The problems with the government's roll-out of the Affordable Care Act have been well-documented. The Department of Health and Human Services' (HHS) national sign-up website, Healthcare.gov, has been a disaster. Some state sites have also had issues.
But technical issues aside, consumers - especially those who have never had health benefits - may face even bigger challenges in the new healthcare marketplace. A study by Washington University School of Medicine in St. Louis finds the whole process, even under the best of conditions, is not exactly a walk in the park.
"Selecting the best health insurance option can be confusing, even for people who have gone through the process for many years," said Mary Politi, an assistant professor of surgery and the study's lead author. "We need to do a better job communicating information about health insurance to help people make the choices that work best for them."
Conducted before the roll-out
The study was conducted just before the Oct. 1 launch of Healthcare.gov and did not anticipate the problems that would occur with the website. However, it did identify difficulties that appear to be common among consumers lacking health coverage.
Most people who have never been insured, the researchers say, are going to be unfamiliar with the language of health benefits, such as "coinsurance" and "deductible," that are necessary to compare and choose among available health plans.
Even individuals who have had previous experience with health insurance confused the meaning of similar terms, such as urgent care and emergency care or co-insurance and co-payment.
The conclusion that researchers have drawn from all of this is that uninsured consumers are going to be heavily dependent on navigators, individuals and groups hired under the new law to help guide consumers in their local communities through the process.
The researchers say navigators can simplify details, use visuals and provide context for unfamiliar terms to help people better understand their health insurance choices. How that plays out is yet to be seen.
In northwest Ohio the Toledo Blade reportsÂ the Neighborhood Health Association and CareNet, two community groups receiving thousands of dollars in grant money from HHS to train health care navigators has yet to get started, missing a Nov. 1 deadline.
Republican opponents of the health care law have been quick to highlight problems with navigators, which supporters of the law contend is unfair and misleading. They suggest that states with GOP-controlled legislatures have thrown up bureaucratic obstacles for the community groups who are trying to get navigators on the job. Officials in those states say the extra regulators are needed to protect consumers and their personal information.
Despite problems, some regions of the country report navigators are in place and signing people up. ACR Health, a community group in Syracuse, N.Y., reports problems are few and far between and it has a number of success stories to report.
Community organizations around the country are receiving $67 million under the ACA to train and deploy navigators who help consumers choose a health benefits package and get enrolled. The researchers say they may be able to help.
Based on their findings, they are testing ways to improve communication about health insurance and the newly created state and federal health insurance exchanges.
"This effort is especially important for individuals with limited health literacy and math skills, given the complex information required to understand plan differences," Politi said.