Sunday, September 21, 2014

Plight of the Navigators

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Certified guides, eager to help Arizona's uninsured find health coverage under Obamacare, get angry earfuls about a screwy system.

At Flagstaff's North County Health Center, a tearful elderly woman waves a piece of paper: "Is this true? Is this true?" It's a letter to senior citizens, suggesting they check out new options under the Affordable Care Act (ACA), aka Obamacare. "Yes," answers health benefits advocate Briana Sherinian. "We can help you with that."

"So you're helping Obama exterminate the elderly!"

If the woman hadn't been so genuinely terrified, Sherinian might have burst out laughing. "Why would you think that?"

"Well, everyone, the elderly community, we're all news watchers. We watch Fox News."

Sherinian told the woman to go online and see for herself. Unfortunately, October's fumbled launch of healthcare.gov doesn't make it easy for insurance-shoppers, and it makes things harder for Sherinian. Her job is to provide free guidance about the ACA. Often called a "navigator," she's technically a certified application counselor (CAC). "It's been very frustrating so far because the website is operating horribly," Sherinian says.

About 50 million Americans, including more than 1 million Arizonans, lack health insurance. By mid-November, only 106,000 Americans, and 739 Arizonans, had signed up for insurance, according to the U.S. Department of Health & Human Services (HHS). Thanks to technical glitches and fears about sweeping social reform, navigators and assisters like Sherinian might as well be tasked with herding cats, while dodging everything from accusations of bloated salaries to concerns about criminal backgrounds.

Four Arizona groups – Arizona Alliance for Community Health Centers, Greater Phoenix Urban League, the University of Arizona Center for Rural Health, and Campesinos Sin Fronteras – received $2.1 million from HHS to fund about 160 navigators statewide. Navigators undergo 20 hours of training on health insurance, privacy issues and other topics. Nationwide, HHS paid $67 million in grants to fund about 18,000 navigators.

Forbidden to plug a particular option, navigators can help potential customers find out if they're eligible for about 100 policies offered in Arizona by eight insurers. At the Greater Phoenix Urban League, navigator David Aguirre says he signed up about a dozen people during ACA's first week. The first "was so excited... about being able to get insurance again and be able to get his medications," he says. "That's very rewarding for us."

But some people take aim at navigators. The Internet rumor that navigators earn $50 an hour gets a laugh from Tara Plese, director of Arizona Alliance for Community Health Centers. Many are volunteers, she says, and most earn $15 an hour.

Arizona Representative Paul Boyer (R) drafted a bill to require navigators to undergo criminal background checks to safeguard against enrolled citizens having their information stolen. He's unswayed by the fact navigators sign confidentiality agreements. "It's more a matter of trust, but verify," says Boyer, who wants his bill to be first on the docket in January.

HHS Secretary Kathleen Sebelius admits it's "possible" for a felon to get a navigator job, adding it's up to states to regulate them. Dr. Howard Eng of the University of Arizona's Center for Rural Health in Tucson says all navigators in his program passed background checks. Aguirre and Plese say all their navigators did the same. Plese says a greater danger is scam websites and people offering signups for a fee. She adds navigators face a $25,000 fine for confidentiality breaches.

Eng says most people appreciate that navigators provide "credible, unbiased information," and says his group is looking into training on how to handle confrontational customers. Sometimes navigators serve as sounding boards for angry citizens. At a health fair in Williams, Sherinian says, "A lady yelled at me... 'They're going to kill the old people and make them pay for your healthcare.' [I said] 'Well, actually, they are going to really be helping subsidize the huge amount of care and prescription costs that older people tend to need.' She mumbled something about Obama and walked away, still pointing and screaming. I wish people would look at the big picture instead of focusing on Obama."

Enrolling in Obamacare
Online: healthcare.gov
By phone: 800-318-2596
In person: Find navigators by county and city at healthcare.gov
*If you're eligible for Medicaid (AHCCCS), applications can be completed athealthearizonaplus.gov, or by calling 855-432-7587.

 

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