ACA HEALTH CARE - Kentucky's Example of How It Should Work

"For Uninsured, Clearing a Way to Enrollment" by ABBY GOODNOUGH, New York Times 11/4/2013

Excerpt

Kelli Cauley’s fingers raced over her keyboard as she asked the anxious woman at her side a series of questions.  What was her income?  How many people lived in her household?  Did she smoke?  (“That’s the only health question it asks,” Ms. Cauley said of the application they were completing.)

The woman, a thin 61-year-old who refused to give her name, citing privacy concerns, had come to the public library here to sign up for health insurance through Kentucky’s new online exchange.  She had a painful lump on the back of her hand and other health problems that worried her deeply, she said, but had been unable to afford insurance as a home health care worker who earns $9 an hour.

Within a minute, the system checked her information and flashed its conclusion on Ms. Cauley’s laptop: eligible for Medicaid.  The woman began to weep with relief.  Without insurance, she said as she left, “it’s cheaper to die.”

Known as “navigators” or “assisters,” people like Ms. Cauley are going to work across the country, searching for the uninsured and walking them through the enrollment process.  Under the Affordable Care Act, these trained, paid counselors typically work for community groups or government agencies, with a mandate to provide impartial guidance.  Given the problems plaguing the federal online insurance exchange used by 36 states, the workers have become even more important in helping people understand their insurance options.

But in Kentucky and some of the 13 other states that have their own exchanges, which in general are running more smoothly than the federal site, watching navigators on the job also provides the clearest view yet of how enrollment could work once the technical problems of HealthCare.gov are resolved.

President Obama and proponents of the health care law have held up Kentucky in recent weeks as a model for the national enrollment effort.  The state is far ahead of most of the nation in signing up people: As of Nov. 1, more than 27,854 Kentuckians had enrolled in Medicaid under the law’s expansion of that program, and 4,631 had signed up for private plans through the state-run exchange, known as Kynect.  The state says it is enrolling 1,000 people a day.

In contrast to the federally run exchange with all its problems, Kynect has had relatively few — for several reasons, Kentucky officials said.  The primary contractor, Deloitte, worked closely with the state agency that runs health programs, ensuring guidance and oversight.  Unlike the federal government, the state tested its online exchange early and often, so problems were addressed before the website went live.  And people can check whether they qualify for Medicaid or subsidies without creating an account, a requirement that caused huge bottlenecks on the federal exchange.

While most states lack enough navigators to reach all who need help, Kentucky is spending $11 million in federal money to promote its exchange, and it shows: Ads for Kynect blanket television and radio, city buses and highway billboards in Louisville.

“Compared to other states, we’re sitting pretty,” said Jacquelynn Engle, who is overseeing the sign-up effort at Family Health Centers, a network of seven clinics in Louisville that treats thousands of the city’s uninsured.  The clinics enrolled 421 people in October and helped an additional 260 start the application process.  Officials in Louisville, a city of 600,000, have set a goal of enrolling about 29,000 people in Medicaid and 27,000 more in private plans by mid-2014.

So far, a total of 5,200 have signed up in Jefferson County, which includes Louisville, far more than in any other county in the state.

Still, the first month’s tally barely starts Kentucky on the path toward enrolling the 640,000 uninsured residents in the state who are eligible for health coverage, a goal that Gov. Steven L. Beshear, a Democrat, has said is urgent because the state has high rates for smoking and obesity, among other health problems.  And if Medicaid sign-ups continue to far outpace enrollments in private exchange plans, with only the sickest people buying private coverage, the cost of premiums could rise.

Though people can sign up on their own, navigators can help those confused by the sea of insurance options.  The navigators listen to people voice their hopes and fears about the law, and their hard stories about being uninsured.  Often hugs are exchanged.  Sometimes tears flow.