The responsibility for training the insurance "navigators" has fallen to two groups: Community Action of Nebraska, a nonprofit that has local offices in all 93 counties, and the Ponca Tribe of Nebraska, which will offer services primarily to American Indians. Both have received one-year federal grants to hire navigators. Nationally, the effort to establish navigator services includes more than 100 nonprofits and other organizations, which specialize in everything from running soup kitchens to organizing farm workers.
Officials with Community Action of Nebraska said they're confident they'll meet the deadline, but caution that early kinks could slow the service during the first days.
"Our biggest concern is there are so many pieces," said Roger Furrer, executive director of Community Action of Nebraska. "The car is being built as it goes down the road. Everyone has to get all of the pieces in line, all at the same time, for this to work really well."
Another concern is the effort to reach groups that typically haven't sought coverage: Low-income residents who don't qualify for Medicaid, and the so-called "young invincible" population of healthy males in their 20s and 30s, who don't believe they need coverage.
Community Action of Nebraska is training 52 navigators, and plans to have 62 in place once the marketplaces open, Furrer said. The agency's goal is to bring some 42,000 uninsured residents into the marketplaces, which allow consumers to comparison shop forhealth insurance and see whether they qualify for federal subsidies. The group has received a $562,000 federal grant.
Furrer said the group also has concerns that people who might benefit from the marketplaces will wait until the last minute. Procrastination could lead to gaps in coverage, even for high-risk customers who are expected to lose state coverage because they will qualify for the federal exchange. The 15th of each month serves as a cutoff: A consumer who enrolls on Jan. 5 will receive coverage starting Feb. 1, but a person who enrolls on Jan. 16 will end up waiting until March 1.
The Nebraska Department of Insurance has deferred to the federal government when it comes to advertising the health insurance marketplace, said Bruce Ramge, the agency's director. Ramge said the department will have a limited role in the marketplaces but will keep a list of registered navigators to protect against fraud.
The navigators-in-training include case managers who already work for the nonprofit agency, in addition to new staff members hired in local offices, Furrer said. They receive 20 hours of training, then must pass an exam and register with the Nebraska Department of Insurance.
Nebraskans who receive coverage through the state's comprehensive, high-risk insurance pool are slated to lose their state coverage on Jan. 1. Furrer said the state has already notified those residents that they'll need to enroll in the marketplaces by Dec. 7 at the latest to maintain continuous coverage. Shifting them into the exchange is expected to provide a net cost savings for the state.
The Ponca Tribe of Nebraska has received a $37,500 federal grant to cover the cost of a single, part-time navigator. The tribe also plans to train between eight and 12 members of its regular staff to serve as navigators. Two have completed the training so far, and the tribe is on schedule and expects to meet the Oct. 1 deadline, said Tina Villalpando, a contract health specialist for the tribe in Norfolk.
Villalpando said the tribe's service area includes more than 14,000 American Indians and Alaska Natives, including about 4,500 who are uninsured. Those residents are scattered in 12 counties in Nebraska, two in Iowa and one in South Dakota. It also extends to other tribes whose members live in the service area.
"Our goal is to reach as many people in this population as possible in the one year that the grant provides funds," she said. "Afterward, our staff will continue to reach out to people who access tribal health and social services."
Villalpando said the tribe could face challenges reaching out to some members, who might have limited access to the Internet or phone service, or who change addresses frequently. But she said the tribe also enjoys a supportive family and community network that could help spread word about the enrollment process.
Lawmakers this year formed a stakeholder commission to give input to the federal government as it creates and oversees Nebraska's exchange. The commission includes consumers, healthcare providers, insurance carriers and agents.
Mike Groene, a citizen member appointed by Heineman, said he preferred that the state take as little action as possible to avoid duplicating the federal government's efforts. Groene also questioned whether the marketplaces would succeed in attracting as many people as intended.
"I don't think our (state) Insurance Department should spend a lot of time worrying about the federal mandates," said Groene, also the president of the Western Nebraska Taxpayers Association. "I'm not criticizing the people here who are involved, because they're good people. But if the federal government wants to do it, let them do it. We shouldn't lose sleep over it."