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Enrollment Assistance Under Health Reform Has Roots in Other Successful Programs

Starting in October, millions of uninsured Americans will be able to enroll in private health coverage through health reform’s new health insurance marketplaces (also called “exchanges”).  But a program designed to help people apply for and enroll in coverage has come under fire, despite its origins in other successful enrollment efforts.

Under health reform, so-called “navigators” — including community and consumer nonprofits, unions, and trade groups — will help people sign up for insurance through the marketplaces, understand their options, and enroll in the right plan.  Critics contend that these assisters could provide poor-quality services or take business away from insurance agents.  But past experience, coupled with the rules that have been proposed to govern the navigators’ work, shows that those concerns are unfounded.

The exchange model included navigators because similar “helper” programs have worked well to connect people with the programs and services for which they’re eligible, including Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP).  For example, the federally funded and administered State Health Insurance Assistance Program offers one-on-one guidance to Medicare beneficiaries in every state.  And similar assister programs have played a significant role in increasing enrollment in Medicaid and CHIP across the country; some 86 percent of eligible children are now enrolled in Medicaid and CHIP, an all-time high.

The Department of Health and Human Services based the navigator program under health reform on these successes and proposed rules that would help ensure that the assisters will be professional and well-trained.  The proposed rules create robust training standards to prepare navigators to provide high-quality assistance and strong conflict of interest standards to ensure that navigators act in consumers’ best interests.

Contrary to criticisms, the navigator program is well designed.  These assisters will help uninsured people find — and join — the plan that’s right for them.