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MNsure navigator: 'Doing group enrollment events has really worked well'

Part of a series of first-person accounts relating to news events of 2013.

Rebecca Lozano
MinnPost photo by James NordRebecca Lozano

Rebecca Lozano is a certified MNsure navigator and the outreach program manager of Portico Healthnet, an organization that has assisted people with finding health coverage for nearly two decades, mainly focusing on public programs.

Portico received a $378,000 outreach grant from MNsure in October, which allowed them to hire four full-time navigators on top of their existing staff.  The organization has so far helped nearly 300 people get coverage for Jan. 1.

Lozano recalls the first outreach event she did in mid-October, where she helped a roomful of people at the Dakota County Public Library in Apple Valley begin accessing health coverage:

It was really kind of a computer-lab type setting . … All and all, I think there were 27 people there that night… so we had really good turnout for the event. Most people were able to create accounts, so most people actually got enrolled, but it was still rather early, so we didn’t necessarily know a lot about strategies in working with the application and the system and things like that.

I remember one family in particular that their daughter was now going to be eligible for Medical Assistance and didn’t have any type of insurance prior to that, so they were really excited about it. ...

MNsure is a huge deal. MNsure is probably the biggest deal that I can think of. … It’s really the biggest impactful change in health care since Medicare. The ability for somebody to go and essentially get their own health care, get their eligibility determination in real time is a really, really big deal for people.

Prior to Oct. 1… we were getting people enrolled in many of the state health care programs, in addition to helping people find any community resources. And also enrolling people in our alternative-care coverage program that we have at Portico, so we work constantly to connect people with the right program at the right time. And that’s what Portico has been doing for the past 19 years.

I think we kind of anticipated [changes from the Affordable Care Act] before it even happened. We were gearing up for it. … We really tried to hit the ground running with our approach. And we had talked about different ways that we were going to do enrollments, by sending our navigators out to different community centers and food shelves because we anticipated that the client need was going to be so much greater with these policy changes. So, we really had a plan in place to meet that challenge.

As the system continues to improve and our knowledge of how to use the system improves, doing those group enrollment events … has really worked well, and so we’re definitely working on expanding that approach.

Minnesota Moments 2013People can be surprisingly patient. They know that this is a new system. They know that there’s going to be some potential challenges, and we try to be as honest as we can with people. … Either way those people will be getting enrolled. It’s just a matter of when.

I actually interacted with one woman who was actually getting insurance for the first time [at the Dakota County event]. Even the computer system was brand new for her, so I spent some time with her, explaining the system. …

I remember her being really confused as to how you create your username, why can’t her username be her password as well, and basic things that a lot of people don’t necessarily think about, especially people where their reality is a lot different from my average reality, for example.

She was so proud … that she was able to make that account for herself and she was really, really happy to be able to have that opportunity [to be on MinnesotaCare].

I felt really good. It was the first time to be able to do enrollments, and to have a few of them be successful was really exciting. The event before that event, the system was down. … Another navigator from here, she went to that and came back [to report that] ‘People were upset. They had really big expectations for this, and it was one of the first events.’ …

She was really disheartened, so my expectations were really low for the second event. But it turned out so well and I was just thrilled. I mean, it was fantastic.

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Comments (11)

By the numbers ...

"Portico received a $378,000 outreach grant from MNsure in October, which allowed them to hire four full-time navigators on top of their existing staff. The organization has so far helped nearly 300 people get coverage for Jan. 1."

Since it is Jan. 1, what better day to consider the math? Without the grant, Portico would still be pursuing their mission of assisting people with the search for healthcare. This fact will have the effect of understating the cost per person assisted, as the budget and staff of Portico is not stated.

$378K / < 300 = $1300 per person, an amount that would buy some of the enrollees a full year of insurance.

Four navigators hired to assist enrollment of less than 300 people over three months, divides down to one help for each navigator each business day.

Mind you, this is the Affordable Care Act. Affordable for whom?

Forbes reported on a comprehensive 49 state analysis by the Manhattan Institute. Read about it in the link below, which includes an interactive map. The most salient point, "Obamacare will increase underlying premiums by 41%."

Only the federal government could name a program that sharply increases the cost of medical insurance the "Affordable Care Act." Seriously, you cannot make up stuff this good.

http://www.forbes.com/sites/theapothecary/2013/11/04/49-state-analysis-o...

Forbes and the Manhattan Institute

The Bobbsey Twins of the Right.
The usual creative math; comparing the number of people enrolled in the first three months of a program with the cost of a grant which will probably run for several years. Certainly the funding will be for at least a year.

And why only 49 states?

And your Forbes link is also broken, so I can't see how they cooked their numbers.

Enrollment costs

Hey, Steve. Before we start calculating the cost per enrollment, don't you think it would be a good idea to know how long the outreach grant lasts? Or might we have done your sort of figuring after the first ten enrollees when the costs would have been $37,800 for each one? Gee, that sounds expensive. But the next one would have cost nothing, which sounds like a really good deal!

Rebecca, I certainly hope you are proud of the valuable work that you and your colleagues do. Thank you and Happy New Year!

Show me the money?

Paul and Frank:

Reference an analysis that shows that the “Affordable Care Act” is affordable.

Is the Bobbsey Twins a negative reference? Rather than a vague attack of the sources of study and publication, show me some numbers to support your position that the ACA isn’t unaffordable. In other words attack the message instead of the messenger.

If interested in the Forbes analysis, click on my link for Forbes, and type “obamacare” in the search box at the upper right corner. The first article of the search is the one to which I refer.

The study indicates that health insurance costs will increase in 41 states and decrease in 8 states. The website for Hawaii was not able to be mined for the cost data; it seems it is more broke than the Minnesota site.

So the grant money has not all been spent? MNsure granted moneys to be spent after the deadline, the deadline beyond which the Obama administration promised that citizens would be fined? I can’t find that in the article above, so perhaps you can help.

I thought the goal was to get everyone signed-up before the deadline. If so, it appears that the grant spent $1300 per person to do so. For a reference to which we can all relate, let’s consider income tax preparation. I happen to know from experience that a married couple with children, with one of the adults self employed and home officing, can get their federal and state income taxes professionally prepared and submitted for $250. So for the price of five years of tax preparations, one person can be helped to navigate the the MNsure website.

That is one tough website.

You made the claim

It's up to you to support it.
I did eventually find the study; you have to download another study behind a firewall to see their actual methodology.

And healthcare enrollment and participation is an ongoing process, not limited to a three month period, even though there's a surge of activity at the beginning.

Refute the Claim or Accept It

Here it is, Paul. This is the most comprehensive study of the state and federal healthcare market places. And, it is really not that hard to find. It is in its third revision, updated as state and federal markets have made data available. Did I mention that it includes an interactive map of 49 states and D.C.?

http://www.forbes.com/sites/theapothecary/2013/11/04/49-state-analysis-o...

The deadline was December 23rd for having insurance on January 1. Nowhere in the article did it state that MNsure was funding sign-up assistance after the deadline; that certainly seems counter to their goal.

So let's take a look at that methodology

In a nutshell, they took "the five least expensive plans (by monthly premium) for the most populous zip code in every county." - with a dubious adjustment for preexisting conditions - and compared those with the the 5 least expensive ACA plans - plans that do not have exclusions and lifetime caps.

In other words, their apples-to-oranges methodology virtually guarantees that the crapiest pre-ACA plans were used for a baseline. Not surprisingly, they found that the cost increased.

Just some psuedo social science intended for consumption in the echo chamber.

And, this is where we find ourselves

Recall, that one of the lies, or misleading statements if you prefer, was that the Affordable Care Act would reduce the annual healthcare bill to the average American by $2500. Our President said it multiple times, and it was happily parroted by the media.

So, it would seem that a comparison of an entry level ACA plan to a an entry level pre-ACA plan should yield a cost reduction. If is not as if the promise was offered when it was not know what an ACA plan would be; that it would cover things not previously covered.

That was the promise of what ACA plans would deliver to America, but did not. The lies with which the ACA came larded will continue to echo for some time; we best learn to enjoy the sounds.

What?

I am still being told on the mnsure phoneline to "call back between 5 and 7 pm or on weekends." On the weekend, I'd gotten the same message. Now without coverage of any sort, I want to thank my nation for the added expense this will ensure and the completely dysfunctional way it has all come about. As a child and young adult, I can remember when having insurance was a real asset. Today, given the products and prices, it's just another burden that provides an opportunity to throw money to industry execs who only want more. Capitalization has really betrayed the citizen.

Capitalization?

You have the state government of Minnesota to thank for MNsure. If not for MNsure, you would be battling the federal government's healthcare exchange.

We need to be mindful of and grateful for the little things.

MNsure Community Outreach

According to MNsure (link), 29 grants were made to organizations for the purpose of community outreach. In the first round (yes there will be more), $3.9 million dollars will be used by these groups to reach 300,000 people. That is $13/person helped, which sounds like a reasonable amount per person, though it seems like a lot of people who need help.

If Portico is spending the average of $13/person, they have only spent $3900 or 1% of their grant. At the current burn rate of 1% per calendar quarter, their grant will last for about 25 years, ending just before 2040.

Plausible, anyone?

http://www.mnsure.org/images/Bd-2013-12-04-CommunityOutreach-Infrastruct...