By Kim Hilsenbeck
The new marketplace exchanges, part of the Affordable Care Act (ACA), opened yesterday amid lingering confusion and misinformation. A recent study by the Henry J. Kaiser Family Foundation showed that 51 percent of Americans felt they don’t understand the new healthcare law well enough to determine its effect on them and their families – three years after it was signed into law.
Those who want to sign up for a healthcare plan, compare prices or just see if they qualify for tax breaks to help pay for insurance could go it alone on the website, www.healthcare.gov.
Or, they can get help from someone designated to help consumers sort their way through the marketplace exchange.
Texas, like 26 other states, opted to let the federal government operate the Health Insurance Marketplace, as the exchange is formally known. For those still unsure what the marketplace exchange is, think Orbitz or Travelocity, but designed to help consumers shop for and compare health insurance plans, not airfare and hotel prices.
To assist the insurance buying public, including small business owners, with what it all means and how to sign up for a qualifying health plan (QHP), the ACA put in place a system of grassroots-based communication and outreach not unlike what already exists for Medicare and Medicaid programs.
Navigators, non-navigators and certified application counselors (CACs), all paid for with federal and state tax money, will be available to help consumers sort through the healthcare marketplace exchanges to determine their best course of action and apply for a health plan.
Each type of assistance is slightly different, with specific roles and rules they must follow. Hays County has CACs, not navigators, as its consumer outreach experts.
Several types of organizations are eligible to become CACs: community health centers, other health care provider, hospitals and non-federal governmental or non-profit social service agencies.
In Hays County, the only approved CAC is Joe Flores at CommuniCare Health Centers, a full-service primary healthcare system serving Bexar and Hays counties. The organization has clinics in Kyle and San Marcos, as well as San Antonio. The organization is working to train another CAC in Hays County, according to Quiara Sherrard, CommuniCare’s chief revenue officer and company spokesperson.
Overall, CommuniCare received $370,047 in federal funds and hired six new CAC positions. Sherrard said the grant money pays for salaries, furniture, equipment, training and more. The money is for the first year of the program. Sherrard said the taxpayer-funded grant money will be available in subsequent years for CACs, depending on the success of this year’s rollout.
Under the new law, CACs, navigators and non-navigators are not allowed to charge a fee for services. They must also undergo at least 20 hours of training with particular emphasis on consumer privacy and confidentiality of personal data.
CommuniCare is one of 105 entities across the country that received part of the $67 million in grants for Navigator Cooperative Agreements under the new healthcare law. Eight Texas organizations received a combined $10.8 million out of that total to hire and train “experts” to help uninsured Texans find health coverage.
CACs, unlike naviagtors, can give advice about the available insurance options and, for example, in the case of CommuniCare patients, inform them of the insurance plans with whom the firm contracts.
“We can tell them, if you want to be a patient at CommuniCare, here are the plans we contract with,” Sherrard said. “We can go beyond just enrolling in a plan; we can provide education about co-pays, deductibles and more.”
She said some of CommuniCare’s patients never had insurance so they need more education outreach.
“More than 60 percent of our patients, or about 24,000 people in Bexar County, are uninsured,” Sherrard said. “We estimate another more than 40,000 in Hays County are uninsured.”
“We can advise which plan may be better for their situation, such as whether they want an HMO or a PPO. If they are relatively healthy, we may advise them to pick a plan with a lower premium with higher out-of-pocket costs. Less healthy folks, however, may want a higher premium with lower out-of-pocket costs,” Sherrard said.
The exchange must have written procedures in place to withdraw designation from an organization if it is found to be noncompliant with federal law, though generally the designation will not be revoked unless there is a pattern of noncompliance. A stricter standard will be applied for violations of privacy and security standards.
According to Sherrard, the new law also allows CACs to register people to vote if they are not already.
