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Life Health > Health Insurance > Health Insurance

On the Third Hand: Crazies

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I think that the people in federal and state government agencies generally mean well and are in danger of getting into huge trouble if they’re too blunt.

Producers speak the language of clarity. Even if, occasionally, they are, arguably, wrong, they’re wrong in a clear way.

State government officials speak the language of “not getting fired due to excess clarity.”

This “Producers are from Mars/Officials are from the murky clouds of Venus” conflict came to mind this week as I’ve been working on a news feature about the role of producers in the world of Patient Protection and Affordable Care Act (PPACA) exchanges.

Health insurance agents and brokers are scared because the drafters of PPACA created “navigators” — ombudsmen who cannot get compensation from health insurers and are supposed to help consumers figure out how to use the exchanges.

In recent months, the U.S. Department of Health and Human Services (HHS) has created “in-person assisters” — people who are supposed help people sign up for exchange plans in person.

Now the State Health Reform Assistance Network is reporting that the Centers for Medicare & Medicaid Services (CMS) has created still another species of exchange helpers: “Certified application counselors.” The counselors will be “individuals in the community who are not paid directly by the exchange as official Navigators or [in-person assisters (IPAs)], but who are still helping consumers enroll in coverage through the Web portal.”

By the time the exchanges actually come to life, maybe there will be so many additional types of exchange helpers out there that naming them all will be akin to being able to name all of the Seven Dwarfs.

Producers have two main sets of objections to the talk about the various species of exchange helpers. One is that low compensation for the helpers could cut commercial insurance producers out of the game, and the other is that low compensation levels and weak helper qualification standards will lead to trouble for consumers.

The first concern has to do with producers misunderstanding the government officials, and the second with officials misunderstanding the producers.

What the officials are trying to hint, with wild gesticulations, without coming and out saying it, is that they can’t imagine producers who are used to working mainly with prudent, clear-minded consumers dealing with uninsured people.

Of course, some uninsured people are sane people who are uninsured simply because they’re broke, or because they have serious health problems that make getting through a medical underwriting process difficult.

But, especially in states like New Jersey that have been experimenting with coverage access expansion programs for years, many uninsured people are … not mentally well-organized.

They may be illiterate or speak no English. They may not be integrated enough into the world of work and modern finances to have a bank account.

Especially if they speak perfectly good English, have low incomes, and have children who should obviously be in the Children’s Health Insurance Program (CHIP) and aren’t, they might be crazies.

Take my acquaintance, John Doe. (Details changed to protect the addled.) He’s a low-income, self-employed musician and loving single parent of two lovely children.

John can’t afford to pay an accountant to help him with his somewhat complicated tax return, and, even if he could pay the accountant, he’s lost the documents needed to prove how poor he is.

If you sit down to help John with the documentation problems, he’ll get you off on a tangent about the dangers of using fluoridated toothpaste.

John can’t just sign up for coverage through the Internet, because he creeps around the Web using a dial-up modem, and viruses have clogged up his computer. The sad truth is that hackers in China have much better financial information about John than John has.

This gets to the point that the government officials are just starting to realize: Actually getting addled, poorly educated or disconnected poor people enrolled in government health programs is a huge amount of work.

Producers aren’t kidding when they tell government officials how expensive and time-consuming helping people with complicated health benefits questions can be.

The real problem is not so much that the navigators or assisters will elbow out producers, but that the navigators and assisters might not have any hope of elbowing their way to the uninsured people they are supposed to be getting into the exchanges.

But the Chinese hackers have reached John. Maybe the exchanges should go make them another major class of exchange outreach helpers…. 

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