ACA navigators steered 10.6M Americans into coverage last year

But funding for this year's open enrollment period remains uncertain

Consumer assistance programs created under the Affordable Care Act (ACA) helped about 10.6 million U.S. residents explore health coverage options and apply for insurance plans during the ACA's first open enrollment period, according to a new Kaiser Family Foundation survey.

Drawing on survey responses from 843 programs, researchers found that the programs that existed during the ACA's initial six-month open enrollment period employed more than 28,000 full-time workers and volunteers, called navigators. On average, each navigator assisted nearly 400 individuals.

Why two ACA navigators dropped out of the program

However, the report observed that programs located in states that ran their own exchange were generally more effective. (These programs also employed 8.7 workers per 10,000 uninsured residents, or about twice as many as in states that did not have their own exchange.) For example, 325 consumers received assistance for every 1,000 uninsured individuals in the District of Columbia and the 16 states that ran their own exchanges, but just 162 consumers per 1,000 uninsured individuals received assistance in the 29 states that used the federal insurance exchange.

Consumers mainly sought navigators' help because they were confused about the ACA and plans offered through the exchanges. In addition, many individuals who received help from navigators had technical issues or did not have the Internet in their homes.

Why didn't more hospitals become ACA navigators?

According to the survey:

  • Nearly 75% of the assistance organizations reported that "most" or "nearly all" of their clients who considered purchasing private coverage did not understand simple insurance terms, such as "deductible" or "in-network service";
  • About 40% of the programs reported not being able to help every individual who approached them;
  • 12% of the programs said demand for their services exceeded their abilities to provide assistance;
  • Nearly 90% of the programs said clients have already returned to them with post-enrollment issues; and
  • 90% of the programs reported that the majority of their clients previously were uninsured.

Navigators could continue to play 'key role'

The report predicts that navigators will continue to play a "key role" in future open enrollment periods.

because the public's "understanding of the ACA remains limited."

Further, the report adds, "If the first wave of enrollment in 2014 was comprised of those consumers who were the most resourceful and motivated to seek coverage, then investment in consumer assistance will be all the more key in the year to come."

However, it remains to be seen just how effective the programs will be in the future, because funding for navigator organizations has not yet been determined, according to the New York Times. Last month, the Obama administration said it would make $60 million available for such programs, which is $7 million less than was available last year for states that will use the federal exchange.

Regardless, the survey found that three-fourths of the responding programs said they will continue to operate during the upcoming open enrollment period. In addition, the survey suggests that programs funded through the federal Health Resources and Services Administration, such as federally qualified health centers, likely will continue to offer their services (Goodnough, New York Times, 7/15; Demko, Modern Healthcare, 7/15 [subscription required]; Al-Faruque, The Hill, 7/15).


Next in the Daily Briefing

Daily roundup: July 16, 2014

Read now