State health exchanges are facing many challenges in the recent scramble to enroll their residents in the healthcare marketplace. Among the numerous obstacles, including online systemic glitches (Washington state botched the tax-credit calculation while Maryland’s appears to be having just general technical incompetence) and complete lack of knowledge (according to a recent Gallup poll, 71% of uninsured Americans have no clue what the exchanges are), a critical challenge is the quick generation of a new healthcare workforce, namely enrollment counselors and navigators.
According to the Center for Medicare and Medicaid Services, enrollment navigators are supposed to help people enroll, whether through online or paper applications, determine individual eligibility for various subsidies and assistance programs, and generally educate the public regarding the new health exchanges. Certified application counselors differ slightly from navigators, taking a less involved role in the process, but still serving as assistants to people who need help completing their application.
However, in many states, including Florida (1 navigator per 100,000 uninsured citizens as of October 1st), Georgia (only 4 people were certified to be counselors when the exchanges went live) and California (official numbers will be released on November 14th, but current estimates suggest less than 20% of future counselors are fully certified yet), there is a huge workforce shortage which is both reducing the rate of enrollment and contributing to people’s doubts about the Affordable Care Act in general.
Part of the problem is that many states, for several months now, have purposely made it more difficult for people to become certified enrollment employees; Ohio and Missouri are widely cited as two of those. They have also instituted regulations on what information counselors can and cannot give patients and have tried to implement large fines, such as in Tennessee, which luckily ruled to temporarily restrain these penalties, for those who may unknowingly breach part of the contract.
As a medical student hoping to be more involved in influencing patient care, but unable to do so at a clinical level just yet, the opportunity to serve as an enrollment counselor or navigator is more than timely.
In my home state of California, training and certification to become a Certified Enrollment Counselor is not easy, but it’s doable. The process involves 20 hours of in-person courses, a number of online modules, and a background check. However, the cost of training is compensated—$58 per completed application, to be exact.
A recent study showed that many uninsured patients do not even have basic knowledge of insurance terminology, let alone a strategy of how to go about securing an insurance plan from the exchanges. As students, even helping to improve health literacy and teaching workshops at local clinics on basic insurance concepts would be a significant community service contribution. A group of medical and public health students at my school, UCLA, and USC are forming a collaborative to serve as certified enrollment counselors.
This experience will allow the next generation of medical leaders in our state to hear first-hand the challenges that patients face in terms of practical considerations that are often left out of medical school curricula, including financial limitations that restrict patient decision-making. In today’s healthcare system, health professionals are not the only ones to have a direct impact on healthcare outcomes for millions of Americans—the opportunity for students awaits.
Abraar Karan is a Yale graduate and MD candidate at UCLA. He blogs at Swasthya Mundial.