not clear to these long-term uninsured persons (surveys show that those going to the marketplace are not alone with health insurance literacy problems). Those still lacking coverage but eligible for exchange coverage and subsidies are going to be even harder to reach than the group enrolled last year. It will take excellent public messaging, consistent community outreach and accessible one-on-one assistance for many of them to join covered Kansans. During the last enrollment period, Kansas navigators found that they averaged one and a half hours to help one consumer secure coverage. All of this work will have to be done in a public environment where misinformation is as frequently provided as accurate information.

The Health Ministry Fund has offered several Kansas groups dollar-for-dollar matching grants for employment of navigators to conduct community outreash and enrollment activities. Our offers targeted communities in the western two-thirds of Kansas where there had been no paid navigator working more than very part-time. The response to our offer has been underwhelming for a variety of reasons. We anticipate that our grants will only assist four or five communities with the presence of a navigator working 30 or 40 hours a week through the enrollment period and beyond. Dozens of Kansas communities will not have a single paid person working to do outreach and enrollment.

We know that insurance coverage means access to care for many persons. Insurance coverage will not always be adequate, but it will likely prevent medical bankruptcy and get a person past the registration desk. Insurance coverage will also mean that Kansas providers, many of whom are experiencing financial stress, can have more frequent sources of full and timely payment. Hopefully, many Kansans in social service agencies, private and public health provider offices, congregations and other groups committed to the public good are gearing up in some way within their resources to encourage and facilitate enrollment. Information about enrollment can be obtained through Debbie Berndsen, DBerndsen@kspca.org, Navigator Project Director, Kansas Association for the Medically Underserved.

We are offering our Healthy Congregations churches a learning opportunity through the web on October 7th at 7 p.m. so that United Methodist Churches can learn how to provide basic referral for persons asking about coverage. This webinar will cover health exchange information and Medicare enrollment information. If you are interested in participating, even if you are not a Healthy Congregations program member, please register online here.

There is a lot of potential benefit for Kansans and their health with affordable insurance coverage. We need to get this done right, and that can only happen if we all do our part.