Health care stakeholders said a keystone of the coming online health insurance exchange will be the “navigators” the government will enlist to get the word out to the uninsured — many of whom are in line for generous subsidies to reduce the cost of plans they will buy from health insurers who compete for their business on the exchange.
The federal government will make the exchange live Oct. 1, in time for thousands of New Jerseyans to buy government-subsidized coverage by Jan. 1, 2014.
Industry insiders said within the next few weeks, the federal Department of Health and Human Services is likely to issue a request for proposals from community organizations that want to become navigators.
"Consumer assistance, including a navigator program, to support individuals in the application and enrollment process, will be a core function of every marketplace," said Fabien Levy, HHS press secretary.
Joel Cantor, director of the Center for State Health Policy at Rutgers University, was among those predicting navigators will face a daunting task. He said more than half New Jersey's 1.3 million uninsured have been without health insurance for more than a year.
"They are the least engaged in the system, and will be the hardest to reach," Cantor said.
He estimated an additional 362,000 residents will buy individual health plans in 2014, of whom 254,000 will be eligible for a tax credit subsidy, which is only available through the exchange. The subsidies are on a sliding scale depending on income, phasing out completely at four times the poverty level, which for a family of four is $94,000.
New Jersey has not yet announced if it will participate in the federal Medicaid expansion under the Affordable Care Act; some anticipate Gov. Chris Christie will disclose his decision during his budget address tomorrow. Cantor estimated 234,000 more New Jerseyans would enroll in Medicaid in 2014 — most of them through the Medicaid expansion — but if New Jersey opts out of the Medicaid expansion, as many as 200,000 residents would not be eligible for Medicaid or subsidized coverage through the exchange.
Christie twice vetoed legislation to create a New Jersey-run exchange, and the governor has announced he's leaving the entire operation in Washington's hands.
Dena Mottola Jaborska, of the consumer watchdog group New Jersey Citizen Action — a member of the New Jersey for Health Care Coalition — said it's essential to have a robust navigator program. It's "a very ambitious estimate," she said, but up to 1 million New Jerseyans might get covered between the exchange and Medicaid.
Ev Liebman, associate state director for advocacy at AARP, said "There are significant numbers of folks over 50 who are uninsured, and we want to make sure they know about the opportunities on the exchange, and we will be working to educate our members."
She estimated more than 220,000 New Jersyans between ages 50 and 64 are uninsured. "In the economic downturn, many older workers are losing their jobs, and when they lose their jobs, they also lose their health insurance."
Jeff Brown, chief of staff of the New Jersey Health Care Quality Institute, said he wants the outreach effort to include public-private partnerships.
"This is really going to have to look like a political campaign, with paid media; social media; grassroots, targeted outreach; and public education," he said.
Ray Castro, a senior policy analyst at the Trenton think tank New Jersey Policy Perspective, said he's awaiting details on how HHS will distribute money to navigators. He said navigators may get a lump sum or be paid per capita, based on the number of people they bring to the exchange.
"It's going to be difficult to get the word out, and we have a bigger challenge than other states," as the state is split between the two very expensive media markets of New York and Philadelphia, he said.
And Castro said partisan debates over health care reform have turned off many people.
"There is a lot of ignorance about this among the public, and a lot of skepticism," he said. "The population we are dealing with will need a lot of educating, and we have to figure it out." He cited a study that found more than 70 percent of people who are eligible for subsidies "don't know they are eligible, and don't know what an exchange is."