Navigators: Assistance for the State Health Insurance Exchanges

In just a few short months, Texas will see the realities of one of the most significant changes in healthcare in decades. The Affordable Care Act is coming to Texas, and a big part of it will soon be available from your home computer.

While the state has decided against expanding Medicaid to cover an extra million or more Texans, a healthcare exchange is on its way to the Lone Star State thanks to the Affordable Care Act. This healthcare exchange will likely be a website where you can compare various different health insurance plans available to you. The decisions you make on this website regarding your health insurance coverage are very important.  But you will have help.

With the healthcare exchange come experts—Navigators—trained to help you understand how the Texas healthcare exchange works and ultimately, what’s important to you when it comes to health insurance. Navigators will understand and be able to explain everything from the technology behind the exchange to the vast resources available to you to help you decide which health insurance is right for you. A Navigator’s job focuses on providing information about the exchange and how it can help or impact you. A Navigator can help you get information about health insurance options and tax credits and help you enroll in a health insurance plan. Given the opportunity to interact with a Navigator, here are a few questions you may want to ask:

– Does the health plan cover my medications?
– Does the health plan use co-pays for doctor visits, hospitalizations, and medicine?
– How much do they cost?
– Are there any other costs to me?
– Can you explain those costs?
– Is there co-insurance?
– What does, “pay out of pocket” mean?
– Where do I go to file a complaint, or for information if I can’t find the coverage I need?

Funding for these navigators comes from the federal government.  Their job is not to make a decision about the best insurance for you, or even tell you which health insurance plan might be right for you. Navigators serve as an unbiased resource to help you collect as much information as you need to make the right decisions about your healthcare coverage. As much as navigators will help some uninsured Texans, the navigators themselves will need support as well.

State Attorney General Greg Abbott is Texas’ top consumer protector. If a health insurance company in some way wrongs a Texan involving the exchange, the grievance eventually lands on Abbott’s desk. He could not be clearer: he is against anything contained in the Affordable Care Act. And while Texas will not expand Medicaid, the U.S. Supreme Court ruled Texas and all other states must implement an exchange. Abbott will have the opportunity and power to ensure any potential problems with the exchange—how it is run, and how Texans sign up for coverage via the exchange—are avoided.

But the responsibility for ensuring a legal, proper, and consumer-protected healthcare exchange also falls to the Texas Department of Insurance. Julia Rathgeber is the Lone Star State’s new insurance commissioner. Rathgeber will have the ability to protect Texans and ensure the exchange truly offers Texans the healthcare coverage we need. Access to healthcare, in the long run, saves the entire state and healthcare system money, not to mention lives. Rathgeber will have the power to make sure health insurance companies provide adequate coverage of various healthcare needs on the exchange. And in conjunction with Abbott, Rathgeber must ensure Texans have appropriate ways to voice concerns and problems, and have access to an easy process to make official complaints about our exchange.

While the arguments can and will continue regarding the Affordable Care Act, a part of it is coming to Texas. Texans will start interacting with the exchange this year and will see its effects in place early next year. We look forward to our state leaders working hard to make sure the Lone Star State’s health insurance exchange provides the healthcare coverage Texans need.

Russ Williamson is the president and CEO of the Health Industry Council of North Texas and is a certified Strengths Performance Coach by The Gallup Organization. Contact him at rwilliamson@thicntx.org

Posted in Expert Opinions.