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State spends $2.5 million on Obamacare outreach effort in Nevada


Charles Dharapak / AP

In this March 23, 2010, file photo, President Barack Obama reaches for a pen to sign the health care bill in the East Room of the White House in Washington.

Updated Friday, Sept. 6, 2013 | 10:29 a.m.

Nevada’s state government is preparing for a huge shopping spree this autumn.

All Nevadans must have health insurance in 2014 under President Barack Obama’s health care law, and the state is contracting with companies to provide “navigators” who will educate people about the law’s requirements and enroll tens of thousands of uninsured Nevadans in insurance plans starting Oct. 1.

“It’ll be a matter of a family or individual sitting down in front of us with a laptop and we’ll go through the entire application process,” said Ted DeCorte, CEO at Consumer Assistance and Resource Enterprise, a nonprofit established specifically to implement the Affordable Care Act and enroll Nevadans in health insurance plans.

DeCorte’s group is one of seven organizations to receive $2,477,000 in grant money — funded by both the federal and state government — to do the outreach work. DeCorte's organization was awarded $200,000.

The state awarded the largest grant to the Ramirez Group, a polling and policy research firm typically aligned with the Democratic Party.

Their client, Know Your Care, received about $1 million from the state this year to help enroll the estimated 600,000 uninsured Nevadans in qualified health insurance plans before the Jan. 1, 2014 deadline under which all Americans must have health insurance or face a tax penalty on their 2015 tax return.

Starting next month, the Ramirez Group and others that received grants plan to help answer questions and guide consumers through the complicated health insurance market.

They’ll steer people to Nevada’s Silver State Exchange, an online marketplace created under the federal Affordable Care Act. The exchange is where consumers can compare insurance plans, see subsidies or benefits for which they may qualify, and enroll in an insurance plan. The effort is funded both by federal dollars, as well as fees the state assesses through the exchange.

Andres Ramirez, president of the Ramirez Group, says he’s doing the job to help people get insurance. But he acknowledged that many suspect ulterior motives.

“We’ve been criticized every day,” he said.

Ramirez said people call the office complaining that his organization is a bunch of “Obama cronies” using taxpayer dollars to implement Obamacare.

That last part is true.

“We’re going to spend federal dollars to implement Obamacare,” Ramirez said. “That’s what the law says. I don’t know why it’s a shock to people.”

Some Republicans in Congress have called for investigations of such navigator programs nationwide while Democrats have defended the programs as worthwhile.

But in Nevada, Republican Gov. Brian Sandoval worked to establish Nevada’s health insurance exchange and expand the state’s Medicaid program, two important parts of the Affordable Care Act.

Operating a state exchange has allowed Nevada to make its own rules for health navigators and escape much of the federal-level criticism.

“Politics doesn’t play a part in this at all,” DeCorte said. “It’s the law. Nevada got on board and formed its own exchange so it could control its own destiny.”

Contractors like Ramirez and DeCorte say they are doing this work for consumers because the president’s health care law has many nuances and requires lengthy explanations. Consumers face tasks such as determining their eligibility for federal tax subsidies or for Medicaid and what kind of insurance plan best suits their health needs.

In theory, Nevada’s health navigators will help answer questions and facilitate an easy purchase of insurance.

“We want educated enrollment facilitators helping citizens in the state,” said CJ Bawden, communications officer for Nevada Health Link, the exchange’s online website.

Bawden said the navigators differ from insurance brokers. They don’t receive payments from insurance companies and cannot be affiliated with insurance companies in any way.

“They can give examples of how each (health insurance) plan can help you, but they cannot expressly tell you which plan to choose,” Bawden said.

In order to become a navigator, applicants will have to go through certification courses, pass background checks, take several exams, and submit to regular monitoring of their activities.

“We have the strictest certification process in the United States,” Bawden said.

The navigators will have access to consumers’ personal information but will be monitored to ensure they’re not stealing data or steering customers to a certain insurance provider, he said.

“On an hourly basis, we can look and pull the numbers on all the in-person enrollment facilitators on each person they’ve enrolled and what plan they’ve been enrolled in so we can immediately see if they’re steering someone to a certain insurance provider,” he said.

Ramirez said he has 34 people going through the certification process.

Advocates for the health care law and health policy experts say that people may need help from navigators because of mass confusion about the law.

“There has not been a lot of information going out to individuals if they do not have insurance,” said Christopher Cochran, associate professor at UNLV’s department of health care administration and policy. “OK, we have Obamacare … what does this mean to me? What am I supposed to do?”

A recent poll from the Kaiser Family Foundation, a health nonprofit that has tracked the implementation of the law, showed that about half of Americans feel like they don’t have enough information about the law. Forty-four percent aren’t even sure whether the Affordable Care Act remains the law of the land.

The survey also says that just 3 in 10 people who are uninsured and low-income, a target demographic for state health insurance exchanges, have heard about the exchanges.

Hispanics, low-income individuals, the uninsured and young adults specifically feel as though they don’t have enough information about the law — demographic groups the navigators are targeting for outreach.

Cochran said he doubts the state government has an adequate number of employees to do this outreach work itself. And while many people report hearing about the health law in the news, the media ranks near last in sources people trust for accurate information about the health law, according to the Kaiser survey.

“There are going to be a lot of people who know something about being required to have health insurance at the beginning of 2014,” Cochran said. “They just don’t know what they’re supposed to do in order to get it. In that regard, the navigators will be vitally important for them.”

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