Health care 'navigators' in race with Affordable Care Act deadline


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On Thursday morning, Angela Byrd sat at a fold-up table inside the glass doors at the entrance to the Salvation Army in Braddock, with an obliging look on her face.

In front of her was a row of neatly stacked pamphlets about the Affordable Care Act. Ms. Byrd, a "navigator" who helps the uninsured sign up for health insurance under the law, greeted people on their way to the food pantry in the basement. But for an hour, no one asked for advice about the law.

Finally, Jill Clemons of Braddock stopped. She heard about the law's requirement to get insurance by March 31. She asked Ms. Byrd a set of questions and grabbed several fliers.

"I just want to feel more secure," said Ms. Clemons, who has been uninsured since she was laid off from UPMC last year.

As the deadline to get insurance approaches, Pennsylvania's navigators are cramming their schedules with outreach events, trying to enroll as many of the uninsured as they can. After that date, the uninsured will have to pay an annual fee of $95 or 1 percent of their income, whichever is larger. The fee will grow over the years.

Working for the Allegheny Intermediate Unit in Homestead, Ms. Byrd is one of six navigators covering Allegheny, Beaver and Butler counties. They're funded by a federal grant from the Center for Medicare and Medicaid Services.

Resources for Human Development, a nonprofit based in Philadelphia, is overseeing the efforts of 30 navigators in Pennsylvania. It's concentrating them in the 10 counties with the largest number of uninsured people, said Laura Line, assistant director for health care. That includes Allegheny County, which had about 97,000 uninsured in 2010, according to the Pennsylvania Budget and Policy Center.

By March 14, the 30 navigators had helped 18,500 people learn about the law or enroll in insurance plans, Ms. Line said.

"I think Pennsylvania is doing pretty well relative to other states, but certainly there are a lot of folks to help," she said.

To reach the uninsured, navigators go to places frequented by low- to middle-income working people who make too much to qualify for Medicaid. Those places include churches, the YMCA and the Salvation Army. Resources for Human Development also has put ads in newspapers, on the radio and on the sides of buses to spread the word about the March 31 deadline.

Ms. Byrd, who graduated from the University of Pittsburgh in December with a degree in health services, became a navigator because she plans to go into healthcare law. Before starting the job at the beginning of February, she went through 20 hours of online training, learning about tax credits, the details of the health law and the insurance industry in general.

She estimates she's enrolled between 20 and 40 people. The job can be tough; people come with tricky questions. But it has its rewards. One woman took Ms. Byrd out to lunch after she helped her enroll in the federal marketplace.

"I like listening to people and their issues," Ms. Byrd said. "I like to connect with people."

One of the job's challenges is explaining the intricacies of the 900-page law, which has different implications for people depending on their incomes and insurance statuses. Many come in knowing little about the law, afraid of the health insurance fees it could bring them, or the penalties for not having insurance.

"When you're not fully educated about something, and you hear things like being penalized, you start to panic," she said.

Another challenge for Ms. Byrd is helping people who don't file federal taxes, making them unable to get the tax credits that subsidize insurance under the law. Some are wary of filing a federal tax return because they don't understand it doesn't necessarily mean they would pay taxes, she said.

Sometimes, Ms. Byrd said, people go through the enrollment process before deciding they would rather pay the penalty for not having insurance, because they're healthy enough to go without it.

Then there's "Medicaid gap" -- people who earn too much to qualify for Medicaid, but not enough to qualify for the Affordable Care Act subsidies. One of those people is Ms. Clemons. Ms. Byrd told her she can apply for an exemption from the law's penalty for not having insurance.

Walking out of the Salvation Army with bags of groceries from the food pantry, Ms. Clemons said she planned to give Ms. Byrd a call. Going without insurance takes a toll on her, she said.

"It's really uncomfortable for me because I know I have appointments I need to make," said Ms. Clemons, 55. "It's uncomfortable to know I can't get my prescriptions. It's really uncomfortable."


Richard Webner: rwebner@post-gazette.com or 412-263-4903.

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