State hires army of humans to drive online health insurance exchange

This week the State Department of Health put out a call for help — in the hope that a human touch will ensure the state’s soon-to-launch online Health Benefit Exchange will sign up more than 1 million of the 2.6 million New Yorkers who currently do not have health insurance coverage.

Using $140.6 million, partly funded by a new federal grant to help New York launch its exchange, the state will hire nonprofit and other groups around the state — including at least 10 in New York City — to help residents navigate the complexities of signing up for an insurance plan.

Called “in-person assisters,” the army of workers will work directly with people who need an extra hand in figuring out how to navigate the exchange. A centerpiece of federal health care reform, state health care exchanges will allow consumers to compare health insurance plans and determine their eligibility for government assistance in paying for insurance. They must begin signing up customers starting October 1.

The exchanges are built around technology. Last year, New York State signed a $183.6 million contract with Computer Sciences Corporation, the same company that previously built the Medicaid billing system in New York (and came under fire for cost overruns and blown deadlines).

A design mock-up for state health benefit exchanges — including, soon, New York’s. Image from

New York was one of 11 states to work with the federal government and a consortium of philanthropies to create the easy-to-use UX 2014 standard for health insurance exchange interface design. Information on the state’s website will be presented at a fourth-grade reading level, in English and Spanish.

But while the state system promises a intuitive and user-friendly portal, the very people most in need of access — the uninsured — are the most likely to have barriers to using it. Particularly challenged will be applicants with low computer literacy or limited experience with insurance, and those who primarily speak a language other than Spanish or English.

“The reality is, the exchange is going to be a little more like TurboTax than Orbitz,” said Elisabeth Benjamin, Vice President of health initiatives at the Community Service Society. In 2011, Benjamin co-authored a study on what assistance consumers would need in navigating the exchange. While the portal is a “tremendous step in the right direction” toward simplifying the process of applying for both public and private coverage, she said, the state will still badly need the assisters to spread information and help people sign up.
“It gets very complicated very fast.”

The assister program will mirror highly successful state programs run over the past decade to help low-income families enroll in Medicaid and New York’s Child Health Plus program. Organizations across the state currently enroll over 100,000 individuals and families a year in public health plans.

With the assisters on board, those numbers are likely to go up, projects the New York State Health Foundation, which expects 212,000 people a year will find insurance annually with help from the new effort.

Because of federal rules seeking to limit conflicts of interest, the assisters program will differ in one important way from past state efforts: the health plans themselves will not be able to participate. Neither will brokers who receive commissions. That leaves an array of organizations like unions, trade associations and community based organizations to help people sign up.

“They know the communities, they know the languages and they know the cultures,” said Lorraine Gonzalez, Director of health policy at Children’s Defense Fund New York.

She contends that low computer literacy, language barriers and a lack of accurate information on health care reform still prevent thousands in New York City alone from enjoying the benefits of coverage. Gonzalez said that assisters making in-person connections is an important response.

“It’s something that you can’t just program into an IT system,” she said.

States that establish their own exchanges can opt to establish an in-person assister program with the help of special federal grants; so far, only nine states have been awarded funds. And all states must come up with some kind of enrollment assistance program by 2014, paid for by fees on insurers participating in the exchanges.

Yunilda Llugcha had no health insurance — until a Bushwick community organization helped her navigate her options. Photo: Curtis Skinner

Even so, millions across the country — including many New York State residents —will remain uninsured even once the assisters and other helpers get to work. The Urban Institute recently simulated the impact of health care exchanges nationally as well as in New York and in four other states, and predicts that nearly 1.7 million non-elderly New Yorkers will remain uninsured after the Affordable Care Act is fully in place. Some will not sign up because they are undocumented immigrants, and therefore not eligible; others will elect to pay a penalty instead of purchase insurance.

But a significant number have other barriers to using the exchange. The Urban Institute estimates that some 600,000 of the state’s uninsured will be eligible for public coverage through Medicaid or CHIP. For hard-to-reach individuals and communities, assisters and other human help could make all the difference.

They did for Yunilda Josefina Llugcha, 43. Two years ago, she moved from the Dominican Republic with her teenage daughter to join her husband, Marco, in Bushwick, Brooklyn. She secured a job as a home health attendant while her husband worked as a grocery deliveryman — jobs that provided their small family with health coverage.

But last summer, Yunilda’s hours were scaled back and her husband was laid off, leaving the Llugchas with no way to pay for Marco’s hernia surgery or the bouts of dizziness and low blood sugar their daughter was experiencing. For half of last year, they were among the ranks of New York State’s 2.6 million uninsured.

“Can you imagine?” she said through a translator of her fears about going without insurance. “We were really worried.”

Staff at the Ridgewood Bushwick Senior Citizens Council, working under a Department of Health contract, directed Llugcha to gather personal documentation like social security numbers and income information, and walked her through the application process. Two months after showing up at their office, she and her family had insurance coverage once again.

Said Llugcha, “It’s a blessing to have programs like this in the community.”

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