Here & Now

Healthcare Navigator Details Healthcare In WI

Frederica Freyberg:

Next Wednesday, November 1, the six-week enrollment period begins for health care under the Affordable Care Act. In tonight’s look ahead, we talk with one of Wisconsin's federally-certified navigators, who helps people looking for care in the ACA marketplace. Adam VanSpankeren is a health care navigator for “Covering Wisconsin.” The agency is funded in part by state and federal health agencies. Thanks very much for being here.

Adam VanSpankeren:

Thank you so much for having us.

Frederica Freyberg:

So how does this six-week enrollment period compare to previous years?

Adam VanSpankeren:

The six-week part, first of all, obviously, so previous enrollment periods have gone from November 1 to the end of January and have even been, in some cases, extended based on need that people still need to get insurance for the following year. This year it is cut down to six weeks. It’s just November 1 to December 15. And we’re expecting a lot of people to be struggling to make those times work and then just to navigate the system. So we are here to help with that.

Frederica Freyberg:

So why is that a struggle, that six-week period, as opposed to a longer one?

Adam VanSpankeren:

Sure. People have until December 15 to get insurance for January 1. Making the time to go online, to call the marketplace, whatever people are comfortable doing, it’s not easy. Insurance isn’t easy. So having to try and decipher that on your own is really hard.

Frederica Freyberg:

How do you help?

Adam VanSpankeren:

How do I help? How do we help as navigators? We sit down with people and we provide free, in-person assistance. We talk them through the website, show them how to enroll and really help them. We educate. We make it easy. We break down those tough insurance concepts and say. “This is what this means for you and your family.”

Frederica Freyberg:

How do people find a navigator?

Adam VanSpankeren:

Anyone can find a navigator by calling 211. Our website, CoveringWI.org, has a find local help feature. Healthcare.gov has a find local help feature. So searching online. Just knowing it is a navigator you’re looking for helps a lot.

Frederica Freyberg:

What kind of changes should enrollees expect in premiums or coverage?

Adam VanSpankeren:

So premiums go up every year. That’s true of health care universally. And we’re expecting premiums, even in Wisconsin, I think to go up by as much as 50% in some cases. That’s a lot of money. It was already a lot of money for people to paying. But the important thing is the tax credit, the discount that people see when they’re lower-income, and even people who do make kind of decent amount of money can still get a discount. That discount goes up when the premiums goes up. So what people see at the end of the day and what they’ll have to pay month to month could still be very affordable and probably will be for them.

Frederica Freyberg:

So is it expected that subsidies will cover the increases?

Adam VanSpankeren:

Maybe not 100%, but yes. Those tax credits go up. The discounts go up to manage those increases.

Frederica Freyberg:

Have you seen the effect of government spending on outreach and ads being cut by 90% this year?

Adam VanSpankeren:

I did see that.

Frederica Freyberg:

How so?

Adam VanSpankeren:

We — the federal government normally sends out a lot of different alerts letting people know that the marketplace is still there. There has been obviously a veil of confusion over the whole conversation with the different repeal and replace efforts. It’s important people know that Obamacare is there. The CMS, HHS, Health and Human Services will normally help us organize events and appear at those events to help kick off open enrollment and that has just been not forthcoming this year.

Frederica Freyberg:

And so navigators and places like “Covering Wisconsin” have had to do that themselves?

Adam VanSpankeren:

We do it ourselves anyway. The outreach is important. It’s critical, actually. But it seems more important than ever this year. A shorter open enrollment period, increased confusion, it’s hard. People need to know we’re still here. Tax credits are still here. Affordable insurance is still an option. Obamacare is still here.

Frederica Freyberg:

250,000 people, we’ve just checked, are currently enrolled in the ACA marketplace.

Adam VanSpankeren:

In Wisconsin.

Frederica Freyberg:

In Wisconsin. How many are out there that are not insured?

Adam VanSpankeren:

Wisconsin still has about 300,000 people who are still uninsured, which is kind of staggering to think about. We are doing our best to connect with those people, get them on the programs they should be eligible for. Children, families especially for BadgerCare, we help with that as well. That’s our local Medicaid program, to connect them to it. Most people are eligible for a tax credit on the marketplace. We can sit down during open enrollment with anyone and show them their options, show them how much they could save and how affordable insurance is.

Frederica Freyberg:

Have health insurers stopped selling plans in Wisconsin because of uncertainty or the loss of these cost-sharing reduction subsidies?

Adam VanSpankeren:

Sure. Yes, a number of insurers have pulled out of different markets in Wisconsin. We still have 11 major insurers in the state participating. In most areas there are two to three to four plans available for people to choose from. Not plans — companies — that is plans. They have many different plans on the marketplace to choose from. We still have a really healthy market here in Wisconsin.

Frederica Freyberg:

What's the bottom line advice for people seeking to enroll this year?

Adam VanSpankeren:

The bottom line is do it sooner rather than later. And if you need help, help is available. So go online, call 211, look for “Covering Wisconsin,” find a navigator. If I — insurance is never easy. And people have questions. I don’t want those questions to stop them from seeking help, because we’re here. We have the answers. We want to get you enrolled.

Frederica Freyberg:

If one were to call 211, find a navigator and have an in-person meeting, how long should they expect to take with you or someone else?

Adam VanSpankeren:

We tend to budget an hour and a half. It usually takes a lot less. We like to have that amount of time available to answer questions and to really help people feel good about the choice they’re making, to understand the many insurance things we talk about. And also I should mention going online to CoveringWisconsin.org, anyone can schedule an appointment with a navigator just by clicking the link there. We have our schedules up. You can find the next available appointment and book it yourself.

Frederica Freyberg:

Great information. Adam VanSpankeren. Thanks very much.

Adam VanSpankeren:

Absolutely. Thank you for having me.