Back in April, Gallup released findings from its regular health insurance survey and determined that
states that embraced Obamacare were seeing a greater decrease in the number of uninsured people than the states that weren't. That was in part because of Medicaid expansion—the states that took it have had much greater success in people getting insured. But it's not just Medicaid expansion by itself that's helping, a new Kaiser Family Foundation survey of people who worked with assistance programs under Obamacare,
reported in the
New York Times, finds. More than 4,400 programs created to help consumers find coverage—the navigators—helped an estimated 10.6 million people. And the states that set up their own exchanges rather than relying on the federal exchange did better.
[T]he programs that operated in states with their own online insurance marketplaces got more funding and helped more people than those in states on the federal exchange, the survey found. In the District of Columbia and 16 states that ran or were working toward running their own exchanges, the programs helped about twice as many people, relative to the uninsured population, as they did in 29 states served by the federal exchange.
Karen Pollitz, a senior fellow at the Kaiser Family Foundation, said she was surprised by the large number of assistance programs, which the survey estimated to employ more than 28,000 full-time-equivalent workers and volunteers. “The size of this infrastructure was something I wouldn’t have predicted when we began,” she said. […]
Most of the states that did not create their own exchanges—and where assistance groups had less funding—are led by Republican governors or legislatures who strongly oppose the law. The survey found the top reason people sought help from the programs was confusion about the Affordable Care Act and the insurance plans available through the exchanges. Many also encountered technical problems or did not have Internet at home.
The job of the navigators—made so much more difficult when Republican state lawmakers created barriers against them—was more than just getting people online. About 90 percent of the programs say that the majority of the people they helped were uninsured, so the process included a lot of education about how insurance works, what all the terms mean. The survey found that "three-quarters of the programs said that 'most' or 'nearly all' of their clients who considered buying private coverage needed help understanding basic insurance terms, like 'deductible' or 'in-network service.'" About two-thirds reported that they spent between one and two hours on average helping each individual client. About 40 percent of the programs said they couldn't help everyone who came to them, and 12 percent said there was just too much demand, exceeding their capacity to help everyone. And this is a disquieting number—about 90 percent said that clients have already come back to them with questions or problems post-enrollment.
The survey shows the need for the navigator program, a need that might not be fully met in the next enrollment period. The federal government has about $60 million—$7 million less than last year—to fund the assistance program in states on the federal exchange for the 2015 enrollment period which starts in November. The good news is that about 75 percent of the assister programs report that they will continue their work in the next enrollment period. The hard part will be that the most motivated and committed customers showed up this year.