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“News People Can Actually Use”: The Media Needs To Do More To Help People Navigate Obamacare

Yesterday, Tim Noah made a point in an MSNBC appearance that I think deserves a lot more attention. Media outlets have been doing lots of reporting on the problems of the Affordable Care Act rollout. What they haven’t done is provided their audiences with practical information that could help them navigate the new system. Of course, most Americans don’t have to do anything, since they have employer-provided insurance. But for all the attention we’ve been paying to the individual market, media outlets haven’t done much to be of service. “The New York Times has published the URL for the New York exchange exactly twice,” Noah said, “both before October first.”

My experience in talking to journalists about the publication of this kind of thing—unsexy yet useful information, whether it’s how to navigate a new health law or understanding where candidates stand on issues—is that they often think that addressing it once is enough. When you ask them about it, they’ll say, “We did a piece on that three months ago.” The problem is that for it to be effective, they have to do it repeatedly or people won’t get it. What we have seen is that this information can be found somewhere on news outlets’ websites (here’s an example), but it isn’t on the evening-news broadcast or in the print edition of the paper.

Of course, conservatives would allege that if a newspaper writes a guide to getting insurance through the new exchange, it has demonstrated its liberal bias and become an arm of the Obama administration. But it’s the law. As of next year, if you don’t get insurance through your employer, you need to go to an exchange. Media outlets would just be helping people do what they have to do. I suppose conservatives could also argue that if the local paper puts up a tool on its website that helps people find their polling places and tells them what the voting hours are, it’s just trying to boost turnout, and everybody knows that helps Democrats. Or that if it reminds you to file your tax returns on April 15th, then it’s just helping fund big government. Or that if it tells you to set your clocks back for daylight savings, it’s just feeding the Illuminati/Bilderberg time-theft conspiracy.

People sometimes mock “news you can use” because it’s often delivered in forms that aren’t particularly useful (“There’s a silent killer in your refrigerator right now!”). But helping citizens understand and respond to changes in the law is part of any major media outlet’s mission. The fact that a law is controversial doesn’t absolve them of the responsibility.


By: Paul Waldman, Contributing Editor, The American Prospect, November 27, 2013

November 29, 2013 Posted by | Affordable Care Act, Journalist, Media | , , , , , | Leave a comment

“Obstructing Obamacare Navigators”: The Republican Suppression Syndrome Continues

On August 15th, Jodi Ray, a project director at Florida Covering Kids and Families, a University of South Florida program that works to get uninsured children access to health care, won a federal grant to hire ninety people as health-care “navigators”: workers who will help applicants apply for insurance through the exchanges set up as part of the Affordable Care Act. In states that declined to set up their own exchanges, like Florida, the Department of Health and Human Services awarded funding worth sixty-seven million dollars for outreach efforts to help the uninsured enroll through the federal marketplace. Nearly four million people in Florida are uninsured—the third highest figure in the country—and Ray had six weeks to recruit staff from community-service groups in sixty-four counties across the state, and guide new hires through twenty hours of online federal training attached to her grant.

“But our navigators don’t only have to comply with federal requirements for the training,” Ray said. “We have state requirements that we have to comply with, too.” Last spring, the Florida legislature, apparently concerned that swindlers would land jobs as health-care experts with access to Social Security numbers and tax information, decided that the navigators should undergo fingerprinting and criminal background checks, and barred them from visiting state-run health clinics. Ray preferred not to comment on what the advocacy group Healthcare For America Now calls “navigator-suppression measures.” She only said, “I’m keeping my head down, the noise out, and focusing on what we are supposed to be doing.”

After the government shutdown ended, attention shifted to the blips and seizures bedevilling the federal marketplace’s Web site, Thirty-four states, all but seven of them Republican-controlled, chose not to set up their own exchanges, leaving hundreds of millions of dollars in outreach funding on the table, and forcing their residents onto the federally-operated Web site at the center of the current uproar. Twenty-one of those states are also expected to refuse nearly three hundred billion dollars in federal funding to expand Medicaid coverage over the next decade, which would have extended care to more than six million people; a majority of those excluded will likely be African-Americans and single mothers. To compound the effects of their recalcitrance, conservative governors, state legislators, and members of Congress have also passed navigator-suppression measures in thirteen states—Arkansas, Florida, Georgia, Iowa, Illinois, Indiana, Maine, Missouri, Montana, Ohio, Tennessee, Texas, and Wisconsin—home to seventeen million people without insurance who are eligible for coverage under the A.C.A.

Two weeks after Ray received her grant, she was notified by the House Energy and Commerce Committee that she would have to participate in a phone interview with the committee’s staff in September; she was also asked to give written answers to half a dozen questions from the committee and provide “all documentation and communication related to your Navigator grant.” Similar notifications were sent to navigator offices in eleven of the most underinsured states in which residents will need to use the federal health-care exhange—including Texas, Florida, and Georgia, home to about a quarter of the nation’s uninsured. Representative Henry Waxman, a Democrat from California, protested, in an open letter to the committee’s chairman, Michigan Republican Fred Upton, that the requests appeared “to have been sent solely to divert the resources of small, local community groups, just as they are needed to help with the new health care law.”

On September 18th, Darrell Issa, the Republican chairman of the House Committee on Oversight and Government Reform, released a report that singled out Florida as the site of “numerous reports of scam artists posing as navigators and Assisters to take advantage of people’s confusion about ObamaCare.” On October 2nd, Fox News aired footage of volunteers for Get Covered America, a non-profit advocacy campaign, going door-to-door in a Miami suburb to distribute flyers about the new insurance marketplace—but wrongly identified them as federally-funded navigators, giving the impression that these “navigators” were hawking plans like pushy insurance salesmen. Upton linked to the report on his Web site. Ray, who still spends much of her time getting new navigators licensed while the federal government fixes the Web site’s glitches, was reticent about discussing the maelstrom of controversy. “It’s been busy,” she said.

As these tactics jam up early efforts in many states, they also amplify the contrast with successful rollouts in states that have wholeheartedly embraced the new law, like Colorado, Connecticut, New York, Kentucky, and Washington.

Elisabeth Benjamin, who leads New York’s largest team of navigators at the Community Service Society, spent much her early career improving health-care capacity in developing countries like India, Tunisia, and postwar Iraq—where, she said, people often told her, “I don’t understand why you’re in our country. You have a lot of problems with health care and poor people in your country.” Back home, she started a health-law unit at the Legal Aid Society to assist low-income New Yorkers with unforgiving medical bills. In 2008, she unveiled an insurance ombudsman program at C.S.S. to help people at every income level understand their options for medical coverage. “If you need a loaf of bread, it’s a buck,” she said, explaining health care’s central distinction from other forms of assistance. “If you need a transplant, it’s five hundred thousand dollars.”

Around the same time Benjamin was starting her program, Eliot Spitzer, then the governor of New York, proposed statewide health-care reform similar to the law Massachusetts had passed four years earlier. Vermont’s legislature had expanded coverage, and Arnold Schwarzenegger had made national news by calling for a similar program in California. Benjamin joined an affordable-health-care advocacy campaign, Healthcare for All New York, and testified before the New York State Legislature. “We just assumed there would be a state-by-state movement to extend coverage,” Benjamin said. But two years later, the Obama Administration, with the help of a Democrat-controlled House and Senate, passed the Affordable Care Act. New York’s governor, Andrew Cuomo, along with the state legislature in Albany, accepted the expansion of Medicaid, and the state established its own online exchange. After the Supreme Court upheld the constitutionality of Obamacare, in June, 2012, Cuomo released a statement that said, “We look forward to continuing to work together with the Obama administration to ensure accessible, quality care for all New Yorkers.”

That spirit of coöperation has been integral to New York’s early success. Elisabeth Benjamin, in New York, and Jodi Ray, in Florida, offer exactly the same services to people who were previously unable to obtain medical coverage: they help determine voucher amounts, parse available options, and submit applications online, over the phone, or through the mail. But because New York set up its own exchange, the state received twenty-seven million dollars to fund its navigators, while Florida has just eight million dollars for outreach. Benjamin, who is herself a trained navigator, conceded that there were glitches on New York’s Web site the first week, but said that most of them have been resolved. In the second week, she helped enroll a woman who had worked as a home-health-care aid for twenty years, earning around twenty-four thousand dollars annually. Home health care “has to be the hardest job in America—so physically taxing and emotionally draining,” Benjamin said. “And we don’t give them health coverage. Are you kidding me? They’re part of the health-care system.” Benjamin helped find a plan for the woman that costs seventy-two dollars a month. “I was crying,” Benjamin said. “That’s what it’s all about.”

For the A.C.A. to succeed in its goal of providing coverage for all citizens at an overall reduction in cost, a critical mass of people—old and young, sick and healthy—will need to participate in the insurance exchanges. As of October 23rd, New York had enrolled thirty-seven thousand people, more than twice the goal set by H.H.S. for the entire month of October. Florida won’t know how many people have enrolled until H.H.S. releases its figures sometime in November. The Congressional Budget Office has estimated that a total of seven million people nationwide could enroll in the first year. But Dr. Kavita Patel, a health-care-reform expert at the Brookings Institution, and a former policy advisor in the Obama Administration, told me, “If by the end of 2014 there are three million people enrolled, that would be a success.” The politicians who are currently bemoaning the looming failure of Obamacare might consider doing more to help navigators like Jodi Ray make it work.


By: Rob Fischer, The New Yorker, November 1, 2013

November 6, 2013 Posted by | Affordable Care Act, GOP, Republicans | , , , , , , | Leave a comment

“What’s Really Obstructing Obamacare?”: An Orchestrated GOP Resistance With Only One Very Ugly Precedent

So we’re a month into the Obamacare era. What does your average American know about it? That the website is a mess, and some number of Americans have suddenly lost their coverage after Barack Obama assured them that wouldn’t happen. These things are true, and a person would be quite wrong to deny this is deeply problematic.

But I wonder how many Americans know the other side of the coin. There are already numerous success stories out there. And then there’s the side of the story that has certainly received coverage but not nearly as much as it deserves to, which is the way—did I say way? Ways—the Republican Party is trying to make sure it fails. Todd Purdum wrote a piece for Politico yesterday on the GOP’s “sabotage” of the law. It was a terrific article, but he didn’t say the half of it.

All across the country, Republican governors and insurance commissioners have actively and directly blocked efforts to make the law work. In August, the Obama administration announced that it had awarded contracts to 105 “navigators” to help guide people through their new predicaments and options. There were local health-care providers, community groups, Planned Parenthood outposts, and even business groups. Again—people and groups given the job, under an existing federal law, to help people understand that law.

What has happened, predictably, is that in at least 17 states where Republicans are in charge, a variety of roadblocks have been thrown in front of these folks. In Indiana, they were required to pay fees of $175. In Florida, which under Governor Rick Scott (who knows a thing or two about how to game the health-care system, you may recall) has been probably the most aggressive state of all here, the health department ruled that local public-health offices can’t have navigators on their premises (interesting, because local public health offices tend to be where uninsured people hang out). In West Virginia, Utah, Pennsylvania, and other states, grantees have said no thanks and returned the dough after statewide GOP elected officials started getting in their faces and asking lots of questions about how they operate and what they planned to do. Tennessee issued “emergency rules” requiring their employees to be fingerprinted and undergo background checks.

America, 2013: No background checks to buy assault weapons. But you damn well better not try to enroll someone in health care.

If you Google “Obamacare navigators,” you will be hit smack in the face with the usual agitprop. “Reports” raise “questions” about their qualifications, you see. This is the old trick of finding one bad apple and extrapolating away to beat the band. But in this case the alleged bad apple wasn’t even bad. One enrollment assister in Lawrence, Kansas—one!—had an outstanding warrant. She hadn’t even been aware of the warrant. The group she worked for said, apparently credibly, that the warrant was “no longer active.” (Interestingly under the circumstances, it was about… an unpaid medical bill!) But my favorite story linked—inevitably—the navigator program to ACORN. You will recall that no one ever proved that anybody from ACORN ever did anything wrong, but of course in right-wing land this means nothing.

A second front: Now, with people trying to sign up, some Republican legislators are openly saying that they won’t permit their staffs to answer constituents’ questions about Obamacare. This is really the main job of a member of Congress, especially a House member: People call up all the time with questions about how to slice their way through the federal government’s briar patches, and you have caseworkers on duty—typically a couple in Washington and several more back home in the district regional offices—whose job is exactly that.

Purdum quoted Kansas Rep. Tim Huelskamp as saying he instructs his staff to refer callers to Kathleen Sebelius. But Huelskamp is not alone. Tennessee’s Diane Black says she doesn’t feel comfortable referring people to navigators. Utah’s Jason Chaffetz is referring people back to the administration, saying: “We know how to forward a phone call.”

Someone I know asked the other day: Has there ever been a law in the history of the country as aggressively resisted by the political opposition as this? Republicans didn’t do this with Social Security. Most of them voted for Social Security. They didn’t do it with Medicare. They, and the Southern racists who were then Democrats, didn’t do it with civil rights. There was a fair amount of on-the-ground opposition to that, but it wasn’t orchestrated at the national level like this was. And when the Voting Rights Act was passed the year after civil rights, Southern states in fact fell in line quickly. Check the black voter-registration figures from Southern states in 1964 versus 1966. It’s pretty amazing.

No, to find obstinacy like this, you have to go back, yes, to the pre-Civil War era. The tariff of 1828, the Kansas-Nebraska Act, which led to the civil war in “Bloody Kansas” and ultimately to the Civil War itself. Not a comforting thought. But it’s where we are.

The administration’s cockups are a legitimate story. I’ve never said otherwise. My first column about the website was quite tough on the administration and on Obama personally, when I wrote that I found it shocking that he apparently wasn’t riding herd on staff to make damn sure the thing worked. I said on television, to some host’s surprise, that yes, I did hold him accountable for the mistakes.

So I get why that’s a story. But the sabotage is a story, too. A huge one. It’s almost without precedent in American history, and the precedent it does have includes some of the ugliest chapters in this nation’s history. It gets coverage, yes. But not nearly the coverage it deserves. As is so often the case—as with Benghazi, as with Fast and Furious, as with the IRS—the bigger scandal is on the Republican side.


By: Michael Tomasky, The Daily Beast, November 1, 2013

November 3, 2013 Posted by | Affordable Care Act, GOP, Obamacare | , , , , , , | Leave a comment

“Health Care Sabotage 101”: The GOP, Not A Botched Website, Is The Real Obstacle To Implementing Obamacare

It’s the latest chapter of Barack vs. the Health Care Killers, The Continuing Saga of Posturing, Bad Faith, Spite and Ineptitude.

Republicans, who have used every trick in their playbook to gum up the works of the Affordable Care Act, are now holding hearings to investigate how the works got so gummed up.

They could save themselves the trouble by looking in the mirror, just as O.J. Simpson could have done to find his wife’s killer. But that would rob them of the chance to grandstand.

In fairness, they do have one point. The Obama administration botched the debut of its insurance marketplace website so badly that it fairly begged for an investigation. And since Republicans had little or nothing to do with the website, the blame for its failures falls squarely on the president and his deputies.

The screw-up was a gift. GOP lawmakers were calling the law a failure before most of it went into effect, but lacking any evidence they had to rely on mere accusation. Now, finally, they can say that their worst predictions had some validity.

Nevertheless, Republican “outrage” over the glitches is hard to take seriously. If they’re really looking to find what went wrong — and there was plenty — one suspects it’s only so they can clone the virus. Then anyplace where the law is working, such as Kentucky, Washington and Oregon, they can infect the system, watch it crash, shake their heads and snicker.

Come on, folks. Republicans want to “fix” what’s broken here as much as they want to “protect” women by targeting their reproductive rights and “defend” the vote by obstructing it. But because went live on the same day that the party crazies shut down the government over the law’s funding, they were too deep in their own morass to capitalize on it. Worse, they had to fold on the shutdown without getting anything in exchange. No wonder they’re pouncing on the chance to grill the people whose job it was to enable what they’ve called the worst law in the history of man.

Yes, the administration deserves to be on the hot seat. There was more than enough time to make sure the website worked properly and there is no excuse for its failure to do so.

Mr. Obama had to know that the first weeks would set the tone for public perception. If he had wanted to raise doubts about the program or shoo people away, he couldn’t have done a better job of it.

Once again, we have to wonder what goes on in his mind. This legislation is only the most important accomplishment of his presidency. He put everything on the line for it. Millions of people are counting on it for coverage they cannot otherwise afford. If he can’t get the introduction right, well, let’s just say it’s a good thing he won’t be running again.

But then there’s that pesky caveat called perspective. A botched website, which can and will be repaired, is nowhere near the biggest obstacle to the success of health care reform. That distinction goes to the program’s sworn enemies, who have been conducting a misinformation campaign of false claims and scare tactics since the law was passed. To hear them tell it, “Obamacare” will turn people into devil worshipping socialist homosexual vegetarians who want the terrorists to win. So of course they will do everything they can to stop it.

Exhibit One: The quickest and easiest way for states to enact the law’s reforms is to expand Medicaid, which would trigger a huge infux of federal dollars for the first several years. Yet Republican governors in 26 states have refused to do so. The primary excuse is that they won’t be able to afford it once the federal money stops. The subtext is that they’d rather sabotage the president than help their own citizens get the treatment they need. Thanks to them, according to a New York Times analysis, the new law will leave out two-thirds of the nation’s black citizens and single mothers, and half of the low-wage workers who currently lack insurance.

In addition, GOP governors (including our own Tom Corbett and, regrettably, a few Democrats) have refused to create insurance exchanges that would facilitate reaching the uninsured. Instead, those people will have to go to the federal exchange.

They’re also refusing to assist applicants and blocking the use of so-called “navigators,” whose job is to help people understand the law and sign up for its benefits. When a constituent calls with questions, they are making sure they’ll get no answers.

Then there was the government shutdown, during which Republicans offered more than 40 measures to cripple the law. They failed in every sense, but it still cost the country $24 billion.

It doesn’t take a genius to see where the real obstruction lies. For all its screw-ups, the Obama administration is trying to make health care reform work. And for all their public posturing, Republicans are trying to ruin it. But the law was duly passed, it’s here, and it’s not going away. They should save the fake righteousness for a cause that isn’t already lost.


By: Sally Kalson, Pittsburg- Post Gazette, October 26, 2013

October 28, 2013 Posted by | Affordable Care Act, Obamacare, Republicans | , , , , , , | 1 Comment

“Hurting Real People Who Have Real Needs”: Republicans Are Suppressing Obamacare Enrollment

Republicans have done everything they could think of to repeal, defund, undermine and otherwise disrupt Obamacare. But they’ve failed, and that’s why they’ve turned to a last-ditch strategy to stop the law and take away the rights of millions of Americans to get the health care they need.

Governors and state legislators are adopting state laws and regulations to sabotage the work of “navigators,” the community organizations that will help consumers sign up for care. We are witnessing navigator suppression, and the Republicans’ objective is simple: the harder they make it for navigators to do their jobs, the harder it will be for people to benefit from Obamacare.

Republican governors in 21 states are already denying more than 5 million people health care by refusing to expand Medicaid. Navigator suppression is another way for the Obamacare haters to pile on and limit the reach of the law.

In a new report, Health Care for America Now conducted a detailed review of the most egregious laws and regulations found in 13 selected states: Arkansas, Florida, Georgia, Iowa, Illinois, Indiana, Maine, Missouri, Montana, Ohio, Tennessee, Texas and Wisconsin. These states are home to 17 million people without health insurance who are eligible for coverage under the health care reform law–fully 41 percent of the nation’s uninsured.

The excessive requirements we found include such things as residency rules, extra fees, additional and unnecessary training requirements, superfluous certification exams, and prohibitions against navigators talking with consumers about the benefits offered by different plans. These measures constitute direct interference in the enrollment process.

For example, in Missouri, state and local officials are barred from providing any assistance to an exchange. In Florida, the Department of Health released a directive prohibiting navigators from conducting outreach at any of the county’s 67 health departments. Fortunately, two big counties, Broward and Pinellas, are ignoring the order.

And just this month, Texas Gov. Rick Perry ordered the Insurance Commissioner to write new navigator regulations that require, among other things, that navigators complete 40 hours of training in addition to the 20 hours required by the ACA and then pass a “rigorous” state exam. Perry is even trying to limit the hours of navigator operations to 8 a.m. to 5 p.m. None of these rules is going to help get people covered in Texas, which has the nation’s highest percentage of uninsured residents.

These roadblocks and restrictions have caused groups to withdraw from the program and return their navigator grants. This is why President Obama in Maryland today criticized the Republicans for creating these sorts of “roadblocks” for the “churches and charities” working as navigators to educate the public about enrollment.

The Republicans claim these laws are about protecting consumers. But Georgia’s commissioner of insurance cleared that up when he boasted on video that he was doing everything he could to be “an obstructionist” to Obamacare.

Some of the Obamacare opponents may think they’re attacking the President or the law, but mostly they’re hurting real people with real health care needs. They’re making it harder for people to buy health care. This isn’t just an abstract political debate. For people without health insurance, this is about whether or not they can get medical care and get it without going bankrupt.

In a growing number of states, navigators are turning back their grants to help consumers because of navigator suppression policies.

Cincinnati Children’s Hospital Medical Center, for example, which was planning to enroll people at three hospitals, turned back $124,000 in federal grant money because of state restrictions that went into effect this past July.

Cardon Outreach was going to educate people in Florida, Oklahoma, Pennsylvania, and Utah. It returned its $833,000 grant.

In West Virginia, the Attorney General, Patrick Morrisey, a vocal opponent of the ACA, launched a harassment campaign against one of his state’s navigators, West Virginia Parent Training and Information. Morrisey posed dozens of questions to the group about its navigator program and gave them only 14 business days to respond. Instead, the organization decided to send back its $366,000 enrollment grant.

The Lower Rio Grande Valley Development Council along the Texas border with Mexico just returned $288,000 in navigator grant funds this week in response to Perry’s attack, and four other Texas navigator groups reportedly may follow suit.

These state officials have taken their cues from members of Congress. Republicans on the House Energy and Commerce Committee sent letters to 51 groups in 11 states, including food banks, legal aid societies, and United Way organizations. The committee demanded that these groups produce reams of paperwork about their operations and schedule a briefing of the committee by Sept. 13. The only purpose of the inquiry was to interfere with the ability of these groups to prepare for enrollment. That’s sabotage, and it’s a politically motivated abuse of power.

Many of the states now going after navigators are also passing laws to suppress voter registration and make it harder for minority, low-income and elderly residents to participate in elections. Just like voter suppression, enrollment suppression is an attack on people’s right to be healthy and free from financial hardship and bankruptcy.

That’s why navigator suppression shocks the conscience: it perpetuates the systematic denial of affordable health care to huge numbers of the most vulnerable individuals in our society, especially those in minority and lower-income populations.

Thanks to Obamacare, Americans no longer have to worry about getting the health care they need. They only have to worry about the Republicans taking it away.


By: Ethan Rome, Executive Director, Health Care for America Now; Health Care for America Now Blog, September 26, 2013

September 29, 2013 Posted by | Affordable Care Act, Republicans, Rick Perry | , , , , , , | 1 Comment


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