The shaky ground surrounding the enrollment process for the Affordable Care Act (ACA) has given birth to an entire industry of professionals whose sole purpose is to guide prospective health care purchasers through the labyrinth of “Obamacare.”
Health insurance has become more accessible for many New Jersey residents thanks to the ACA, but on the road to coverage, legions of prospective beneficiaries have been stonewalled by website flops, user-unfriendliness and abundant misinformation.
It is the mission of organizations like the nonpartisan Enroll America to untangle the mess of red tape blocking clear pathways to coverage for the tens of millions of Americans who they say stand to benefit most from the program. “There are 900,000 uninsured New Jerseyans eligible for coverage under the new [law],” Enroll America spokesperson Alescia Teel said. “Our focus is to reach out and educate as many of those folks as we can and help them get the information they need so they can make educated decisions and enroll in the near future.”
Enrolling so many people “won’t be easy,” the Enroll America mission statement reads. “Experience from previous reforms suggests that there are significant barriers that prevent many people from enrolling — and staying enrolled — in health coverage.”
But those barriers, largely the result of bureaucratic blundering, are not insurmountable.
Federal and state governments will need assistance to fully address the “enrollment gap,” or the gap between people who stand to benefit from the program and those who have thus far been able to enroll, the organization states. It seeks to close the gap by creating a consumer-friendly enrollment process and ensuring that Americans know how and where to sign up for coverage.
In lieu of a federal or state government that has the resources to take on that responsibility, organizations like Enroll America are stepping up to level out what has thus far been a steep learning curve for prospective purchasers. While the emissaries at the nonprofit devote their resources to helping uninsured and underinsured New Jerseyans take the first step toward getting covered, it is the responsibility of other specially trained professionals to usher those people through the capricious federal enrollment system.
Government officials dished out more than $2 million in federal funds to five organizations in New Jersey, including the FoodBank of Monmouth and Ocean Counties, where a handful of so-called navigators meet with enrollees to discuss coverage options. Each navigator underwent a 20-hour online training course before the marketplace rollout Oct. 1, and passed an examination in order to become certified.
When clients stop in, navigators “go online, set up a username and password for them, plug in their income and get an eligibility determination,” said navigator Barbara Scholz, director of advocacy and programs at the FoodBank.
“The eligibility determination is key, because it tells [the client] how much a policy could cost and how much lower their deductible might be,” she said.
During the next step, the navigatorclient team compares and contrasts policies in the marketplace, keeping in mind the client’s medical needs and financial reach.
Since the inception of the navigator program at the FoodBank of Monmouth and Ocean Counties, navigators have advised more than 1,000 prospective insurance purchasers and successfully enrolled approximately 120 people.
In the first six weeks after the rollout, online system failures precluded navigators from offering anything more than advice to their clients, but the enrollment picture, still far from perfect, has been steadily improving, Scholz said.
“Sometimes we have several hours where everything works beautifully and the client gets through without a hassle. Other times it takes a few tries, but it’s worth the wait,” she said. “The other day we helped a cancer patient who’s working two jobs and doesn’t have health insurance. She needed treatment and was relying on charity care, but still wasn’t getting the treatment she needed. She was thrilled when we got her an affordable plan. She said she felt like she had found life all over again, like she was going to make it. It’s heartwarming.”
In Middlesex and a handful of other New Jersey counties where navigators cannot be found, prospective insurance purchasers can reach out to certified application coordinators (CAC), who provide the same essential services as navigators, usually for public health institutions.
At the Eric B. Chandler Health Center in New Brunswick, approximately 20 CACs are experiencing the now-infamous technical issues that have characterized the marketplace’s rollout, but they are seeing improvement.
While organizations like the Food- Bank of Monmouth and Ocean Counties receive federal funding to train navigators, health centers like Eric. B. Chandler are largely taking it upon themselves to train CACs, because offering help to the uninsured aligns with their mission statement.
“The CAC program has contributed to our mission to service patients regardless of their ability to pay. If there are other insurance options out there for them, we’re happy to assist. We really believe that health insurance is vital, so we’re willing to take on the challenge and get as many people as possible covered,” said Sandra Adams, executive director of the New Brunswick health center. She added that, like navigators, CACs offer their services for free.
With navigators, CACs and enrollment advocates like Enroll America smoothing out the kinks in the federal enrollment system — and the system itself beginning to operate more smoothly — now is the perfect time to get covered, said Justine Ceserano, New Jersey state director for Enroll America.
“I’m sure a large number of people will be hesitant to make the major decision to enroll independently and a lot of people are overwhelmed by the amount of options available, but it’s important to know that there is help out there and it’s readily available,” she said.
Many people are better off than they were before the ACA was implemented, Ceserano said.
“You may disagree with the program or critique its rollout, but because of it, you’re going to have a healthier, more productive nation,” she said.
For information on the Affordable Care Act (ACA) and facilitators:
FoodBank of Monmouth and Ocean Counties:
732-918-2600
[email protected]
Enroll America: 202-737-6340
New Jersey State Director Justine Ceserano:
[email protected]
Eric B. Chandler Health Center: 732-235-6700
[email protected]
General information on the ACA:
www.getcoveredamerica.org
www.healthcare.gov