Enrollment assisters an essential piece of ACA’s success, survey shows


Navigator Leon McIntosh helps New Yorker Anna enroll

We all know finding the right health insurance plan can be complicated and overwhelming – even with the launch of the insurance marketplaces offering one-stop shopping under the ACA. One of the most exciting features of the ACA is the establishment of assister programs to help people enroll (e.g. Navigators and Certified Application Counselors). A new survey from Kaiser Family Foundation shows just how effective these groups were during the first open enrollment period.

According to the survey, administered to directors of assister programs around the country:

28,000 assisters helped 10.6 million people apply for coverage and financial assistance.

States with State-based Marketplaces, like New York, had a much higher ratio of assisters to uninsured and helped two times as many people relative to the uninsured population when compared to states with a Federally-facilitated Marketplace. Our own NY State of Health‘s recent enrollment report shows that 643 Navigators and nearly 4,000 Certified Application Counselors helped over 413,000 New Yorkers enroll in coverage. That’s nearly half of enrollees.

Most consumers who sought help applying for coverage were uninsured and had limited health insurance literacy.

The vast majority of programs reported that consumers seeking help had a limited understanding of the ACA and struggled with basic health insurance terms, like “deductible.” As a result, assistance took time – between one to two hours in most cases.

Nearly all assister programs have been “re-contacted” by consumers with post-enrollment problems, including questions about how coverage works.

Questions from consumers don’t stop at enrollment. However, assister programs are not trained on post-enrollment issues, and in many cases don’t have funding that allows them to provide this type of assistance. Instead, the ACA established Consumer Assistance Programs (CAPs) to provide these services, but these programs haven’t received federal funding since 2012. Luckily, New York legislators recently approved $2.5 million in the 2014-2015 budget for the State’s CAP, Community Health Advocates (CHA). Thanks to the funding, CHA will be able to provide more robust hotline and in-person services through community-based organizations in the coming months.

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We already knew that nearly a million New Yorkers had enrolled through NY State of Health during the first open enrollment period from October 1 to March 31. But now we know more than ever about who they were, where they live, and how they enrolled. That’s thanks to the new enrollment report released yesterday by NY State of Health, the official health plan marketplace, which includes eagerly awaited demographics data such as age, race and ethnicity of enrollees.

HCFANY issued a press release, highlighting key findings from the data, such as the importance of in-person assistors in helping New Yorkers obtain health insurance. Nearly 50% of insurance applications were completed with help of in-person assistors, including Navigators, Certified Application Counselors, and brokers. In-person assistance was particularly critical for low-income New Yorkers: more than half (59%) of the Medicaid enrollees used in-person assistance to complete their application.

For the first time, the report offers a glimpse into the race and ethnicity, as well as preferred language, of New York enrollees. Though the data is incomplete – about one in four enrollees chose not to respond to the application on race – it nonetheless will help direct future outreach and enrollment efforts across the state. About 37% of enrollees who answered the question reported their race as Black/African American, Asian/Pacific Islander, or “other” non-white race. About 20% of Medicaid enrollees chose a language other than English, but no enrollees reported their preferred language as Korean, Russian, or French Creole, pointing to potential gaps in these communities. As useful as this data is, it only provides a statewide picture – there is still a need for race, ethnicity and preferred language by county in order to target outreach to the communities that need it most.

Financial assistance was key to the high enrollment numbers in Qualified Health Plans (private health insurance). Nearly 3/4 of enrollees got private health plans with financial assistance in the form of Advanced Premium Tax Credits (APTC) or a combination of both APTC and cost-sharing reductions. An average New Yorker who was eligible for financial assistance saved $215 per month in premium.

And, while some enrollees (about 13%) clearly benefited from the Medicaid expansion that made them newly eligible for public insurance, a whopping 93% of Medicaid enrollees were newly insured overall. That means many of those who enrolled in Medicaid were previously eligible but, for whatever reason, had been unable to enroll. New York clearly did something right in building it’s health insurance marketplace – the single, streamlined web application our State officials built is working. And, boy, did New Yorkers come.



Kevin Dwyer, client of Community Health Advocates

A couple of weeks ago, we posted about enrollment hitting half a million New Yorkers on NY State of Health. We’re now at over 700,000 New Yorkers according to this week’s press release, 70% of whom were previously uninsured. Nearly one quarter of enrollees are signing up for insurance with the help of an in-person assistor – either a Navigator, a certified application counselor, or a broker – according to the most recent data on how people enroll. This number is likely to grow as more people find out about these services.

In-person assistors, located across the state, are doing phenomenal work helping people to enroll in health insurance plans, but their services are limited to enrollment: What happens after a person enrolls in a plan? The health care system is notoriously difficult to navigate, and consumers will continue to have questions about how to use their new insurance. This will be especially true for the nearly 500,000 New Yorkers who were uninsured before signing up on NY State of Health. Where can these consumers turn when they have a question or run into a problem with their insurance?

Thankfully, New York already has a designated program for this kind of consumer assistance. The program is called Community Health Advocates (CHA), and it’s there to help consumers use their insurance, once they have it. CHA provides services through a toll-free helpline (888-614-5400) and a network of community-based organizations and small-business organizations throughout the state of New York. The CHA helpline number is listed on every Explanation of Benefits from every insurance company in the state. And, since it became the state’s designated consumer assistance program in 2010, CHA advocates have tackled over 162,000 cases like this one and saved consumers over $12 million in health care costs.

CHA services can make a life or death difference in people’s lives. They likely did for Kevin Dwyer (pictured above). When Kevin’s insurance plan denied his request for a new, promising drug for his cystic fibrosis, because it had not been FDA-approved for his particular genetic mutation, he contacted CHA. His case was particularly surprising – and frustrating – because his sister, who has the same disease, genetic mutation, physician, and health plan – had gotten approval using the same approval. With the help of CHA advocates, Kevin was able to get the treatment he desperately needed. In his words, “With CHA, you’ve got somebody.”

HCFANY is actively advocating for sustainable funding for these important services. They are desperately needed, particularly now with so many newly insured New Yorkers. This year’s Executive Budget from Governor Cuomo and the Assembly’s budget proposal both include funding for Community Health Advocates – authorizing a pass-through of $2.5 million of federal funds to go to the program. However, the Senate bill has not yet agreed to authorize the funding, which is surprising given the positive impacts of the program and the fact that there are no state funds involved. HCFANY members and other organizations continue to work to ensure that this vital resource is supported in the final budget, which is set to be enacted by April 1.

speakout pic Mark H speakout pic Heidi

HCFANY steering committee members Mark Hannay of Metro New York Health Care for All Campaign and Heidi Sigfried of New Yorkers for Accessible Health Coverage “speak-out” to stop surprise medical bills by sharing consumer stories

Yesterday, HCFANY members joined advocates from Medicaid Matters New York and New Yorkers for Accessible Health Coverage to make a final push for the Basic Health Program, consumer protections from out-of-network surprise medical bills, and much needed consumer assistance program funding. New York’s budget process is set to wrap up in sometime in the coming week, with the goal of a final budget by April 1.

Advocates met with several legislators and staff, emphasizing the importance of creating the Basic Health Program and supporting health consumer assistance, in addition to other issues.

Basic Health Program

The Basic Health Program would have clear benefits for consumers, offering more affordable health insurance to New Yorkers who earn too much to qualify for Medicaid but not enough to afford in insurance through NY State of Health, even with subsidies. Initial reports from the Urban Institute and Community Service Society also projected State savings if the program were implemented, which makes sense given that the program would be largely funded with federal dollars.

Even so, the program was not included in the Senate’s budget proposal and negotiations continue. An updated Urban Institute analysis of the program’s projected fiscal impact is due to be released any day now, but the legislature could pass the bill without this report – the bill includes language that says the State doesn’t have to create the program if it turns out the cost would be too high. Advocates continue to educate legislators about the importance of this program for the health of our residents, as well as the State’s financial health. You can learn more about how to take action for a Basic Health Program on our website.

Consumer Assistance Funding

Also missing from the Senate’s budget proposal is a pass-through of funding for Community Health Advocates (CHA), the state’s consumer assistance program. The proposed funding for the program, which helps New Yorkers use their health insurance once they have it, is entirely from federal sources. Given the past successes of the program – CHA has saved over $12 million for New Yorkers over the past four years – and the fact that no state money would be involved, it is unclear why the program was removed from the budget.

Out-of-Network Protections

The day also involved several activities related to surprise medical bill protections that are currently in the Governor’s, Assembly’s and Senate’s budget proposals, but are yet to be fully resolved. You can read more about the current state of out-of-network negotiations here.

In the morning, partners held a press conference featuring various advocates from HCFANY, New Yorkers for Accessible Health Coverage, American Cancer Society Cancer Action Network, Consumers Union, AARP, and New York Public Interest Research Group. Superintendent Benjamin Lawsky shared his perspective on the importance of protecting consumers from surprise medical bills, an issue he and his staff have championed for several years (See Sup. Lawsky’s report, “An Unwelcome Surprise,” for more).

Consumer Claudia Knafo shared her personal story of surprise medical bills – nearly $100,000 worth – that she received in 2012 after spinal surgery from a doctor she had every reason to believe was in-network. Claudia did extensive research before booking the surgery, and she still got stuck with the bill – it turned out the surgeon, despite his website listings and numerous assurances from staff and her insurance plan, had not been a part of the plan since 1997.

Later in the afternoon, Claudia joined other advocates to hold a “consumer speak-out” to stop surprise medical bills in front of the Assembly Chamber, followed by the Senate Chamber. Participants read dozens of stories from consumers across the state who have faced surprise medical bills for out-of-network services they didn’t know they were receiving. From emergency surgeries to deliveries, these consumer stories represent just a small fraction of New Yorkers who desperately need stronger consumer protections in this area.

Learn how to take action to stop surprise medical bills here.