Open Enrollment Begins on Nov. 15

David R. Jones, The Urban Agenda

In a few short weeks, New Yorkers who are currently uninsured or set to renew their Marketplace health coverage will be able to do so when “Open Enrollment” begins under the Affordable Care Act (ACA), or as it has come to be known, “Obamacare.”  

The ACA was passed four years ago amid political discord in Washington and threats from critics who avowed to dismantle the law before its components had a chance to go into effect. Today, there is no disputing the ACA’s impact on expanding and improving access to affordable health insurance for 30 million uninsured nationwide through the expansion of Medicaid and the offer of commercial coverage through the new health insurance Marketplaces. 

Making the Nation’s Finest Health Insurance Marketplace Better

New York has implemented what is arguably the finest health insurance shopping website, or Marketplace, in the country.  Uniquely, it offers instant eligibility determinations for both public insurance (Medicaid and Child Health Plus) and financial assistance for commercial Qualified Health Plans to New Yorkers who earn less than 400 percent of the federal poverty level (or around $95,000 annual income for a family of four).  In addition, the State has wisely invested in a robust system of community based enrollers, known as “Navigators.” The mere establishment of a central Marketplace with financial assistance and the potential of a tax penalty for those who remain uninsured resulted in staggering premium rate cuts.  And New Yorkers purchasing coverage on their own now pay premiums that average 53 percent lower than those paid before the ACA was in effect.

As a result of these measures and more, an eye-popping 1.5 million New Yorkers (including 165,000 African-Americans) have enrolled in health insurance through the New York State of Health Marketplace by the end of September 2014.  These numbers tripled all prior reputable enrollment estimates.  Almost 90 percent were not insured when they applied.  

A major driver of New York’s successful Marketplace launch was the State’s decision to invest in community-based “Navigator” groups.  Many Navigators have years of experience helping communities with public health insurance applications as facilitated enrollers, in addition to  bringing an understanding of the unique needs of low- and moderate-income communities.  In short, they established the “word on the street” that shopping for health insurance didn’t have to be hard.

As a sponsor of New York’s largest “Navigator” network, the Community Service Society helps consumers enroll in health insurance through a system of 33 community-based organizations in 61 out of 62 counties statewide and all five boroughs. Our Navigators are repeatedly told by the clients we assist that they value the “high touch” assistance through the system.  For many of the communities we serve, completing even relatively simple eligibility questions and selecting among different health plans offering different rates, networks of doctors and co-pays can be intimidating.  The State has trained Navigators to provide neutral assistance so that consumers both successfully secure the financial aid and select a health plan that meets their needs.  Navigators are grant funded. They do not work for insurance companies—nor do they receive any commissions for completing a set number of enrollments. 

 While Navigators are important local resources for people who need enrollment assistance, they are not funded to address the post-enrollment needs of consumers.  In fact, in a recent Kaiser Family Foundation survey of more than 800 Navigator assistance programs across the nation, 90 percent reported that enrollees returned for additional, post enrollment, insurance assistance—assistance that they were not funded to provide. The reality is that some consumers need post-enrollment assistance navigating their new plans, resolving billing disputes, and filing appeals for service denials.

City Council Hearing on ACA

Today, the New York City Council Health Committee is scheduled to hear testimony from advocates and members of the public on how to boost access to health care under the ACA.  New York still faces challenges implementing the ACA:  the uninsured rate among black and Latino populations continues to be disproportionately high; and some consumers need extra help after they enroll in their new coverage. 

One way New York City can help achieve this is by restoring funding for post-enrollment community-based consumer assistance programs. CSS’s Community Health Advocates (CHA) program has served as the state’s consumer assistance program since 2010. Through a live answer toll free helpline or at one of its partner community based organizations (CBOs), CHA provides unique education and health coverage assistance services that can build on the services provided by Navigator groups.

New York City had its own City-wide consumer assistance program for over 10 years until it had to be dismantled when City Council funding was abruptly eliminated in 2010.  Fortunately, the State stepped in and secured federal funding for a statewide consumer assistance program, which means New York City’s share of resources is reduced.  The federal/state funding is slated to end in June 2015. 

With the start of the Open Enrollment period on November 15, the number of insured New Yorkers is expected to grow even more. As a result, the need for local post-enrollment services and support will be more critical than ever.  By restoring City funding for community based health insurance assistance, the City Council can ensure that consumers who receive services from Navigators have somewhere to go for help with their post-enrollment needs.

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