The wide variation in spending to hire and train navigators and others to assist consumers in the first year of the new marketplaces could have a major impact on how many people actually get coverage under the new health law, experts say.
Yet states with some of the nation’s highest uninsured rates, such as Florida and Texas, are getting far less federal money per uninsured resident than states with low rates, such as Maryland, Vermont and Rhode Island, according to a Kaiser Health News analysis.
That’s because states relying on the federal government to run their marketplaces are getting far less money than states setting them up themselves as a result of how the health law was written. In addition, some states such as Maryland that are running their own operations are supplementing the federal dollars with their own funds.
“The spending difference could have a huge impact,” said Jon Kingsdale, a consultant who helped launch the Massachusetts health insurance exchange in 2006.
Consumer assistance is considered key to enrolling the uninsured for several reasons. Polls show most people are unfamiliar with the law’s benefits, including new government subsidies that take effect next year. For example, those subsidies will apply to a family of four with an income as high as $94,000.
The online marketplaces, which open for enrollment Oct. 1, were envisioned to be as easy to use as travel Web sites such as Expedia, but experts say that many people will need help figuring out which plan is best for them and what information they might need to sign up for coverage.
Some have never applied for health insurance coverage and may need assistance even to navigate the Web site, said Sonya Schwartz, program director of the National Academy for State Health Policy, and project director of State Refor(u)m, a discussion forum about implementation.
The marketplaces, also known as exchanges, are the key way the law expands health coverage to about 27 million people by 2016. That’s where people will shop for and enroll in private coverage and determine whether they are eligible for premium discounts, or for Medicaid, the state-federal health insurance program for the poor. Although many customers will not yet have insurance, others with coverage will use the exchanges to take advantage of government subsidies.
“It’s a shame that we see states with lower rates of uninsured putting more money into education and outreach than states with higher rates of uninsured,” said Deborah Bachrach, a former New York state Medicaid director who is special counsel at the law firm Manatt Phelps & Phillips.
To be sure, consumer assistance is only one way that potential enrollees can learn about new insurance options and how to sign up for them. Additional federal dollars will go to advertising on radio, television and billboards. And insurers, hospitals and nonprofit groups may supplement public education efforts in many states.