The success of the Mississippi Health Access Collaborative (MHAC) in south Mississippi can’t be measured simply by the number of health insurance enrollees through the federal government’s Affordable Care Act – though the program met its goal with 2,000 over three years.
Much of MHAC’s good work goes unnoticed: About 70 percent of that work has been resolving consumer issues with accounts, taxes, and other insurance eligibility questions, says MHAC project director Kathryn Rehner. She says the grant-funded program also helps those who are eligible sign up for Medicaid or CHIP (Children’s Health Insurance Program) coverage.
In total, the program has helped more than 38,000 south Mississippians navigate the complexities of the federal health insurance marketplace.
Unfortunately, those services to the state’s 24 southernmost counties will officially end Sept. 12 when its three-year federal funding runs out.
Hopes to extend the program were dashed with the decision by the Trump administration, announced July 9, to cut nearly 75 percent of the funding for ACA “navigator” programs like MHAC. That reduction, from $36 million to $10 million, comes nearly two years after a decrease from $63 million.
“My view is that these cuts are further attacks on the Affordable Care Act, which has been a despised object from the beginning of this administration,” says Southern Miss School of Social Work professor Michael Forster, a co-Principal Investigator who helped apply for and manage the grant. “Failing to kill ‘Obamacare’ outright through repeal legislation, the administration set a course of bleeding it out; as the saying goes, it’s ‘death by a thousand small cuts.’ ”
With only $100,000 in guaranteed funding per state after the latest cut and the possibility of splitting that money with a second navigator program in Mississippi, Forster says the project team decided not to apply for another year.
“We’ve always met our goals, which is a great testament to what we’re doing here,” Rehner says. “We’re a mediator between people and this big healthcare system that is complicated and difficult to access.
“We can’t track how many actually call the marketplace or sign up on their own after they talk to us. They may start the application and want to take it home to finish. So a lot enroll themselves in a plan.
“When critics say navigators are responsible only for one percent of the enrolled population, they are only looking at people who completed and enrolled in the plan based on a navigator ID number. There’s no good way to measure the impact we have in the way they’re tracking it.”
Mississippi and 33 other states that did not support expanded Medicaid coverage wound up in 2015 with navigator programs to assist the uninsured in enrolling through a federally managed health insurance marketplace.
The problem for many Mississippians – as many as 300,000 – is that they are not eligible for any kind of federally subsidized insurance program; these “working poor” make too much money to be eligible for Medicaid and yet not enough to pay for insurance through the marketplace.
In the latest state-by-state Census data available (2016), Mississippi had the sixth-highest percentage of uninsured, at 11.8 percent, and the highest poverty rate at 20.8 percent
To be eligible for marketplace enrollment, a single person must earn at least $12,140 and a family of four around $25,100 according to Rehner.
“It’s like looking for needles in a haystack,” she says of trying to find marketplace-eligible enrollees. “You can’t walk down the street and touch everyone and say, ‘You’re eligible.’ ”
She estimates 90 percent of enrollees are single mothers, though there are also some elderly or disabled enrollees. The unfortunate part of her job, she says, is when someone can’t be covered by any plan.
“A good 10 to 15 percent of what we do every day is telling people they’re not eligible in the state of Mississippi,” she says. “We take time to explain why they’re not eligible for what would allow them to be eligible for Medicaid or Medicare, so they understand the predicament they’re in.
“We don’t want to just say sorry, you’re not eligible. We spend a lot of time talking people down. We try to refer them to other services, like federally qualified health centers or some free clinics in the area or prescription programs we can connect them to. It’s piecemeal healthcare, but it’s something to ease the burden for them.”
Along with the funding cuts, the federal administration has now opened up the marketplace to insurance coverage that doesn’t meet consumer protection standards outlined in the originating ACA legislation, according to the New York Times.
“A lot of those (new) plans are like, “We’ll pay you $100 if you get the flu or $300 if you break your arm,’ ” Rehner says. “It’s not really insurance in the sense that most people are used to, being covered by a percentage or 100 percent preventative care. What bothers me is people think they have full coverage when they sign up and they get sick and are stuck with a huge bill.
“They come to use and say, ‘Can you help fix this? I have insurance but I don’t understand why I have to pay.’ Well, you don’t really have full insurance coverage. The whole ACA is about protecting you from financial disaster. The people who sign up (for non-standard) plans will be the people who can’t afford the compliant ones. But I guarantee you, every single one of them thinks they have full coverage.”
Forster has few regrets. “We’ve done good work under demanding circumstances and in a shifting political environment. Kathryn and her team deserve all the credit for our success. My biggest regret is not the attack on the navigator program per se, but that the county is reneging on its responsibility to address the health care needs of working Americans.”
Contact MHAC: If you need assistance with your health insurance through Aug. 31, you can visit MHAC at 301 W. Pine St. in Hattiesburg, call 601.596.68.59 or email firstname.lastname@example.org.