Navigators, assisters, and certified application counselors are the unbiased people who are there helping consumers understand what the Affordable Care Act means for them and the new insurance options available to them through the law. We want to elevate their voices to share the experience of enrolling people and asked enrollment specialists to share their experiences with us in their own words. You can learn more about our work on Outreach and Enrollment here.

“I don’t want anything to do with Obamacare!”

“I don’t want a ‘government’ health plan.”

David Stewart, a Navigator in Pennsylvania, stands outside of the Benford County Library, where he helps people understand their insurance options and enroll in coverage. I hear these or similar statements regularly. I am a Certified Application Counselor and Certified Navigator working out of a community health center in Bedford County, PA. I work in a low-income, rural and conservative area. “Obamacare” is not popular and that is my greatest challenge in helping people in my county learn about their insurance options and enroll in health coverage.

The hostility toward “Obamacare” has made it difficult for me to find venues for outreach. However, the most notable exception has been the Bedford County Library. I have regular hours at this public library each week, and I have found that it is by far my most successful place to meet with the public. Given how strong the opposition is to the ACA, I work very hard to be seen as neutral and avoid anything “political.” The library turns out to be a great place to talk about something that is unpopular and largely misunderstood.

When I first meet with someone, I state clearly at the beginning of our conversation that I can provide information and assistance, but not opinions. I also state that what they do with the information or assistance is entirely up to them. The first thing I explain is that there is not a “government-run” health plan. Frequently, people are surprised to learn that all of the plans offered in the Marketplace come from private insurance companies, and even companies that are familiar to them. I believe it is important for people to understand that if they enroll in a plan, they become the customer of an insurance company and not the government.

Another misconception is that the Affordable Care Act is another form of “welfare” or some kind of entitlement program. To debunk this view, I explain that the premium they pay is lowered by a tax credit, but only if they qualify for it. While “Obamacare” and taxes aren’t popular here, tax-credits are. Most people can relate to taking deductions when they file their taxes. I explain that it is different from other tax credits because it can be used on a monthly basis in advance of tax time. I also let them know that part of qualifying for the deduction is enrolling in a Marketplace purchased insurance plan. I have found that it is easy for people to grasp that the amount of the deduction is based on income.

I would estimate that about 80 percent of the people I meet with qualify for cost sharing reductions – financial assistance to help pay out-of-pocket health costs. When the effect of these reductions is explained, and more importantly shown to consumers through a series of slide presentations, they are more willing to continue the application process.  Once the application is submitted and consumers can view their anticipated costs with the tax credits and cost-sharing reductions, the whole atmosphere of our discussion changes and their relief is palpable. It is usually only after seeing how the cost-sharing reductions apply to them that they will say something like, “I have always wanted insurance and I am ok with paying for it. But, I don’t want a handout. I just couldn’t afford to pay the full cost.”

Even after illustrating the effects of the cost-sharing reductions, many individuals still don’t believe that the plans could be so affordable. I have encountered a lot of skepticism over the “see plans before I apply” results, which is a display page that lists the available plans based on the person’s age, income and location. If the results show just an estimate of their premium costs, they still feel unsure of what their actual costs will be. But by at least showing them their options, they become more interested in learning about the plans. To alleviate someone’s mistrust of what the results page shows, I suggest that we “apply as if,” in which we go through the entire application process but stop before enrolling in a plan. In doing so, consumers can view their actual premium costs and contemplate their options further before making a decision. So far, everyone who has been willing to get to the point of seeing their actual premiums has enrolled.

“How can I make too little money to get help?” That statement came from one of my youngest consumers and is a direct result of my state’s decision not to expand Medicaid. For me, explaining this coverage gap is the most disappointing part of my job. It is harder on me personally than the unpopularity of “Obamacare.” Many of the individuals I speak with are enrolling and getting insurance. However, those who fall into the “coverage gap” are still going without.  Even here in rural and conservative Bedford County, the Medicaid “coverage gap” is the hardest thing for most consumers to understand.

— David Stewart, Navigator