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Creating a Culture of Coverage

March 26, 2013

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Individuals with HIV/AIDS, as well as other vulnerable people, will have an easier time accessing health care in the coming months as a result of the Affordable Care Act (ACA), the national health reform law.

But linking them with coverage will be a challenge.

“Essentially, people just don’t know the Illinois Health Insurance Marketplace is here,” quipped Brian Gorman, director of outreach and consumer education at the Marketplace, a centralized online hub that will allow individuals and small businesses to choose affordable, high-quality health insurance options. He was delivering a presentation to the Service Providers Council, informing participants about ways they can connect their clientele with insurance.

 

Gorman’s smile soon dissipated. “The last number I saw said that 78 percent of [Illinois residents] don’t know we’re here.”

This is problematic because the ACA requires nearly all Americans to have health insurance by January 1, 2014, and the initiative Gorman represents will play a key role in making this happen.

The Marketplace is housed in the Illinois Governor’s Office, demonstrating that successful outreach and enrollment is a priority for Governor Pat Quinn.

The Illinois Health Insurance Marketplace, formerly known as the Exchange, will serve as the front door for individuals applying for coverage through new ACA programs. The Marketplace will automatically direct applicants to private insurance plans or Medicaid, depending on their income.

“The best way to trust, educate, and ultimately enroll the uninsured is through trusted local validators and communities,” Gorman said. “The ACA provides funds and mechanisms within itself through the navigator, in-person assistor, and the certified application counselor to make this possible.”


The difference among these three is essentially a matter of funding: Navigators receive money directly from the federal government and assist with the Marketplace application.

The in-person assistor program also functions on federal money; however, its funding filters through the state.

Finally, certified application counselors receive accreditation to guide people through the enrollment process without the oversight and challenges of requesting grant money.

The bottom line, Gorman said, is both ambitious and daunting: “Our overarching goal in Illinois is to create a culture of coverage.”

This starts by educating people that the Illinois Health Insurance Marketplace exists and is an essential tool for linking individuals with health insurance.

“The good news is that there’s not a whole lot of behavior that needs to be unlearned,” Gorman said, “but the reality is that there’s a tremendous amount of work that needs to be done.”

On behalf of the Northeastern Illinois HIV/AIDS Case Management Cooperative, the AIDS Foundation of Chicago (AFC) intends to apply for patient navigation and assistor funds as a way to augment the Ryan White case management system. If your agency is interested in collaborating with AFC, please email Joe Hollendoner, senior vice president of programs, at jhollendoner@aidschicago.org.

You can discover additional implementation resources for the HIV/AIDS community by visiting HIVHealthReform.org. Also, learn more about the federal government and marketplaces at Healthcare.gov/marketplace.

 

Categorized under Inside Story.

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