Making Sure DC’s New Navigator is Fully Loaded for Residents and Small Businesses

The District has taken another step forward in implementing health care reform ‘ aka Obamacare ‘ by taking initial votes on the program that will help residents and small businesses understand and purchase insurance plans under the Affordable Care Act. Last week, the board charged with governing the DC Health Care Exchange unanimously approved recommendations for the Navigator Program, which set the broad structure and core functions of the program.  While the initial recommendations are promising, the next design phase of the program will need to flesh out more details as to ensure that the program will be an effective tool for consumers seeking affordable health insurance.

Navigators will be a network of consumer assisters, contracted and trained by the DC exchange authority, to provide outreach, education, and guidance on purchasing insurance through the Exchange. The Exchange Board voted to limit a Navigator’s role to five functions defined in the Affordable Care Act: providing education and outreach to consumers on health plans offered on the Exchange; distributing impartial information on plan enrollment and eligibility for premium subsidies and other public programs; helping consumers and businesses select and enroll in a plan; referring consumers with complaints or concerns to District regulatory agencies; and presenting information in a ways that are culturally and linguistically appropriate for all DC consumers.

Due to the barriers many District residents face, the city may need to provide more help than the basics required by the federal law to connect residents buying health insurance for the first time with the plan that best fits their needs. The District should not limit itself to federal regulations, since many of the Navigators will be community-based organizations, chosen because of their long-standing understanding and relationships with our city’s vulnerable and hard-to-reach populations.  These community-based organizations may have the capacity to provide more intensive assistance that will decrease the barriers between consumers and the health insurance option that best meets their needs.

The board also voiced the need for all Navigators to go through training and certification ‘ including testing requirements ‘ to ensure that they understand and can share with consumers the full range of the Exchange’s functions.  Lastly, the board voted to have the Exchange pay Navigators set amounts as opposed to on a fee-for-enrollment basis. This will incentivize Navigators to provide the wide range of services above, rather than focusing mainly on enrollment.

The board’s approval of the Navigator recommendations only sets the broad program structure and core functions.  We hope that the board revisits several of these areas in the design phase, especially with respect to clarifying the limits on services provided by Navigators.  With continued development, the program could be a key driver in helping DC residents and small business find the health plan that best meets their needs and pocket books.

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