Reform Update: Exchange navigators 'challenged' by glitches, frustrated consumers

After months spent preparing and training to help people sign up for health coverage, federally funded navigators have found themselves contending with a glitch-ridden federal marketplace website while trying to ease consumers' frustrations.

“We've been very challenged,” said Vicki Tucci, lead navigator and an attorney at the Legal Aid Society of Palm Beach County in West Palm Beach, Fla., which received a federal grant of $446,783 to provide navigator services in four counties. “Hundreds of people have contacted us over the past two weeks and we've had to reset appointments—sometimes more than once.”

In August, HHS awarded $67 million in navigator grant funds to 105 organizations in the 36 states where the federal government fully or partly runs the exchanges. These navigator organizations, which include community groups, healthcare providers and faith-based groups, are tasked with providing education and assistance to help people sign up for health plan coverage through the exchanges.

But since the Oct. 1 start of open enrollment, HealthCare.gov, the federal marketplace website, has been plagued by system outages, long waits and error messages. Most people have encountered big problems in creating the personal account necessary to enroll and qualify for federal premium subsidies. Some observers say while people with pre-existing medical issues are likely to persist in signing up, healthier people might be less motivated and may drop out when faced with difficulties in enrolling.

Although exchange clients visiting the Legal Aid Society have expressed frustration at not being able to browse plan choices and enroll, they have shown willingness to return when the process has been smoothed, Tucci said. “We try to answer as many of their questions as possible and provide them with resources so they're ready.”

Until the system is up and running, Tucci and the Legal Aid Society's four other trained navigator staffers are focusing on outreach opportunities, including handing out fliers and brochures and attending speaking engagements.

William Rivera, a navigator at the Puerto Rican Cultural Center in Chicago, is taking a similar approach. The center received a $600,000 federal grant to provide navigator services but has had little luck helping people enroll online through the federal marketplace site. In the meantime, Rivera says he and the other navigators have been canvassing door-to-door and passing out information at local events. As of Wednesday, navigators at the center had helped about 25 people get started on their applications, with plans to complete them later, he said.

“I do believe people will keep trying,” said Rivera, adding that the center recently added weekend hours to accommodate more visitors. “There's a lot of interest out there.”

Although most navigators are relying on the online application system, some are using paper forms to get people signed up. The Tombigbee Healthcare Authority in Demopolis, Ala., for instance, has helped roughly 100 consumers complete paper applications, said Loretta Wilson, project manager for the navigation program. The THA was awarded $392,356 from HHS to provide navigator services in 18 counties in the Alabama Delta.

“Most people in our region are not computer-literate so they prefer the paper applications anyway,” Wilson said.

Some experts, though, have warned that use of paper records could open the door for future errors and inefficiencies because consumer data will have to be entered manually into the marketplace system.

Staff at the Greater Phoenix Urban League saw a light at the end of the tunnel Wednesday when one of their navigators was able for the first time to guide someone all the way through the online application process.

“It was really exciting,” said David Aguirre, the league's head marketplace coordinator. “We have lots of appointments set up for next week so hopefully the system will be ready.”

Small-business owners say they are interested in the health plan choices offered on the Small Business Health Options Program, or SHOP, marketplaces across the country, according to newly released results of a survey of more than 600 businesses conducted by NORC at the University of Chicago and supported by the Commonwealth Fund. Specifically, 56% of respondents expressed interest “in being able to offer a choice of health plans while paying a fixed cost, with the employee paying extra for choosing a more expensive plan,” according to a news release. That option of letting each employee choose from multiple plans is available in 17 state-operated SHOP marketplaces, but will not be available in federally facilitated marketplaces until 2015.

Roughly 5.2 million low-income uninsured adults will remain without coverage because they live in the 25 states that have refused to implement the Affordable Care Act's expansion of the Medicaid program and they earn too little to qualify for subsidies on the federal insurance marketplace, according to a new report from the Kaiser Family Foundation.

Follow Maureen McKinney on Twitter: @MHMMcKinney