During the open enrollment period for the state and federal health care exchanges, each staff member worked with an average of 1.8 people per day, according to a survey of navigator programs released by the Kaiser Family Foundation.  This was a massive survey, with more than 4,400 Navigator Programs, employing more than 28,000 full-time staff, paid between $15 and $24 per hour, were questioned.  If you do the math, 28,000 individuals assisting an alleged but not verified 10.6 million people over 210 days breaks down to 1.8 people per day per service representative or “Navigator.”

 

About 40% of the Navigators could not help those who approached them at all, the survey found, and 12% percent said of those who they attempted to help, the demand for help far exceeded their ability to provide it.  90% of clients have already returned with post-enrollment problems.

 

These post-enrollment problems were significant — 54 percent of people didn’t receive their insurance; 37 percent from those who felt they “picked the wrong plan and want[ed] to change;” and 37% of those with providers outside of their network, or outside a 100 miles of their home.

 

Other challenges included unaffordable deductibles, some as high as $18,300 yearly per couple, and other costs (53% fielded this concern); claim denials and other claim issues (21%); no coverage of specific prescriptions (20%); and “other uncovered health services” (15%).  Finally, Navigators had  16% or 1,780,000 of the reported 10.6 Million clients who called whose coverage was terminated. 

In quite the understatement, Kaiser warned in its conclusion, “Such problems, if not addressed, could prompt some consumers to drop coverage.” YA THINK!!!

Some other key findings: 

– 30% of the programmers had no “prior experience helping consumers.” 

– A total of 89%of those calling encountered clients who couldn’t find answers on the marketplace  websites. 

– “Explaining ACA requirements to consumers was most difficult for 25% of the Navigators,”    according to Kaiser. 

– Many states did not give Navigators access to marketplace data to check on        applications status;  in some cases this data does not exist or is not collected;30% of    Navigators “did not know the enrollment outcome for their clients.”  Or put another way, there is  no way to ascertain the effectiveness of a particular Navigator, or even the  effectiveness of their program. 

I just wonder how many private businesses could survive more than a week with these metrics!

John Noland

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