Welcome to Health Reform Watch, Sarah Kliff’s regular look at how the Affordable Care Act is changing the American health-care system — and being changed by it. You can reach Sarah with questions, comments and suggestions here. Check back every Monday, Wednesday and Friday afternoon for the latest edition, and read previous columns here.
Do you really, really love Obamacare? Have you been searching for an outlet to express that love but live in a state that just doesn't share your passion? Then the Obama administration might just have a job for you!
On Tuesday, the Department of Health and Human Services announced $54 million in grants for Affordable Care Act navigators -- people or organizations that will help explain the health law's new programs.
It's hard to understate how much is riding on this one program, the federal government's main effort to tell millions of uninsured Americans about the new programs in the health care law.
When the Congressional Budget Office projected how many Americans would gain coverage under the health care law, it assumed that 30 million people will remain uninsured in 2022. About a third of those would be undocumented workers, who aren't eligible for the health law's programs. Others would qualify for religious exemptions from the individual mandate; and others will live in states that choose not to expand Medicaid.
That still leaves millions of Americans who are eligible for the new programs but simply do not sign up.
If these navigators succeed in their outreach, the Affordable Care Act might end up reaching many more people than the CBO estimated — the people who the budget forecasters assumed would not enroll in benefits. On the flip side, a lackluster performance by these navigators could mean Obamacare doesn't hit its coverage targets.
One issue to clarify upfront: These will not be insurance brokers. Navigators are specifically barred from enrolling people into insurance plans. Instead, they have a more educational role of providing "information and services in a fair, accurate and impartial manner," according to the grant announcement.
Navigators will have to "maintain expertise in eligibility, enrollment, and program specifications and conduct public education activities to raise awareness about the Exchange" and "provide information in a manner that is culturally and linguistically appropriate to the needs of the population being served by the Exchange." They will also need to complete 30 hours of training run by Health and Human Services, to prepare for all these responsibilities.
These navigators should expect lots of questions. Most Americans have no idea of the new options in the health care law. When Enroll America did a survey last fall, it found that 78 percent of those likely to qualify for programs didn't know it. A more recent study found 90 percent of Americans don't know when they could start shopping on the health exchanges (answer: Oct. 1, 2013).
Competition for the jobs could be stiff. The $54 million gets distributed across states depending on the size of their uninsured populations. Most health policy experts say this is a pretty small amount of funding, given the size of the task of reaching 48.6 million uninsured Americans.
When you consider the funding in that light, we're talking about only a few dollars for each American eligible for the new programs (the 48.6 million number includes undocumented workers, who would not be eligible for the programs). Stan Dorn at the Urban Institute has described the navigator grants as "a drop in the bucket" when it comes to educating millions of Americans.
The navigator grants recognize that some states will have greater needs than others. Smaller states, like Delaware and South Dakota, have $600,000 in funds available. Texas has the biggest funding pool ($8.15 million), to reach 6.1 million uninsured residents. Florida has $5.8 million on the table.
The health care law requires that there be two navigators in each state, with one of those being a nonprofit.
While the job is a big one, the pay may not be. Initial reports have suggested that the federal government would offer navigators an estimated $20 to $48 an hour.
Those reports prompted Rep. Kenny Marchant, a Republican from Texas, to send a letter to Health and Human Services Secretary Kathleen Sebelius, noting that "these seem to be inflated hourly wages compared to corresponding positions in the private sector" and asking why the government has any business setting salaries for these workers.
The short answer is: They don't. Medicare spokesman Brian Cook explains that these are estimates that the agency comes up with to get a rough sense of a program's cost. They are not federal mandates.
"There is nothing in the proposed regulations released today that would require any of these workers to be paid $20 an hour, $48 an hour, or any other amount of money," Cook says. "These are estimates, not a recommendation or a requirement. Nothing in the law or proposed regulation set payment levels for these employees."
KLIFF NOTES: Top health policy reads from around the Web.
The White House wants to delay the Affordable Care Act's DSH cuts. I have more on that in this Wonkblog post.
Consumer groups worry about Obamacare's out-of-pocket costs. "Consumer groups are warning that insurers and employers may be able to keep offering health plans next year that include out-of-pocket caps for individuals of $12,500 or more -- double the amount allowed under the federal health law." Julie Appleby in Kaiser Health News.
Legislators are mocking ICD-10 (and its codes for assaults by turkeys). "Rep. Ted Poe (R-Texas) on Wednesday mocked a medical coding system that will soon require doctors to use a giant codebook that includes more than 140,000 kinds of injuries and illnesses, including nine separate ways to be injured by a turkey and three ways to be injured by a lamppost." Pete Kasperowicz in The Hill.
There are all sorts of explanations for why health costs vary (and a cool map to go with them). "Connecticut and Maine also have significant spending, and Maine's expenditures were some of the fastest-growing in the past two decades. Experts generally attribute the region's higher spending to its higher cost of living, greater proportion of elderly residents and number of high-profile hospitals. Expansive, sparsely populated states such as Alaska and North Dakota also have high spending. Their representatives often attribute this to care delivery being more expensive under their conditions." Louise Radnofsky in the Wall Street Journal.