Enter the “navigators,” an enormous new workforce of helpers required under the law. In large measure, the success of the law and its overriding aim of making sure that virtually all Americans have health insurance depends on these people. But the challenge of hiring and paying for a new class of workers is immense and is one of the most pressing issues as the Obama administration and state governments implement the law.
Tens of thousands of workers will be needed — California alone plans to certify 21,000 helpers — with the tab likely to run in the hundreds of millions of dollars.
“I would say the task we face is herculean,” said Denise de Percin, executive director of the Colorado Consumer Health Initiative, an advocacy group that has studied what it will take to staff her state’s navigator program.
Over the short term, some workers may be funded by federal grants, state budgets or private money. But over the longer term, most of the costs are to be covered by the new health-care marketplaces, called “exchanges,” being set up in every state. The money will come from fees that insurers will pay to sell their plans on the exchanges.
Groups such as unions, chambers of commerce, health clinics, immigrant-service organizations, and community- or consumer-focused nonprofits can use the grants to train and employ staff members or volunteers to provide in-person guidance — especially to hard-to-reach populations — and to provide space for them to work.
Added to the logistical challenge is a political one: Insurance brokers in many states are lobbying to prohibit the navigators from giving advice on which plans to choose and to make them liable for their guidance if it results in financial harm.
The brokers, who earn commissions and fees by enrolling people in plans and who might lose business to the navigators, contend that the navigators won’t have sufficient expertise.
“What you don’t want is for our agents to be cut out and to have this force of untrained, unlicensed individuals giving advice with no financial responsibility,” said Ryan Young, head of government relations for the Independent Insurance Agents and Brokers of America, an industry trade group. “Consumers are going to get hammered.”
Under the law, the exchanges must fund enough navigators to ensure that every applicant who needs assistance can get it.
“You have to ask, how many people can one navigator help in one day?” de Percin said. “Well, the people who do this kind of work might spend an hour to three hours with folks. So the answer is not many.”
Colorado Insurance Commissioner Jim Reisberg stunned a recent gathering of state officials when he said that, to be viable, the state’s exchange will need to sign up 150,000 people, or about 800 people a day, seven days a week, over the six months of the open enrollment period, which will run from Oct. 1 through March.