Sunday, December 8, 2013
From lobster wharves and supermarkets to town libraries and public health centers, the topic of health insurance will be inescapable starting Oct. 1.
A team of more than 125 so-called navigators -- essentially, insurance translators -- will blanket the state to help Mainers understand the insurance marketplace being created by the Affordable Care Act.
"We'll go down to the docks. We'll call community meetings. We'll go to the libraries and shopping centers. We'll make ourselves known," said Brian Delaney, spokesman for the Fishing Partnership Health Plan, based in Massachusetts, which is working with the Maine Lobstermen's Association to help explain the new insurance laws to fishermen. "The insurance changes are going to happen. It is imperative to get everyone signed up. It's our job to find everyone, reach out and explain what's changing and how it will affect everyone."
The health insurance exchange, now known as the insurance marketplace, was mandated under the Affordable Care Act, or Obamacare. The marketplaces will be the place for individuals to buy health insurance. Subscribers can sign up from Oct. 1 to March 31 by mail, online or in person with the help of a navigator.
Beginning Jan. 1, Obamacare will require almost all Americans to have health insurance or face tax penalties.
In Maine, the marketplace will feature insurance products from Anthem Blue Cross and Blue Shield and Maine Community Health Options.
Choices will include plans ranging from bronze -- the cheapest, providing coverage for about 60 percent of health care costs -- to platinum, the most expensive plan, covering roughly 90 percent of eligible expenses. Gold and silver plans, which offer different levels of coverage, will also be available.
The Maine Bureau of Insurance expects 5 percent to 8 percent of state residents, or 65,000 to 104,000 people, to purchase insurance on the exchange. The federal government aims to sign up 7 million people in the U.S. in the first year.
That number is expected to grow to 24 million in 2016, according to the Congressional Budget Office.
The likely buyers of insurance through the marketplace will include those who don't get insurance through an employer or a government program, as well as self-employed workers and the unemployed.
Although the insurance marketplaces will begin enrolling subscribers in just a few weeks, a Kaiser Family Foundation poll released in August found that nationally only one-third of Americans say they've heard about the new exchanges in their state.
The navigators will be the on-the-ground networkers who will help people learn about and enroll in the marketplace
Two groups won federal funds totaling $542,000 to help Mainers navigate the insurance options. The grants were part of $67 million awarded 105 agencies throughout the country from the U.S. Department of Health and Human Services.
One agency, Western Maine Community Action, received $475,000 to set up eight informational offices throughout the state. The group has 59 staffers statewide who are being trained and it hopes to have a network of 48 trained volunteers, as well. The group will have eight centers -- in Sanford, Portland, Bath, Belfast, Waterville, Wilton, Ellsworth and Presque Isle. The other group, the fishing partnership, received $66,846 to reach out to lobstermen.
The federal government also awarded $1.4 million to 19 Maine health centers to help them sign up residents for insurance under Obamacare. The funds will allow the centers to hire 25 workers to help people jump through the hoops of finding insurance care.
The grants were awarded in August, giving groups in Maine and nationally little time to train teams of navigators and map out strategies to reach people. The groups must make arrangements to reach people with disabilities -- such as going to people's homes, if needed -- and to work with translation services for non-English speakers.
Other states also are rushing to train navigators and find ways to reach the uninsured.
In Mississippi, navigators plan to go into rural areas without Internet access to help people with the enrollment and insurance policy selection process, which is done online. In Arizona, navigators at Campesinos Sin Fronteras, or Farmworkers Without Borders, plan to be up at 3 a.m. to meet farm workers on the buses to the fields or on their lunch breaks. In the District of Columbia, a call center will be open 24 hours a day, seven days a week to answer questions because some people who may be eligible for subsidies may work several jobs and need to seek help at nontraditional hours.
The navigators must talk to people about the often uncomfortable topics of health and money. They have to hear real stories about people's income, health needs and determine if they qualify for subsidies and which level of insurance they may want to buy. For some people, not buying insurance and paying a penalty may be a better option financially.
Navigators receive no compensation from the insurance companies. They are paid with federal funds funneled through the community organization that employs them. They cannot promote one insurer over another. Instead, they are intended to be impartial guides who will help people find the insurance plan that best fits their needs and demographics.
Navigators, who will begin fielding questions Oct. 1, when enrollment in the insurance marketplaces starts, go through 20 hours of training and take more than two dozen exams from the Centers for Medicare and Medicaid Services. The courses include learning the basics of the Affordable Care Act and the exchanges, cultural competence and language assistance, serving vulnerable and underserved populations, working with consumers with disabilities, community outreach, privacy and security standards, and customer service standards.
"Training gets down to the nitty-gritty of scenarios to find out what plan is best for them and their family," said Jake Grindle, health marketplace navigator and program specialist for Western Maine Community Action. "The exams require you to apply the knowledge you gain to real-world scenarios."
The navigators said they can't estimate how many people will seek help buying insurance on the exchange.
Finding the uninsured may be challenging. The state Bureau of Insurance doesn't track the uninsured by county.
"We'll be doing outreach events -- anything we can do to bring people together. We'll be talking to everyone who qualifies for various types of assistance, from Head Start to fuel assistance to free or reduced lunch programs. These programs may help identify people who lack insurance and qualify for subsidies," said Martin Sabol, director of Nasson Health Care, a program of the York County Community Action Corp. "From supermarkets to hair salons, we'll be there. It's the magic of outreach -- it's who we are and what we do. We're ready to roll it out to the people."
People who earn less than four times the poverty level, or up to about $46,000, can receive sliding-scale subsidized coverage through the online marketplace. Other individuals making more can still buy insurance on the exchange, but won't receive subsidies.
Not everyone is going to buy insurance. Some may choose to pay the penalty. The annual penalty for a single adult would be $95 in 2014, rising to $625 by 2016.
"Lobstermen, typically, (are) a group of people who don't have experience with insurance. The penalty may be the choice for a lot of people," said Patrice McCarron, executive director of the Maine Lobstermen's Association, which aims to reach out to 6,000 lobstermen throughout the coast with the insurance information.
"We're probably not going to be the most popular people, but it's the right thing to do. The lobstermen are the gatekeepers of the coastal community. By reaching them, we can spread the word through many towns," McCarron said.
Roughly a quarter of lobstermen in the southern part of the state and more than half of them in the northern part of the state lack insurance, the Maine Lobstermen's Association said, citing a study from the Gulf of Maine Research Institute. That exceeds the state average of about 14 percent of adults ages 19 to 64 who lack health insurance, according to the U.S. Census Bureau. Nationally, about 50 million people, or about 15 percent of the population, lack insurance.
While the fishing partnership said some outreach efforts will begin Oct. 1, the bulk of the communication with the lobstermen will occur after the holidays, in the off-season lull when fishermen have more time to meet and talk about insurance.
While states operating their own marketplaces have developed multipronged public education campaigns to help people understand their options and obligations, Maine and 33 other states have opted to have the federal government run their marketplaces and don't have the same level of resources to pay for a broad, coordinated approach for a public education and marketing campaign.
As a result, the Maine Health Access Foundation hired Burgess Advertising & Marketing of Portland to develop a campaign that includes television and radio ads and uses social media, such as Facebook and Twitter, and even grassroots efforts across the state. The firm is putting together the campaign now with a goal for it to go live Oct. 1.
The ads must target a wide range of Mainers, from the uninsured to the underinsured to the "invincibles" -- the 20-something adults who think they don't need health insurance -- to the 50-year-olds who don't yet qualify for Medicare, said Meredith Burgess Strang, president and chief executive of Burgess Advertising.
The ads will direct Mainers to a new website -- http://www.enroll207.com -- at the end of September that provides state-specific information about health plan options and offers a ZIP code locator that will help people find navigators and "certified assisters" in their communities. The site also will provide a link to http://www.Healthcare.gov, the federal Health Insurance Marketplace website, to purchase coverage.
Although navigators will try to reach out and find people themselves, Mainers can also call 2-1-1 to find their closest navigator.
"The advantage of navigators is that we can meet face to face in the community. Our strength is you'll meet someone in their town and you know and understand their life and needs," Grindle said. "We want to be nimble. Because we're based in the local communities, we're going to be where the people are. We're trying to focus on people."
Jessica Hall can be contacted at 791-6316 or at: