Even if HealthCare.gov was working perfectly — which, of course, it isn’t — open enrollment through the Affordable Care Act’s insurance marketplace still would be tricky for many people.
Insurance industry jargon — words like premiums, co-payments and deductibles — may sound more like Greek than English to many of the nation’s estimated 47 million uninsured.
More than half of 1,008 adults polled by the American Institute of CPAs in July could not define even one of these terms correctly.
Affordable Care Act navigators, paid for with federal grant money, have been trained to explain all this vocabulary more simply. They also can offer residents free, unbiased advice and help them purchase a health insurance policy during face-to-face, one-on-one meetings — that is, as long as you’re lucky enough to live near one.
More than 100 navigators have been hired in South Carolina this fall, but depending on where you’re located, they can be difficult to find.
The navigators are unevenly distributed throughout the state, and the federal government isn’t tracking where there are too many or too few. It’s simply one more snag in the bumpy health care reform rollout.
For example, only one navigator works exclusively in Charleston, Berkeley and Dorchester counties, but there are more than 110,000 uninsured residents in the tri-county area, according to Census estimates.
Loreen Myerson said she takes up to 20 calls a day from people who need help, even though her role as a navigator is only supposed to be a part-time job.
“I could use some help down here,” she said.
Meanwhile, there are seven navigators based in Beaufort County, which has less than 27,000 uninsured residents. In other pockets of South Carolina, there aren’t any navigators.
“I’d love to have enough money to send someone to Myrtle Beach because there aren’t any navigators in Myrtle Beach,” said Tim Liszewski, a lead navigator based in Columbia in charge of staffing other locations.
More than a quarter of all residents in Myrtle Beach’s Horry County, or about 58,000 people, have no insurance. That’s the second-highest rate of uninsured residents in the state, exceeded only by Jasper County, where 27 percent of county residents are uninsured. There aren’t any full-time navigators there either.
In August, the federal government awarded nearly $2 million to three groups to hire Affordable Care Act navigators in South Carolina — part of a $54 million grant program for all states participating in the federal health insurance marketplace.
Each applicant had to submit a plan to the Centers for Medicare & Medicaid Services, detailing where it would hire these part-time employees and which areas of South Carolina it would target.
Based on the awards that were announced this year, the entire state should be covered by this new network of navigators, but that hasn’t happened yet.
DECO Recovery Management, a for-profit company based in Maryland, won the most money to hire navigators in South Carolina — $1.2 million. DECO said it would canvass the whole state, but, to date, it has hired navigators on the ground only in the Upstate, the Midlands, Aiken and Manning.
One DECO navigator floats around the state, and 12 hired with the grant money aren’t stationed in South Carolina at all, but are located in Maryland.
The Beaufort County Black Chamber of Commerce won $234,000 to hire seven navigators for 14 counties in the Lowcountry, including Charleston, Berkeley and Dorchester counties, but all seven are based in Beaufort.
Chamber of Commerce President Larry Holman said his navigators, three of whom were already employed by the chamber, organized 34 outreach events in October, including some events in Charleston. Holman would not provide a complete list of those events. The group planned only two navigator outreach events in Charleston this month.
The Cooperative Ministry, a nonprofit group in Columbia, won a $508,000 grant and has hired 48 navigators with that money.
The nonprofit partnered with the Greater Columbia Community Relations Council and South Carolina Progressive Network to focus its efforts in the Midlands. The Progressive Network is the only group that hired a navigator to work in Charleston, when it realized that no one was stationed here.
Myerson, Charleston’s only navigator, is paid $14 an hour to work 20 hours a week. In reality, she said she works more than that because so many residents call her for help.
“It’s become a full-time job,” she said.
Liszewski, who hired Myerson, said the Progressive Network is currently training another navigator for this area.
“I’m looking to bring her some help. She’s kind of inundated,” he said. “I do know that DECO is bringing people in to the Charleston area — that’s what I was told anyway. You may see more navigators in the Charleston area as this thing progresses. I think people are rethinking strategies.”
But time is ticking. Residents can sign up for a policy through March 31 to avoid paying a $95 penalty under federal law, but they must enroll and pay their first month’s premium by Dec. 15 to ensure coverage on Jan. 1.
Cause for concern
More than one person has expressed concern about how the federal grant money has been used — specifically the $1.2 million grant awarded to DECO Recovery Management, a for-profit corporation hired by hospitals to collect unpaid bills.
Bianca Crawford, a spokeswoman for DECO, confirmed that the grant money has been used to hire 58 navigators for South Carolina, although none are located in the Lowcountry and 12 are stationed at a remote call center in Maryland.
DECO is actively hiring Charleston-based navigators and opening more walk-in centers around the state, Crawford said. The only walk-in centers the company has staffed so far are in Greenville, Aiken, Manning and Columbia.
The company will send more than a dozen navigators to facilitate a one-day enrollment event in North Charleston in December.
“We’re actively hiring navigators all over,” Crawford said. “The whole state will be covered.”
DECO Vice President Andy Foland admitted the company’s initial coverage plan isn’t working well.
“Our plan is not set in stone. We are modifying the plan as we move forward to address areas of weakness,” Foland said. “I’m hopeful that within the next week we’ll have a number of centers opening up in the Charleston market.”
Like The Cooperative Ministry, DECO partnered with several South Carolina-based organizations to hire navigators, including the Benefit Bank of South Carolina, the Office of Rural Health, the South Carolina Chamber of Commerce and the South Carolina Hospital Association.
Tricia Brooks, a Georgetown University professor, said several medical bill recovery companies like DECO won federal grant money to hire navigators in nine states, including South Carolina.
“They’ve got the biggest chunk of the navigator grants in the share (in South Carolina),” Brooks said. “They should not be invisible in the state.”
But so far, DECO and its local partners have been virtually invisible in the Lowcountry, said Shelli Quenga, programs director for The Palmetto Project, a Mount Pleasant-based nonprofit. The Palmetto Project applied for a federal navigator grant, but was not awarded any money.
Palmetto Project employees met with DECO representatives last week to air their concerns.
“We were very frank with them. This is not working. What are you doing with this money?,” Quenga said. “They were very receptive to our suggestions … In the next two weeks, I think there will be a marked change for what’s available for Charleston.”
Each organization that was awarded grant money sets its own hourly rates for its navigators, but none of the navigators are paid to enroll residents in a health insurance plan on a per person basis, and none of them are allowed to take money from clients asking for help.
According to a spokeswoman for the Centers for Medicare & Medicaid Services, the selection process for hiring the navigators with federal grant money is strict, and each navigator is subject to state and federal laws protecting consumers. They all are required to complete 20 hours of online training and pass course exams.
But signing up for health insurance doesn’t require a navigator. Federal marketplace enrollment specialists are available to answer questions over the phone, 1-800-318-2596, and there are plenty of other local experts who have been trained to explain how the law works.
“I’ve said to everybody they should use the 1-800 number,” said U.S. Rep. Jim Clyburn, D-S.C. “The navigators are not the only ones that are out there.”
There are also insurance brokers and agents, insurance company employees and certified application counselors who understand how the law works.
S.C. Department of Insurance Director Ray Farmer has repeatedly warned consumers about who they should trust — navigator or not.
“Citizens will just lead with their Social Security number as soon as they say hello,” Farmer said. “Our consumers need to guard their personal information.”
No one should pay a navigator or an insurance agent to help them sign up for insurance, he said.
“Unfortunately, we have people out there willing to take advantage of other folks.”
Reporter Schuyler Kropf contributed to this story. Reach Lauren Sausser at 937-5598.