The role of navigators

One of the problems with insurance is understanding exactly what is on offer and how well the various policies will meet your needs. Most people assume the main barrier to accessing medical insurance is affordability. But, particularly among the poor, education is just as big a problem. If you do not know how to get information about insurance and, more importantly, you do not understand the language in which the information is provided, you are not going to get the cover you need. Even if you do get access to health care, you are likely to be dissatisfied with the outcome. You must know what to ask for and how to explain your problems to get the best results. While, in policy terms, it may be acceptable to leave adults to look after their own interests, this has proved a real barrier when it comes to enrolling children into the various programs offering subsidized or free medical cover.

As a result, one of the innovations is to produce a new group of people called Navigators. It's their job to develop relationships with disadvantaged groups and help them work their way through the sometimes complicated paperwork to access all the available assistance. Research shows more people enroll in Medicaid with the help of community-based organizations than by going to the Medicaid offices. So states like Massachusetts and Wisconsin are already employing people to educate people and help them through the online application process for various health programs. The Affordable Care Act makes grants available to community organizations and individual advocates to help in outreach efforts, particularly to communities where English is not their first language and among those people who do not have internet access.

Needless to say, the GOP is strongly against this approach. Ignoring the unspoken fear that, with more poor people enrolled, the total costs of providing health care may rise, the main objection seems to be the fear that the Navigators will not be independent. Up to now, it has fallen to insurance agents to provide advice. Although many are paid by commission and therefore likely to recommend the policies offering them the greatest rewards, people who feel they have been sold the wrong policy have the right to sue their advisors. But if the Navigators are trained and employed by the state, and they are offering advice on which policies are available through state-run Exchanges, the advice is not going to cover the range of what is on offer, i.e. it will potentially fail to discuss the private health plans - often because they are more expensive.

So there you have the issue. You are reading this online and, if you have read this far, you are interested in how the insurance market works. So what does the poor Spanish-speaking family do without no internet access? How do they find out what health insurance quotes are available? How do they decide which of the several possible policies represents the best value for their needs? The answer is that, without an outreach service through Navigators, they are unlikely to enroll in the existing programs. They will be denied the subsidies to provide cheap health insurance or fail to access the free plans for their children.