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Health Insurance Is Great – Navigators Needed to Help People Use It

This spring, Adriann Barboa and her colleagues at Strong Families New Mexico went on a five-county tour, fanning out across the state to share findings from the Breaking Barriers study they’d conducted on progress under the Affordable Care Act (ACA).

The report is part of a ten-state series by the Alliance for a Just Society.

“In all the towns we went to, many people said it was great to finally have insurance, but they didn’t know how to use it,” Barboa said.

“The Breaking Barriers report recommends using navigators to help people understand what a primary care provider is, what preventive care is, and how to get those services using their insurance,” Barboa said. “Across the five counties people pointed to that recommendation and said ‘That’s what we need.'”

Since passage of the ACA, the United States has seen a record decline in the uninsured rate. In 2013, more than 13 percent of people in the country were uninsured. By 2014, that figure had dropped to 10.4 percent.

These gains were achieved thanks to the ACA’s Medicaid expansion and subsidies for coverage through state and federal marketplaces. The new law made millions of people eligible for health coverage when they’d been shut out in the past.

But, even with these changes, it took real people to get so many new enrollees through the door – these are the navigators mentioned by Barboa.

In the first open enrollment period alone, navigators and other enrollment assisters helped more than 10 million people apply for coverage. These navigators provided information about plans, assisted people with forms, helped them submit documents, and showed them how to make their payments.

This help was – and continues to be – key to the ACA’s success, which is why the federal Department of Health and Human Services is increasing its investment in navigator programs.

We all know how apt the term “navigator” is, since the process of enrolling in health insurance is so complicated. But those complications don’t end once you’re signed up for insurance and have sent off your first premium payment. Using health insurance can be very confusing, too.

Many of us have had questions about our coverage. How do I select a doctor or other practitioner from my health plan’s list of providers? What kind of care comes free of additional costs, and when may I be charged out-of-pocket payments – and how much will those payments be? How do I find out what services or prescriptions are covered? If I’m denied a service, what are my rights to challenge that denial?

These questions are hard enough when you’ve had health insurance your whole life. It’s that much harder if you’re getting coverage for the first time. In that case, you’re entering a new world of formal terminology, provider lists, and paperwork.

That’s why navigator-type programs should be there for us after we enroll, too.

Without an effort to make sure coverage translates into care, we run the risk of missing out on the promise of health reform – which, we should remember, is about transforming our health sector so people can get the care they need. Enrolling all those millions of formerly uninsured people is just the first step.

As the Alliance for a Just Society’s recent Breaking Barriers reports show, many people – especially people of color and low-income people – still aren’t getting into the doctor’s office even after they have coverage.

Some community-based organizations provide good models for how an integrated assistance program can help people move into coverage and then turn that coverage into care.

The Community Service Society of New York (CSSNY) provides one such model. Drawing on funding from New York State, CSSNY has established an innovative coverage-to-care approach – using both a navigator network and a community health advocates program – that helps people obtain coverage and put their coverage to use.

A New Yorker needing help can call CSSNY’s toll-free helpline, where advocates connect people to enrollment assistance, answer questions about coverage, or help troubleshoot insurance issues (such as coverage denials or billing problems). Using a hub-and-spoke structure, CSSNY also works with a broad, statewide network of community group and small business groups, offering help in almost 200 languages.

We need more programs like this one if we hope to truly transform our health care system and make it work for everyone. We need to make sure a person’s insurance card is worth much more than the plastic it’s printed on. Good coverage-to-care navigator programs are key to achieving that goal.

A Question for Lawmakers Who Backtrack on Expanded Health Coverage: Seriously?

With two weeks left in the second enrollment period for Affordable Care Act health coverage, marketplace enrollment is projected to reach between 9 million and 9.9 million people this year. That’s a net increase of between 2 and 3 million people gaining coverage through the marketplaces. Millions more will gain coverage through Medicaid expansion.

That’s something to celebrate – but the celebration could be short-lived for many people. Instead of figuring out how to get more people health coverage in 2015, many newly-elected and re-elected state legislators and governors are actually plotting how to take health care away from people who just received it for the first time.

It’s a real threat to people who’ve just gained coverage through Medicaid expansion – especially in states where incoming lawmakers are openly hostile to anything related to the Affordable Care Act. Those at greatest risk of losing coverage are women and people of color.

In Arkansas, where 211,000 people recently gained coverage, the state legislature must reapprove the Medicaid expansion plan by a three-quarters majority again in 2015. The incoming Republican governor is unenthusiastic about the plan – and expansion opponents won seats in the legislature. That doesn’t bode well.

In Ohio, where more than 400,000 people have coverage under Medicaid, the state legislature is also required to reauthorize the program in 2015. And in New Hampshire, where more than 20,000 people enrolled in just three months, the new Republican majority in the NH House of Representatives will also take a fresh vote on the program as well.

The continuing failure of more than 20 states to adopt any expansion plans at all, and the prospect of newly elected legislators revoking expanded coverage for hundreds of thousands of residents, represents a serious health threat to women.

A recent 50-state report card on women’s health by the Alliance for a Just Society clearly shows that most of the states that rejected Medicaid expansion have poor or failing records on women’s health. When it comes to ensuring that women have access to health care, the majority of legislators in these states have turned their backs on women.

The 2014 Women’s Health Report Card ranks and grades every state in the country on 30 distinct measures of women’s health. The results: 17 of the 21 states that rejected Medicaid expansion received final grades of C, D or F – and 13 of those states received a D or F.

Politicians in these states are failing women, but they are especially failing women of color who are more likely to be working low paying jobs, not covered by health insurance, and are least likely to have access to medical care.

The number of black women without health insurance is at least 20 percent higher than for women overall in 17 states. The uninsured rate for Latina women is at least 50 percent higher in 44 states. Black, Latina, and Native American women without access to health care have dramatically higher rates of hypertension, diabetes and infant mortality than other women.

While it’s encouraging news that Wyoming, Montana, and even Idaho seem to be moving toward Medicaid expansion, it will also leave our nation with a disturbing illustration of how alive and well racial segregation is in America. Take a look at the map of states that are refusing coverage to their most vulnerable residents: being denied access to health care is the latest Jim Crow.

Lawmakers in states that haven’t expanded Medicaid yet should move quickly to adopt expansion plans this year. If they don’t, they will bear the responsibility for their states falling even further behind on women’s health, and worsening racial disparities in our health care system.

As for lawmakers considering a vote to take health care away from thousands of their constituents, all I can ask is: Seriously? Do you really want to do that?

It’s one thing to stand in the way of people gaining access to quality, affordable health care. But it’s something else when people have just experienced quality, affordable health care for the first time, and then you snatch it away from them.

I can’t imagine that many will take kindly to it. And just in case anybody’s forgotten, there’s another election just a couple years away.

LeeAnn Hall is the executive director of the Alliance for a Just Society, a national policy, research and organizing network focused on racial and economic justice. The Alliance has produced pivotal reports on state and national health issues including Medicaid, prescription drugs, and insurance industry practices for 20 years.

Will Health Coverage Translate into Receiving Health Care?

LAH Orange 2019735258LeeAnn Hall, executive director of Alliance for a Just Society, published this article originally in Huffington Post.

More than 7.5 million people have signed up for new health coverage through the Affordable Care Act’s state and federal health insurance marketplaces at the close of the first enrollment period.

The Department of Health and Human Services reports that another 3 million people have gained health coverage through Medicaid or the Children’s Health Insurance Program (CHIP) as of the end of February, compared to figures five months earlier.

Now we’re about to find out something critically important: whether having health coverage translates into receiving health care.

Let’s be blunt: one of the biggest problems with America’s health care system is that it neglects the poorest among us. People of color suffer more and die earlier than others. The U.S. continues to have one of the highest infant mortality rates among the 14 wealthiest countries, and it’s higher in communities of color. Read more

After Obamacare Enrollment, Three Critical Steps

Massachussetts Considers Mandatory Health InsuranceThis article by LeeAnn Hall, first appeared in Colorlines.com

More than 7.1 million people have obtained health coverage under the Affordable Care Act, despite the early confusion and glitches with the computer system. In addition, 6.3 million are approved for Medicaid and the Children’s Health Insurance Program, and an estimated 3 million more young people gained health insurance by staying on their parent’s plans.

We have a once-in-a-generation opportunity to eliminate health disparities so people of color are no longer living sicker and dying younger. If we do our job, no mother will ever have to choose between paying the rent or taking her sick child to the doctor.
Read more

Affordable Care Act Reports are Missing Data on Enrollment by Race and Ethnicity

For Immediate Release:
February 17, 2014
Contact: Kathy Mulady
Communications Director
Kathy@allianceforajustsociety.org

 

Affordable Care Act Reports are Missing Data on Enrollment by Race and Ethnicity

The Affordable Care Act has great potential to shrink the racial gap in health coverage.  But we can’t tell how it’s doing without data on race and ethnicity.

Again last week when numbers were released by the Department of Health and Human Services about those enrolling in coverage under the Affordable Care Act – there was no data by race and ethnicity.

The ACA is an unprecedented opportunity to shrink the racial gap in health coverage and end inhumane disparities. How do we know who is being reached if Health and Human Services isn’t providing the data?

“It’s inexcusable. The department should collect and release full race and ethnicity data. Failure to do so suggests that HHS doesn’t see closing the racial coverage gap as a high priority,” said LeeAnn Hall, executive director of the Alliance for a Just Society.

“Our nation faces critical health disparities that are associated with race, ethnicity, culture and language. Minorities and the poor suffer more, and die sooner, than the general population,” she said.

In January, HHS released its first numbers on enrollment. More data was released by the agency February 12. Again, an analysis of enrollees by race and ethnicity was missing.

The most difficult groups to enroll are those who have never had health insurance, who speak different languages, or who have never been able to afford health insurance. They should be the first priority of enrollment efforts. The department’s own reports show that 31 percent of Latinos, 21 percent of African Americans, and 18 percent of Asian Americans are uninsured.

It is imperative to count who is enrolling – and make that data public.

Those who are working to bring information about health care benefits to minority communities need data. With these tools we can make sure no mother, father or child suffers or dies because they can’t afford to go to the doctor.

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The Alliance for a Just Society, based in Seattle, WA, is a national research, policy and organizing network that focuses on health care, economic, racial and social justice.