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The navigator is lost


During his 2008 presidential campaign, Barack Obama promised to cure America’s ailing health care system.  I applauded his commitment.  After his election when he began his legislative campaign to enact a health care measure, I cheered him.  After all, health care in the United States is expensive and becoming more so.  But the quality of care lags behind several nations that spend far less that we do.

Now I admit that I was wrong.  The Affordable Care Act (ACA) is bad for America.  More than three years after it was signed into law on March 23, 2010, because of numerous delays in implementation, and far too frequent tweaking of the law, the act has proved to be everything its original detractors predicted and I foolishly ignored.

Now an older, wiser man, I see that the latest Obamacare initiative–the ACA Navigators and Assisters Program–will fail.  It’s Dead On Arrival (DOA) and here’s why.

The purpose of the Navigators and Assisters Program is to educate those Americans who have not yet purchased health insurance and help them make wise decisions.  

Health and Human Services (HHS) this week announced the recipients in each state of financial grants to implement the program and train the navigators and assisters to provide consumer information.  A total of $67 million was awarded to 105 applicants nationwide.  Iowa’s share is $600 thousand divided among three organizations.

However, the  Navigators and Assisters Program is doomed because to fulfill their mission the grant recipients must identify, hire and train Navigators/Assisters.  Those hired must demonstrate expertise in private health insurance, know how to execute public education and outreach, and interact with so-called “underserved and vulnerable populations.”

All of this after only 20-30 hours of training.  We’ve been through this before.  In the aftermath of 9/11, the Federal Government created the Department of Homeland Security (DHS) to oversee the national challenge of protecting our borders and interior from potential calamities ranging from terrorism to natural disasters.

Among the agencies under Homeland Security administrations, that hired thousands of new workers, are the Federal Emergency and Management Agency (FEMA) and the Transportation Security Administration (TSA).

FEEMA you’ll recall was universally criticized for its ineptitude in recovery operations in the aftermath of Hurricane Katrina in 2005 and Storm Sandy in 2012.  And TSA has a long history of employee incompetence, which was documented this year in an audit by the Government Accounting Office (GAO).

Now we have the ACA Navigators and Assisters Program.  In Iowa the three groups that won grants are:

Genesis Health System            $128,430.00

Visiting Nurse Services of Iowa        $257,142.00

Planned Parenthood of the Heartland    $214,427.00

How many Navigators and Assisters will each organization hire and what will be their pay?  If each navigator/assister is full time at the current median U.S. salary of $40,352, the number of workers will range from only 3 to 6.

If each navigator/assister is a part-time employee earning just half the median U.S. salary ($20,176), then each organization can hire between 6 and 12.  

Visiting Nurses pledges to cover 38 of Iowa’s 99 counties.  That would be just over six counties per full-time navigator/assister.  

Planned Parenthood says its navigator/assisters will visit 61 counties.  If full-time workers, each navigator/assister will be responsible for 11.5 counties.

Most likely the navigator/assisters will be paid half the current national median salary and will work part time.  This means those responsible for educating and advising consumers about health insurance will not be the best possible candidates for these positions.  Salaries usually reflect the quality of employees and their corresponding performance level.  

Low or part-time salaries for the navigator/assisters promises less than optimum candidates.  The one-week training (20-30 hours) may be adequate for some hires, but not for others.

It’s obvious that the Navigators and Assisters Program is flawed on several fronts:

*Low salaries will not attract the best applicants.  

*There will be an uneven distribution in the geographical area each navigator/assister is expected to cover.  In some cases this will reduce the effectiveness of the navigator/assister.

*There will be uneven distribution in the number of clients each navigator/assister is expected to contact.  This, too, will reduce the effectiveness of the navigator/assister.

*The training period for the navigator/assisters will be insufficient in many cases.

*Those most willing and likely to buy health insurance already have coverage.  Few of the remaining Americans either cannot afford health insurance or will refuse to buy it regardless of the overtures of the navigator/assisters.

We have the mediocre performance of FEMA and TSA as examples of what happens when you hire unqualified, low-paid, poorly-trained  employees and entrust them with responsibility that exceeds their abilities.

I am not denigrating those persons who eventually will be employed under this program. Although Iowa has a higher-than-average educated population from which to hire navigator/assisters, that is not true elsewhere.   I simply recognize that the history of other federal employee initiatives gives little reason to be optimistic about the Navigator and Assisters Program.

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