Launch of HealthCare.gov has been a rough passage for program ‘navigators’

November 30, 2013

For Patrice McCarron, whose goal is to sign up hundreds of Maine lobstermen for medical insurance, a faulty health-
insurance Web site is more than a mere inconvenience. It’s a major logistical headache.

With uninsured lobstermen scattered along 3,500 miles of coastline, McCarron, executive director of the Maine Lobstermen’s Association, can’t risk driving to a remote community to host an insurance-enrollment fair only to discover that ­HealthCare.gov is down, again.

“Mileage is expensive. Hotels are expensive,” she said. “So we’re really trying to be strategic.”

McCarron’s group is one of about 100 organizations across the country that received government grants to help people sign up for coverage. These groups of “navigators” have been stymied by the same technical problems that have thwarted individual consumers, and many say they have become worn down and discouraged.

Now they are hoping that this weekend will mark a turnaround for the program, which they once promoted with enthusiasm and more recently have had trouble defending.


A look at the consumer's route through the HealthCare.gov Web site and the potential failure points. (ARIANA CHA AND LENA SUN/THE WASHINGTON POST/Government contractors)

Saturday was the Obama administration’s self-imposed deadline for getting the online marketplace working much more smoothly.

In interviews, navigators in different parts of the country said they are feeling both hopeful and anxious about HealthCare.gov, the federal Web site that serves Maine and 35 other states that decided not to set up their own insurance marketplaces. They’re determined to see for themselves whether the Web site is working better before stepping up enrollment efforts again. The last thing they want to do is to steer frustrated individuals back to a balky Web site.

And they know that, even if the site works perfectly, they face a tougher task than they had anticipated when it launched Oct. 1. They have just three weeks to coax people back to the site to buy coverage that begins Jan. 1 — three weeks that, with Christmas approaching, will make lots of competing demands on people’s money and attention.

But their biggest challenge, they say, is to overcome skepticism sown by the marketplace’s rocky rollout.

“There was so much concern and discourse surrounding [the health-care law] to begin with. For this to happen made people withdraw a little more,” said Katrina McGivern, communications coordinator for the Kansas Association for the Medically Underserved. McGivern said that between the Web site’s troubles and the holiday season her group will probably put off its enrollment push until after the start of the new year.

The administration has said that HealthCare.gov should be working smoothly for 80 percent of users by this weekend, and many navigators said they have already noticed an improvement. But problems persist. For example, some navigators have had trouble getting people through a part of the Web site where they have to verify their identities.

Kali Chapelle, a navigator in an economically depressed community near Flint, Mich., said she expects most of the sign-ups over the next few weeks to involve people who are sick and lack insurance and people whose policies are expiring.

“The younger kids and the ones who don’t have to go to the doctor January 1st, they’re not going to be trying during the holiday times when everyone is eating turkey with their families,” she said. She said those younger prospects are more likely to sign up closer to March 31, when the open enrollment period ends.

Some navigators said they were encouraged in recent weeks by the Web site’s performance.

Paige Ashley, a navigator in Topeka, said she was thrilled one day last week when she guided two women all the way through the enrollment process without much difficulty. One woman lost her coverage when her husband left his job after a heart attack; the other became uninsured when she got divorced. Both yelled with joy when they learned that hefty federal subsidies would help them pay their premiums, Ashley said.

“Some of these people have been in my office in tears when they found out they could get affordable insurance — when they find out they can afford insurance and eat,” she said.

Not all of her clients have been so lucky. One man had come in three times to buy coverage, to no avail. Ashley said she thinks his complicated family situation — he is a U.S. citizen but his wife is in the country illegally — is confounding the system. Some Hispanic clients struggle because the government has not finished building the Spanish-language version of HealthCare.gov, she said.

“I have noticed that the ­Spanish-speaking population is wanting insurance and they are kind of lost as to how to find it,” she said.

McCarron, of the Lobstermen’s Association, said the lack of comprehensive health insurance is a major problem among the 5,800 men who make their living fishing for lobster along the Maine coast. Many don’t have any health insurance, or they have basic plans that cover only catastrophic accidents or illnesses and not repetitive stress and other injuries common in the lobster fishery.

The high season for lobster fishing runs from October to December, which means a lot of lobstermen are just starting to deal with the health-care law. But skepticism about the law is deeper than ever, and a number of community leaders are so convinced that the health-care overhaul will fail that they contend that it’s not worth spending time on, McCarron said.

The Rev. Michael O. Minor, a navigator and a pastor in the Mississippi Delta, said he is hearing a lot of naysaying about the health-care law. But Minor said he thinks that the opposition will ease as the site improves and the program finally picks up momentum. He has organized a series of “enrollment blitzes,” with the first one held on Saturday.

“A lot of folks hate the Affordable Care Act, hate Obamacare,” he said. “But they’re going to start seeing their friends and family get it and like it, and it’s going to be a different ballgame.”

Sandhya Somashekhar is the social change reporter for the Washington Post.
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