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August 21, 2015 - Kim Moore [see other posts]

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From the Frontlines of Health Insurance Coverage

Yesterday it was my privilege to meet with navigators and program administrators supported by grants from United Methodist Health Ministry Fund working full-time since last fall/winter to assistant Kansans in securing health insurance coverage through the health insurance marketplace. All of these navigators are part of the Cover Kansas program which supported 165 navigators (most of them unpaid, part-time volunteers) around our state during this last open enrollment period ending in March. Debbie Berndsen and her staff at Cover Kansas (a program of Kansas Association for the Medically Underserved) answer technical questions, cut-through the marketplace processes when possible and encourage these navigators. The system is solid in operation but certainly not at the scale needed.

The seven navigators (which we support with matching funds) stationed mostly in western Kansas enrolled 534 persons/families in marketplace coverage, referred 143 to Medicare/VA/TriCare and referred another 96 to Medicaid. They participated in outreach events—both to inform about the marketplace and to conduct health insurance literacy training—in 88 events reaching almost 7000 Kansans. Many started functioning after the start of the open enrollment period, but all have continued working through the subsequent special enrollment period and continue today to help people with special circumstances to enroll in coverage outside the enrollment period. They are gearing up for OPEN ENROLLMENT THREE starting in November.

The navigator from Coffeyville told about her work in assisting some of the 600 unemployed Amazon workers find coverage as Amazon closed its plant there, leaving many families uninsured and unemployed. Another navigator told a story of a couple where the husband had been injured at work 1½ years ago and, while still covered with insurance, had received a colostomy with the attached bag. Without health insurance, he was unable to get the bag removed and the incision closed. He could not go back to work. Health insurance through the marketplace was affordable for this couple with the wife working part-time jobs. The coverage immediately permitted the procedure to be done and the husband went right back to work—a productive, taxpaying citizen once again. A widow, who was a self-employed business person with a Ph.D., had never dealt with health insurance and could not secure coverage. A rural navigator helped her get affordable, comprehensive coverage which thrilled the client. Another man came in unable to afford treatment for his rectal cancer; coverage has permitted that treatment and he hopes to get back to work. Again and again, there was the theme: people who did not think they could afford coverage had limped by, constantly threatened by overwhelming medical bills, and now, because of the ACA, they could get affordable, comprehensive coverage which changed their lives.

Sheldon Weisgrau, Health Reform Project Coordinator, shared national and state statistics with the group. Almost 30 million Americans have health insurance coverage through the marketplace (13 million), through Medicaid in 30 states plus the District of Columbia (13 million) , and through age 26 coverage expansions and other provisions of the Affordable Care Act (3 million). While not all of these were previously uninsured, the uninsured numbers are down 16 million. The uninsured rate for adults over 18  nationally has dipped from 18 percent to just over 11 percent. Kansas, which has historically had better coverage rates than the national average, is now right at the national average of 11 percent for adults over 18, while some states are below 10 percent and even a few are approaching 5 percent uninsured adults. The difference in coverage rates is the effect of the Kansas failure not to expand Medicaid.

With 11,000 Kansans getting enrolled during the recent special enrollment period (permitted for people who were not aware of the tax penalty for non-coverage), Sheldon said we are on the cusp of 100,000 people enrolled through the marketplace in Kansas.

This is quite an accomplishment and reflects favorably on the navigators and certified application consultants doing outreach and the considerable public awareness through social media, radio, and television supported by the six health philanthropies in Kansas. However, I think it primarily reflects the great need for so many people in Kansas to secure access to health care and the protection of their financial well-being by being insured. It has occurred in a very difficult environment.

Navigators told many stories about consumers coming in interested in health insurance but not that awful Obamacare. One western Kansas navigator set up a public information booth in a public library and local citizens derided the local librarian for consorting with Obamacare. One navigator program said its experience was that nine out of ten consumers don’t know how health insurance works. That is very consistent with surveys nationally showing that high numbers don’t know the meaning of basic insurance terms like co-payment, deductible, network, etc. In many cases, the explanation of coverage has to be translated into Spanish, Burmese, or other languages, and navigators use electronic translation or translation services when a translator is not available. 

The new Kansas Insurance Commissioner took down that agency’s website which gave consumers a quick look at premiums for products in their regions. One of the biggest barriers to people seeking coverage is that they think they cannot afford it. Quick and accessible information like that provided by this website addressed that problem. Governor Brownback returned more than $30 million to the federal government to stop development of a Kansas marketplace, throwing us into the federal marketplace and its early adoption problems. Kansas officials have ordered state workers in various departments to be non-cooperative with the marketplace and not refer people for coverage. Our entire Congressional delegation talks of repealing Obamacare. And yet, 100,000 Kansans have sought improved health care for themselves since 2014!

As we move into a new third opportunity this fall and winter for Kansans to secure health insurance and free themselves to live their lives with health and financial security, I want to express the appreciation of the Health Ministry Fund to Cover Kansas and its small squadron of navigators; to Kansas Association for the Medically Underserved for its commitment to this effort; to Sheldon Weisgrau for his exceptional service in the whole realm of health reform; and to all the hospitals, social service programs, community health centers, and health care providers who are going the second mile to reach out, inform and enroll Kansans in health coverage through the marketplace, through Medicaid (when available), and other products.  

We need to hold to the vision of all Kansans having financial health coverage and the proven benefits of that status. Reach out and enroll…work for Medicaid expansion…educate on health insurance literacy and health literacy. There is work to be done on the frontlines and in the policy arena.

Footnote: Of course, Kansas has not expanded Medicaid coverage as encouraged by the Affordable Care Act. Kansas also has one of the lowest eligibility levels in the nation for its Medicaid program.  Navigators expressed that one of their biggest problems and greatest disappointments was when they have to tell a person he or she is “too poor” to qualify for coverage.