Nation & World

Enrolling uninsured may be a challenge in states that decline to run marketplaces

The Obama administration said this week that it would award $54 million to community groups in 33 states to provide personal assistance for people who are signing up on the new online health-insurance marketplaces, which open next fall.

The size of the long-awaited grants offers a glimpse into the potential difficulties of carrying out the health law in those 33 states – including Texas and Florida – which are relying on the federal government to run all or part of their marketplaces. The states that are setting up their own marketplaces are getting separate funding from the federal government, and they’re expected to have more money to reach out to the uninsured."There’s no way that’s enough money to make a difference," said John Poelman, a senior director of Leavitt Partners, a consultant that’s working with many states to set up the marketplaces.

Stan Dorn, a senior fellow at the nonpartisan Urban Institute, called the money "a drop in the bucket.” “It’s not enough to enroll tens of millions of uninsured into coverage,” he said.

The $54 million in federal grants for so-called "navigators," workers who’ll provide assistance to individuals signing up for coverage, covers one year and will be distributed to states based on how many uninsured people they have. Texas and Florida, for instance, with almost 9 million uninsured between them, together will get up to $14 million. In contrast, California, which is setting up its own exchange with federal funding, has budgeted more than $50 million for in-person help for consumers this year and next. It has more than 7 million uninsured residents.

The law’s framers gave states broad financial assistance to set up their own online marketplaces. They required the federal government to set up the exchanges if states failed to do so, but they didn’t create a separate pot of money for that effort. The assumption was that most states would set up their own marketplaces. In the end, however, only 17 states and the District of Columbia did.

Resources for the federal effort also may be constrained because of the spending cuts imposed by budget sequestration.

Navigators are supposed to provide unbiased information to consumers about obtaining health insurance in the new marketplaces.

Health experts and consumer advocates worry that the states that are relying on the federal exchange will get less help than the people in states with their own exchanges will. The marketplaces, which open for enrollment Oct. 1 with the coverage taking effect Jan. 1, are the key way the federal health care law is attempting to provide coverage to about 27 million people by 2016.

Hospitals, county health agencies, religious groups and chambers of commerce are among the kinds of groups that are expected to apply for the grants. Applications are due June 7, and the awards will be made in August.

"I think HHS would probably be the first to say it’s not enough, but it’s a great start, and it’s an important down payment," said Ethan Rome, the executive director of the advocacy group Health Care for America Now.

Laura Goodhue, the executive director of Florida CHAIN, a consumer health group, applauded the announcement of the pot of money, but said private groups would have to pitch in to help enroll people.

"The federal funding will significantly assist community-based groups who are closest to serving the needs of the uninsured with the task of educating and enrolling millions of people in a short time period," she said. "However, additional support from state, local agencies, providers and others will be needed to make sure that everyone is aware of the opportunities."

Texas consumer advocates said they were happy to get funding to help the enrollment effort.

"Any money that they’re putting forward is more than there is right now, which is zero," said Anne Dunkelberg, associate director of the Center for Public Policy Priorities in Austin. "At least it’s proportional to our number of uninsured."

"Navigators will be an important resource for the millions of Americans who are eligible to enroll in new coverage opportunities through the marketplace,” Marilyn Tavenner, the acting administrator of the Centers for Medicare and Medicaid Services, said in a statement.

Adam Searing, project director of North Carolina Health Access Coalition, said his state would have far less money for outreach than those that were setting up their own marketplaces, but that was mostly because its politicians opposed the law and didn’t want a role in implementing it. He noted that the state gave up $74 million in funding for the exchange this week, which could have been used for outreach. “We know we will have less money,” he said.

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