One of the most visible, and arguably impactful, aspects of Obamacare has been the establishment of health insurance marketplaces through which individuals can purchase coverage. While their future may be uncertain as we await a Supreme Court ruling on subsidies for low-income purchasers, their importance in increasing the number of Americans enrolled in health insurance is clear. The marketplaces provide an easy to understand and use website that millions of individuals have used to enroll in health insurance.

To further streamline the process, the law provides funding for what is frequently referred to as the navigator program.  Navigators are individuals who are certified to help people enroll in insurance plans both in the marketplace and, if their incomes are low enough, in Medicaid. While navigators cannot recommend specific plans, they have provided crucial help to individuals in navigating the marketplace website.

What has been the experience of navigators, and what can it tell us about the way Obamacare is working? To find out, I sat down with Hannah Sendolo, a certified navigator who works at a city health center in Philadelphia. For the past two open enrollment periods, she has met with hundreds of individuals seeking to enroll in the marketplace. In addition to in-person advice on how to sign up, she works to educate people about the policies and plans from which they can choose. To reach people in need of coverage, she reaches out to local churches and libraries, and even visits people's homes.

Working as a navigator has included its share of difficulties and frustrations. One of the biggest problems Ms. Sendolo encountered during this most recent open enrollment period was that "individuals were unaware that they needed to update their marketplace applications for 2015. Therefore, many individuals were incorrectly afforded tax credits which in turn automatically would re-enroll them in the same plan as the previous year with inaccurate monthly premiums."  Such a problem makes it difficult for individuals to accurately estimate their insurance costs.

Another problem that was encountered in Pennsylvania was created by the state's delay in expanding Medicaid. Between the first and second open enrollment periods, the maximum income for Medicaid eligibility in Pennsylvania increased, in part because the state accepted Obamacare's expansion of the program. As a result, some people with low incomes were directed to the marketplace last open enrollment. However, this year, with the same income, they qualified for Medicaid, so they had to switch, "which can be difficult to explain."

The good news is that the second open enrollment period has been significantly smoother than the first. The marketplace website has operated with fewer glitches, and the user experience has been much better. Ms. Sendolo explained that "before we started the second open enrollment period, the Obama administration made it clear that they hired a whole new staff and revamped everything. I would say it worked."

One of the main reasons for the glitches, crashes, and frustrating delays during the first open enrollment period was that the officials who planned the marketplace did not anticipate the volume of people who would try to use the website. Ms. Sendolo feels that they have learned their lesson and that the most recent enrollment period has gone much more smoothly. "It hasn't really crashed as much this open enrollment period," she observed. "In my experience, I've only seen it go down once or twice this open enrollment period, and when it did go down it was only for ten or fifteen minutes."

Another area of improvement this year has been in the marketplace call centers. They were intended to provide another level of support to those attempting to enroll. However, "you could wait an hour and the call center would just tell you that they would call you" at a later time. This open enrollment period, the call centers hired and trained additional staff, which produced wait times that were typically less than ten minutes.

If the first open enrollment period was something of a test run, Ms. Sendolo sees the second enrollment period as a success. While certainly not without frustrations, the role of talented navigators like her has helped to increase enrollment in Pennsylvania, resulting in more people with insurance and individuals who, in her words, are "excited when they do receive insurance, knowing they can go to the hospital as freely as possible and having to pay small co-pays, or no co-pay at all."


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