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Why Are 'Navigators' Needed for Obamacare?

Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.
Lottie Watts
The Florida Channel
Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.

When the new online health insurance marketplace opens Oct. 1, millions of people will be able to buy insurance at the click of a mouse. The federal government has a website and a hotline people can call for help. But they'll also have people who can help face-to-face. They're called "navigators."

During a stop at the USF Tampa campus last week, U.S. Health and Human Services Secretary Kathleen Sebelius said "navigators" will assist many people who have never been enrolled in a health plan before. 

"These are individuals who will really be connecting people to coverage, and having that ability to do outreach to many people who really haven't had coverage before and answer questions and get folks information so they can in turn make good decisions for themselves and their families is really an important piece of this puzzle," Sebelius said.

In Florida, several non-profit organizations are getting $7.8 million in grants to pay for "navigators." Sebelius also says there's funding for other outreach efforts.

"This is a multi-part effort,  where it won't just be up to groups that receive the navigator grants, but lots of networks," Sebelius said. "Every community health center now has resources to hire individuals who will be at that community health center, a logical place to say to people, if you don't have coverage, here are some options available to you." 

Gerry Skinner has worked at Tampa Family Health Centers as a financial counselor for five years. At the East Tampa location, she sees uninsured people "every day, all day." 

"Every single day, I come in and then we help them," Skinner said. "We do it as a courtesy to our patients, help them find insurance."

Uninsured Floridians who can't afford insurance or aren't offered it through their employer have limited choices for coverage. Some of the patients Skinner meets can get health care through Medicaid or the Hillsborough County Health Plan for low-income residents.  

"If they're over the income limit, that's when we place them on a sliding scale and that's for all of our clinics, for any patient that walks in the door that don't have insurance or whatever, we'll put them on a sliding scale based on their income," Skinner said. 

Skinner recently found out she's going to get training to help people sign up for health insurance once the online Marketplace opens.  

"All of our patients can have options. They can have something else. They don't have to say, 'oh, we're only here on a sliding scale.'"

"It ties into my job and what I do already. Because that's what I do, is submit applications and help all our patients don't have no insurance so this is something I definitely need to learn, especially all the stuff that's going to be offered to us now."  

Skinner said the clinics provide care for patients who are able to pay on a sliding scale, but it's not the same as having a health insurance plan. She says that will change drastically come Oct. 1 for many of her patients. That's when they'll be able to start shopping on the marketplace for comprehensive plans, ones that don't exclude people with pre-existing health conditions.

"All of our patients can have options. They can have something else. They don't have to say, 'oh, we're only here on a sliding scale,'" Skinner said. 

All of the health insurance plans that consumers can choose from on the Marketplace have to include essential health benefits, including:

  • ambulatory patient services
  • emergency services
  • hospitalization
  • maternity and newborn care
  • mental health and substance use disorder services, including behavioral health treatment
  • prescription drugs
  • rehabilitative and habilitative services and devices
  • laboratory services
  • preventive and wellness services and chronic disease management
  • pediatric services, including oral and vision care

"They can finally get an insurance card that they're able to use and go to referrals and see specialists. When you're on a sliding scale, you don't have the insurance to see a specialist," Skinner said.  "And a lot of specialists, they charge a lot of money for out pocket. So, I can't wait for this Obama thing to kick in. I think it's going to be great, because for a long time, there really was not too much I could offer my patients that were on sliding scales over the income limit."
Skinner starts her special training on the health insurance exchanges next week.   

Open enrollment for the new health insurance Marketplace runs from Oct. 1 through March 31.  

Lottie Watts covers health and health policy for Health News Florida, now a part of WUSF Public Media. She also produces Florida Matters, WUSF's weekly public affairs show.