Speaker 1 00:00:20 Hi all. Welcome back to Just a Bite. I talk with our Director of Health Initiatives, Zach reit, along with two rockstar Health Navigators, Josh Newland and Julie Grason about the 10th anniversary of open enrollment for marketplace coverage.
Speaker 0 00:00:43 Hi,
Speaker 2 00:00:44 Josh, Julie and Zach for being on the podcast today. Welcome to Just A Bite. Um, could you all introduce yourselves and Josh and Julie, Can you please tell the listeners how long you've been a navigator for?
Speaker 3 00:00:58 So, I'm Julie Grason. I'm the executive director of Toledo Lucas County CareNet, and we have been either a navigator entity through the grant with the Ohio Association of Food Bank since the beginning in 2013. And for a short period of time we were also a certified application counselor entity.
Speaker 4 00:01:21 I'm Josh <laugh> in Newland. Um, I'm with the Valley View Health Center's Community Action of Pike County. Um, and just like Julie, we've been doing it from the beginning. We transitioned a little bit there to uh, certified application counselors, but now that we have the funding, we're back as navigators.
Speaker 5 00:01:40 Yeah, and I'm Zachary. I'm the Director of Health Initiatives for the Ohio Association of Food Banks and did this then as a navigator from 2013 to 2017, and then came back to the program again in 2020.
Speaker 2 00:01:53 Wonderful, thank you. All this year's open enrollment period starting on November 1st, we'll mark the 10th open enrollment period since the Affordable Care Act was enacted. What has changed and what has stayed the same during those 10 years of enrollment? I know there were four years where you guys kind of switched, um, missions, but kind of wondering what has changed and what has stayed the same?
Speaker 4 00:02:18 You know, when we first started with there was a lot of complications. Um, I think, you know, with the website, all the technology getting buy in from partners and, uh, finding those resources. Um, I think as, as we travel further on, you know, obviously we, we have more buy in. We, we have a lot, lot of community partners that are helping us. Um, it, you know, people have learned a lot more. It was at one point, you know, it was brand new. No one really knew what to expect, what was going on. Um, sometimes you kind of felt like you were out in the cold if you were doing, you know, doing everything you needed to be doing. Which, uh, the navigator meetings always, uh, for me anyway, in the beginning, you know, we came to those and was like, Oh, we are doing exactly what we're supposed to be doing.
Speaker 4 00:03:09 Everything's going well. So that always helped. Um, you know, like I said, all the buy in now is great. Um, we've learned some lessons, what not to do, you know, Um, like for me, um, not doing, uh, I I like to go to events that are already pre-populated. Um, you know, things of that nature. We've learned that doing your own events sometimes isn't the best way to do things. So just, you know, the trial and error of things. Um, learning as we go. Um, also, uh, you know, the administration now is starting to change some things, um, seeing what's not working, what can help people, more people get more coverage. So I think, like I said, buy-in has definitely, um, ticked up a bit since we started.
Speaker 3 00:04:00 Yeah, so I think one of the biggest things that's changed in the past 10 years is in the beginning, you know, depending on which region you were in, there seemed to be some political, um, taboo with the whole idea of marketplace plans and the Affordable Care Act and, you know, depending on which side of the aisle you were on, determined whether or not you wanted to participate or if it was a good thing. And over the course of 10 years, it is so refreshing to see that that political divide has gone away. People have seen and truly experienced whether for themselves or for loved ones, the value of having access to affordable. He healthcare provides them and their families and just the bigger impact that it has on each of our communities. So I, you know, I'm thrilled that that has progressed and gone the direction that I had always hoped it would. Um, you know, and tying into what Josh said, you know, the, um, website was scary and not always user friendly in the first year. And, you know, it's a great thing that, um, those updates are routinely made so that every year, every open enrollment, the process gets easier for the consumer. Um, which, you know, makes it easier on the navigator as well to provide more services across the region.
Speaker 5 00:05:40 Yeah, I think I just wanna add that, um, some of the policy has been smoothed out, right? Back in, back in 20 13, 20 14, open enrollment, we were, uh, dealing with a completely new law, right? It was actually three years old, but the, the marketplace and the Medicaid expansion was brand new at that point. Um, and there were a lot of policy just wrinkles that created real problems for Ohioans, um, who needed to enroll in coverage. Uh, one or two really good examples of that are before, I think it was 2020, uh, there was sort of an arbitrary cutoff of premium tax credits at 400% of the federal poverty level. And that really created a flip where people making four, five, you know, four 50% of the poverty level weren't eligible for subsidies. And were based with ban the full premium, um, for health insurance, which, which is often still unaffordable, um, if that was corrected by, uh, some emergency legislation around coronavirus and has been, um, extended for three years in the Inflation Reduction Act.
Speaker 5 00:06:55 And that just makes a lot of people, um, eligible for subsidies who weren't before and creates a softer landing there. Um, another example is a family glitch in which, you know, is a euphemism, um, because it really created a hard barrier for, um, family members of people who are working and applying for coverage on the marketplace that they made it unaffordable for 'em. Um, that's been fixed through an administrative change just finalized by the irs that'll make more people eligible for tax credits and subsidies to reduce the cost of health insurance coverage this year, who were not eligible for that coverage before. So over 10 years, the sort of policy wrinkles, which, which again is a euphemism, but um, describes a lot of the, um, difficulties that, that we ran into in the first couple of open enrollments. Those have been smoothed out over 10 years and I feel like we're in a better place now.
Speaker 2 00:08:01 I know, Julie, you kind of touched on, you know, political distrust and, um, things being taboo. I'm wondering was there some just general distrust in certain communities? Um, you know, like not really knowing what, you know, the, the marketplace was, um, and kind of nervous to even talk to some navigators about, about healthcare coverage?
Speaker 3 00:08:29 Um, yeah, I mean there was definitely mistrust. Um, you know, cuz when the Affordable Care Act came out, it was, you know, it removed the preexisting condition clause. Um, you know, it was promoted that we didn't need to know what your medical conditions or history were. We didn't need to know what medications you were on. Um, and I just think through the history of health insurance, individuals knew that all of those things played a factor into the cost of their health insurance. Um, you know, I think another mistrust was, um, the whole access to care. You know, how are the tax credits going to be applied? How is it that, you know, the federal government is going to be able to help subsidize the cost of my insurance? So yeah, I mean it, you know, there were just a lot of mistrusts out there.
Speaker 2 00:09:35 I think all of you had mentioned the four year gap, um, in funding when, uh, navigator services were defunded and Ohio weren't able to look to that navigator service, um, when applying for marketplace coverage, um, when the Navigator program was funded again in 2021 and then the group of Ohio navigators came back together, what were some of those lessons learned and what was kinda prioritized when coming, coming back together?
Speaker 5 00:10:07 Yeah, we ran into a lot of challenges last year. Um, you know, going from a program that hadn't been around, um, at least through our organization and through our subcontractors, including the A of Pike County and Polito Lucas County Care, um, that was standing up a, a program again. So that was getting people hired, uh, that was getting them trained, that was getting them licensed through the Department of Insurance. Um, it was getting those relationships with community partners reestablished. That took a lot of time. Um, and unfortunately the window that Centers for Medicare and Medicaid service that gave us to do that was very short. Um, we only had from late August to November 1st to get all of that up and running again. I think the major lesson learned for us was that people need to, um, be told about a resource over and over and over again, um, before they'll utilize it.
Speaker 5 00:11:14 Right? And that's just, you know, human nature. You've gotta see things 6, 7, 8 times, um, before you reach out and, um, ask for the assistance that that's being provided. So we focus a lot on making sure that our materials are out in the communities, making sure that we, like Josh mentioned, we're at the community resource fairs. We are, um, in the, the meetings and talking to the people who are trusted members of our community so that they know we're available. Um, so lesson learned was like, keep, keep going back, do more advertising, do more flyering, do more events, be out in the community and be available.
Speaker 3 00:11:57 And I'd like to just add in there too, that the Ohio Association of Food Banks has been amazing in creating a unified message that goes throughout the state. So it's not as though each member of the consortium is producing their own material. It's the same message whether you're in Cuyahoga County, Lucas County, Allen County. And I think that that has a huge impact, uh, the trustworthiness of the services that are being provided through this grant.
Speaker 5 00:12:32 Thanks, Julie. Uh, <laugh>? Yeah, Julie's talking about, I can't believe I forgot to bring it up until now. We have our statewide campaign, it's called Get Covered Ohio. Um, we got a
[email protected] and, and people are gonna see, uh, TV commercials, you're gonna hear about us on the radio, you're gonna see billboards. Uh, we're doing a lot of focused advertising, for example, in African American known newspapers, Spanish language outlets, Arabic language outlets, um, so really trying to get to those communities, um, who are in need of health insurance and in need of assistance getting the health insurance. So thanks for the shout out, Julie, and for the reminder to get that into this podcast.
Speaker 3 00:13:17 Um, and not that I have the phone number memorized, but I'm sure Zach does the statewide 800 number for consumers to call. You know, yet again that great, um, unified front that it's the same no matter where you're at.
Speaker 5 00:13:31 Yep, yep. It's 8 3 3 6 2 3 4 4 6 7, and we'll make sure we get that in the show notes as well.
Speaker 2 00:13:39 Great. Good. Good job, Zach and Julie for tag teaming that. Um, Josh, do you have anything to add?
Speaker 4 00:13:47 Um, as far as what the get covered Ohio campaign?
Speaker 2 00:13:51 Yeah. Or, you know, maybe some of the lessons you guys learned coming back.
Speaker 4 00:13:56 Yeah, I, you know, just going back to some of the challenges and the, the political process you were discussing, you know, um, down in southern Ohio, I, I tend, you know, when it started, um, Obamacare was kinda weaponized the term Obamacare, uh, that has changed tremendously. You know, I, I had people come in the first year and we struggled with the website. Um, they were already, you know, distrusting everything. And now those people are still coming in 10 years later, and we have that bond, the trust. Um, that's, that's a lot of what I've seen throughout the 10 years. You know, we've developed that trust. Um, things have just gotten better with the, the website, the, the law, you know, just keeps improving.
Speaker 2 00:14:50 I'm wondering, since you guys have the perspective of pre pandemic and post, or I guess during the pandemic, you know, what, what things changed during the pandemic? I'm sure your outreach strategies are different, um, but yeah, just wondering, you know, what has changed and what, um, is different there?
Speaker 3 00:15:10 Uh, I was just gonna say, you know, one of the nice things, if you can put it that way, that came out of the pandemic was the ability to provide that one-on-one consumer assistance using things like Zoom or, um, Microsoft Teams and doing phone assistance over the years. You know, I think at most navigators have seen the progression, especially for consumers that have been able to, or who have benefited from Marketplace for more than a couple years. They're totally comfortable going in and updating their application and doing that initial work, but they really want the assistance from navigators to understand the differences in the plans and what help or what best meets their individual or family needs. And being able to do that through Zoom or a phone call was a huge added benefit. So that's one of our biggest takeaways doing Navigator during a pandemic.
Speaker 5 00:16:17 Yeah. I'm gonna second that, Julie. And, and, you know, to some policies are just really don't make sense, right? And one of the policies that did not make sense one bit was not allowing navigators to provide assistance over the phone, um, or virtually before, um, it never made sense. And the pandemic sort of forced us into a position where policy change had to happen to catch up with the times. Um, and I think that's just, just an important lesson for us to reflect on in the human services space. Like, let's take a look at our policies and if they didn't make sense during a global pandemic, maybe they never made sense. And, and maybe this can be a lesson for us to, to take away from this, um, look at things, look at policies that don't work for people, um, and, and ask ourself the tough, tough question of why are those policies in place?
Speaker 5 00:17:18 You know, is it political distrust? Is it sort of a, a history of trying to, to cover our butts when, when really we could, um, make some policy changes that make people's lives easier? Like, um, exactly what Julie's talking about, giving people the opportunity to not have to come out and meet us at a library, you know, 15, 20 miles from their home if they're in a rural area, and instead connect with us over the phone or over Zoom. Sorry for the commentary there. I just, that's just such an important point that Julie brought up
Speaker 4 00:17:51 Now. It really did add another tool to our belt. It was restrictive at first and, you know, hard to get around, but we learned and now we're better for it. And actually that, you know, I still, um, work remotely to help a few people. We haven't went back to face to face, and it, it actually works better.
Speaker 2 00:18:13 Thank you for that. That's a a great point. Having people where they're, where they're at, said ways that the pandemic has sort of improved or navigator services. I was wondering where can both the marketplace in general as well as navigator services improve as we look towards the future, You know, recovering from a pandemic, um, and all, you know, the uncertainties.
Speaker 5 00:18:38 Yeah. I'm gonna put a plug in here for assuring some stability and funding for the Navigator program and, and, uh, ensuring, you know, some resilience for the Navigator program. This can be done, um, particularly if the state were to take more, um, ownership of the marketplace, um, and transition toward a state-based marketplace or provide funding, uh, for sister organizations like bacs, um, like Valley View Health Centers and, uh, uh, to Lucas County Care net or Navigator programs, um, states can fund these programs. And here in Ohio, we've, we've advocated with legislators and, and administrators to do that. Um, so we'd love to see some investment to provide some stability to this program given what we saw with federal funding for the program, um, between 2017 and 2020. Um, and I think that, uh, that would, that would take us a long way toward, um, improving the, uh, health insurance landscape, making sure that more people who need access to health insurance can get it, uh, regardless of what happens with the Federal
Speaker 3 00:19:55 Way. And I'll just add in, there's a little side note to what Zach just shared, is that the work of the navigators is so critical in meeting the needs and me thinking into the future. I believe that the state will see the impact that the navigators do have, especially once the public health emergency ends, and the role that we all will play in helping those consumers that are either now found to be over income for Medicaid and need assistance getting enrolled into marketplace, as well as those consumers that may have relocated since they initially were approved from Medicaid and they fall off strictly because they did not receive their new notices. And so I just have high hopes that the state will, this will be their eyeopener for the true impact that the work that we all do provides in each of our communities.
Speaker 4 00:21:02 We just jumped into my brain there, set it way better than I could have, but yes, uh, use us as a tool if, if we could work better with, uh, jfs, um, the counties and, you know, I know a lot of 'em realize what we do, but if, if we could keep working just better and better with them, it would help a ton of people.
Speaker 5 00:21:23 Yeah. And thanks for do bringing that up, Julie. Most systems and policies are set up to, to serve the, the greatest number of people, right? And, uh, what navigators do is help to fill in the gaps. So for people who are comfortable going to a website that's available in Spanish or English, and navigating that website on their own, know what health insurance is, what a premium is, what a deductible is, what co-insurance is, know how to search for a network of providers, know how to do all of that. They don't need our help. And frankly, the policies and systems are set up that, that they'll be able to navigate it and, and get what they need. Um, navigators are here for the people that aren't comfortable with that. And you may have noticed in that setup, there's a lot of people that might have some level of discomfort, um, with that whole process of shopping for health insurance.
Speaker 5 00:22:26 So I think that particularly through the covid 19 public health emergency unwinding, um, I hope that the state and counties really are able to form, um, solid partnerships with, uh, navigator and CAC organizations around the state to ensure that the people who need that extra hand holding to get through this process and come out right on the other side, um, have access to that assistance again through their navigator and, and CAC partners. Um, because that's, you know, we talk a lot about health equity. The Navigator program is a health equity program in that we are here to support those individuals that are kind, uh, left behind by the existing policies and systems that are in place.
Speaker 2 00:23:18 Great. That's a great place to end. Um, final question for you all, where listeners find you and your respective organizations and another plug for get Covered Ohio and the hotline.
Speaker 4 00:23:34 Okay, so I can be reached at 7 4 9 4 7 7 7 2 6. Um, I'm at extension 77 19. Um, my email is jay newland pike cac.org. Um, I'll let Zach plug the get covered connector. I don't have all of that memorized yet. Um, but, uh, I, I help, well, obviously we can help anybody anywhere in the state, but, uh, I help out on Ross Pike, Jackson Gallia, Lawrence, Iotta Adams, I think I got all of them there, <laugh>. But, uh, yes, uh, we're here to help anybody that needs it.
Speaker 3 00:24:18 And Kat is covering northwest Ohio, So we have 21 counties from Williams, uh, all the way down to Mercer, over to Richland and update area in Ottawa and everything in between. Anybody looking for us, we can not only be found through the connector and get covered Ohio site, but Facebook, um, I can be reached at 4 1 19 8 4 2 0 8 and extension seven. And Zach, you can give them all those statewide data.
Speaker 5 00:24:53 Yeah, so the Ohio Association of Food Banks Navigator Consortium serves 77 of Ohio's 88 counties. Um, there's also two other Federal navigator grantees, Equias Health and Southeast Incorporated. And between the three of those organizations, we cover the entire state. Um, people can find a navigator in their area by going to get covered ohio.org or calling 8 3 3 6 2 8 4 4 6 7. Again, that's 8 3 3 6 2 8 4 4 6 7. Um, Sarah, thanks so much for this opportunity. This is, this has been a lot of fun talking about the last 10 years and thinking a little bit about the future.
Speaker 2 00:25:39 Awesome. Thank you to three. I appreciate, um, taking time today and, um, for all the work that you guys do in your community.
Speaker 4 00:25:49 Thank
Speaker 3 00:25:50 You. Thank you. And thanks for the opportunity to spread the word.
Speaker 1 00:26:00 I wanna give a huge thank you to Josh, Julie, and Zach for chatting with me and for all the good work that they do in their communities to make sure that they are healthy and insured. If you think you may need navigator services in your area, you can visit get covered ohio.org or call 8 3 3 6 2 8 4 4 6 7 to schedule an appointment. Both will be available on the show notes of this episode, but don't wait. The open enrollment period will begin on on November 1st and will last until January 15th, 2023. Thank you all for listening, and we'll talk to you soon.
