Alexandra Dixon threads her way听among the听people waiting to see a doctor at the Community Clinic, Inc.听in Silver Spring, Maryland. She introduces herself with a bright smile and an outstretched hand: 鈥淚鈥檓 one of the new health care navigators. Have you heard of the Affordable Care Act?鈥�
While听some folks mumble, 鈥渦m, no I don鈥檛 think so,鈥� Dixon is nonetheless booked up with appointments. She鈥檚 one of 350 people in Maryland who have been hired and certified to help consumers enroll in the new health insurance options that are offered as part of the health law.听
Navigator Alexandra Dixon discusses insurance options with Alex Compagnet at Community Clinic, Inc., in Silver Spring, Md. (Photo by Jenny Gold)
She says that a few frown at what they call听鈥淥bamacare,鈥� but 鈥渇or the most part, people have been really excited and really happy and know what this is, you know.鈥�
Dixon sits down with Maria Hernandez,听a construction worker who鈥檚 a legal immigrant and has been uninsured for the past five years. Hernandez says听sometimes she gets sick, but without insurance, it鈥檚 better just to take some medicine and stay home. With Dixon鈥檚 help, she鈥檚 gotten an application started for insurance.
Despite Dixon鈥檚 enthusiasm and persistence, no one at the has actually enrolled in a new private insurance plan on the exchange. The Maryland exchange website freezes up at some point in the process almost every time. But whenever Dixon hits a road block, she just sets up an appointment for the patient to come back:听鈥淏ecause the portal is a lot better this week than it was last week. I have every expectation that next week it will be working better than this week,鈥� she says.
And she has her state behind her鈥� the health law.听 It鈥檚 one of the 16 states plus the District of Columbia that are running their own exchanges. The rest are being , whose efforts听have been stretched thin, according to , a consulting company that鈥檚 been tracking exchanges.
鈥淭he states that are operating their own exchanges just have a lot more funding available to do outreach and enrollment. The federal government just had limited funding left to do that, and it was spread across a large number of states,鈥� she notes.
The entire state of Ohio, for example, got just $3 million in grants to do consumer outreach. That鈥檚 compared to $24 million in Maryland, which has half as many uninsured residents.
That frustrates Lisa Hamler-Fugitt,听who runs , the state鈥檚 main consumer outreach group for the exchange.听听鈥淲e have too few boots on the ground,鈥� she worries. 鈥淲e need hundreds if not thousands of individuals to assist us.鈥�
Instead,听she鈥檒l have听about 40. Ohio听has laws putting additional听restrictions on navigators, including requiring them to go through a longer certification process with the insurance department. Hamler-Fugitt believes that鈥檚 stalled the process of getting her navigators on the ground by three weeks. These early differences between states could hamper the goal of the ACA, which is to get as many people insured as possible,听according to Avalere鈥檚听Pearson.听
鈥淩ecent polling show that only about 12 percent of the uninsured population, who could benefit from exchanges, understand that they are launching and began on October 1st. So doing a big push out in the community can potentially bring a lot of people into the market, that you鈥檙e not going to see in a state that isn鈥檛 as proactive,鈥� she says.
But she adds, this is only the beginning of the enrollment process. And launching a program of this size is always a huge lift. Consumers have until the end of March to sign up for coverage in 2014. And as the kinks get worked out, it鈥檚 still possible that this year鈥檚 enrollment will be a success.