During the open enrollment period for the state and federal health care exchanges, each staff member and volunteer worked with an average of 1.8 people per day, according to a survey of assister programs released by the Kaiser Family Foundation. Kaiser calculated the number of people receiving aid between October 1, 2013 and the end of April, 2014:
More than 4,400 Assister Programs, employing more than 28,000 full-time-equivalent staff and volunteers, helped an estimated 10.6 million people during the first Open Enrollment period.
If you do the math, 28,000 individuals assisting 10.6 million people over 210 days breaks down to 1.8 people per day per service representative. While the individualized guidance was time consuming, the study revealed that the assister programs should have been able to help more people in the span of a full workday. The questionnaire answers indicated that 64 percent of the programs spent an average of 1-2 hours with each person, 18 percent took 2-3 hours, and just five percent exceeded three hours.
The assister programs faced a myriad of other issues too. From the New York Times (buried deep in the second to last paragraph):
About four in 10 of the programs could not help everyone who approached them, the survey found, and 12 percent said the demand for help far exceeded their capacity to provide it. Nine of 10 programs said clients had already returned to them with post-enrollment problems.
These post-enrollment problems were significant -- 54 percent of programs heard from people who didn’t receive their insurance cards; 37 percent from those who felt they “picked the wrong plan and want[ed] to change;” and 37 percent from those with providers outside of their network. Other challenges included unaffordable deductibles and other costs (35 percent of programs fielded this concern); claim denials and other claim issues (21 percent); no coverage of specific prescriptions (20 percent); and other uncovered health services (15 percent). Even 16 percent of programs had clients whose coverage was terminated.
In quite the understatement, Kaiser warned in its conclusion, “Such problems, if not addressed, could prompt some consumers to drop coverage.”
Some other key findings:
- Thirty percent of the programs had no "prior experience helping consumers."
- A total of 89 percent of those questioned encountered clients who couldn’t find easily accessible answers on the marketplace websites.
- “Explaining ACA requirements to consumers was most difficult for one in four Assister Programs,” according to Kaiser.
- Some states did not give assisters access to marketplace data to check on applications status; 30 percent of programs “did not know the enrollment outcome for a majority of their clients.”
- The marketplace call centers didn’t get rave reviews. Only 69 percent of assister programs categorized both the federal and state centers as “very or somewhat helpful,” contrasted with a 92 percent rating for brokers and agents and a 90 percent rating for state insurance departments. Kaiser also discovered incompetence: “some complain that call center representatives didn’t always provide accurate or consistent information.” A survey of consumers by the Urban Institute and the Robert Wood Johnson Foundation revealed similar sentiments last month.
The Kaiser study, including both federal and state exchanges, estimated that state exchanges helped twice as many people per 1,000 uninsured. Lead Kaiser author Karen Pollitz attributed this to “the barrage of bad noise against the ACA” in federal exchange states.
For these 34 states that opted not to set up their own exchanges, HHS doled out $67 million last year to 105 navigator groups, including Planned Parenthood, United Way, the National Urban League, and an ACORN offshoot. The now infamous navigators came under scrutiny for reports of corruption, fraud, lax screening procedures of hires, and identity theft, despite President Obama’s lavish praise last month. This year, $60 million will be up for grabs by these navigators.
Various government agencies directed about $413 million to all assister programs last year, according to Kaiser. Navigators comprised just two percent of these programs -- the bulk was made up of certified application counselors (45 percent), federally qualified health centers (26 percent), and in person assisters (26 percent). In the Kaiser study, 76 percent of the assister programs said they were "very likely" to work in the same capacity for this year’s fall enrollment.
There’s certainly room for improvement this time around.