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'Navigator' flaws compound new health care law's glitchy start

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Health care navigators

The federal government is paying to train, support and certify navigators to assist the public in signing up for health care as spelled out in the Affordable Care Act. The navigators:

• Must undergo a 20-hour training program, so they can guide consumers through various health insurance options.

• Are prohibited by law from receiving any type of compensation from insurance companies or from making specific recommendations for a particular plan.

• Must be literate, but no minimum education level was established by the federal law.

• Must meet any standards set by states. Pennsylvania is considering legislation that would require navigators to undergo a criminal background check.

Saturday, Oct. 12, 2013, 10:50 p.m.

A program intended to help educate uninsured people in Western Pennsylvania about Obamacare started sluggishly because “navigators” are not trained, and several positions remain vacant nearly two weeks after online insurance marketplaces went live.

“This is a new program, and there are going to be some glitches,” said Larry Klinger, who oversees a navigator program at Allegheny Intermediate Unit, where two such workers are in place. “You work through the glitches, and you make the best you can.”

The intermediate unit is one of several organizations statewide hiring and training navigators, a category of workers established under the federal Patient Protection and Affordable Care Act to assist consumers as they buy health insurance.

The two Western Pennsylvania organizations that received grants to hire navigators, the AIU and Mental Health America of Westmoreland County, have not filled all positions or have not completed mandated training for some.

The setbacks compound challenges the Obama administration faces as it tries to iron out problems with the online marketplaces since they debuted on Oct. 1. Customers of have experienced long delays to sign up for insurance because of demand and technical problems with the website.

Navigators are experiencing problems of their own. Several states imposed restrictions to control what navigators can tell consumers.

In Pennsylvania, where Gov. Tom Corbett chose to let the federal government set up the marketplaces, a bill under consideration by the House would set rules for navigators such as not selling, soliciting or negotiating insurance. Under the bill sponsored by Rep. Mike Tobash, R-Pottsville, violators could face a $1,000 fine.

As part of its plan to spread the word about Obamacare, the government awarded $67 million to private nonprofits in 34 states where the federal Department of Health and Human Services oversees the marketplaces. In Pennsylvania, five nonprofits received nearly $3 million to hire and train navigators.

The amount is less than that given to states that chose to run exchanges, but experts said there are volunteers and privately paid workers teaching people about the law. Drugstore chains such as Rite Aid, for example, have stationed independent, licensed insurance agents to help uninsured customers.

Having fewer navigators than some other states is a marginal issue, said Joel Ario, former Pennsylvania insurance commissioner and managing director of Manatt Health Solutions, a New York consulting firm.

“I don't think it's a fundamental problem,” Ario said.

The state's largest grant, roughly $953,000, went to the Philadelphia nonprofit Resources for Human Development Inc., which contracted with the AIU to hire navigators for the Pittsburgh region.

In addition to two who are trained, the AIU hired a part-time worker to start this week. Officials want to hire a fourth part-time navigator who speaks Spanish to help educate the city's growing Latino population, Klinger said.

At Mental Health America of Westmoreland County, officials hired a navigator, but the person is undergoing training, said executive director Laurie Barnett Levine.

Levine downplayed the delay, attributing it to the regular hiring process. She had to find someone qualified to work with the organization's target population, which consists of people who have psychological issues and mental illnesses.

The person she hired, who started working on Oct. 3, had to give her former employer two weeks' notice, she said. Even though the worker has not completed training, callers are being directed to navigators at the Pennsylvania Mental Health Consumers' Association.

“They're getting a live person right away,” Levine said of those needing help.

Experts say the navigator program is one of several ways to educate consumers about the Affordable Care Act.

In Pittsburgh, for example, groups such as the Consumer Health Coalition and the Squirrel Hill Health Center trained workers to help, including certified application counselors.

“People are confused about what's a navigator and what's a counselor,” said Susan Friedberg Kalson, CEO of the federally funded Squirrel Hill Health Center.

Like navigators, counselors undergo federal training. At five hours, however, it is not as detailed as the 20-hour navigator training.

The Squirrel Hill center hired one full-time, certified counselor and plans to hire several part-time workers.

“We are eager to work with people who need help,” Kalson said.

The Pennsylvania Association of Community Health Centers in Wormleysburg, near Harrisburg, received about $694,000 to provide navigators, but the training of a second class of navigators was delayed, said Jim Willshier, director of public policy.

Willshier said the association certified 45 trained navigators. It plans to train more navigators but is waiting for federal identification numbers, so navigators can access online training modules. He didn't know the reason for the delay.

“It's like taking the SAT all over again,” Willshier said.

His training, begun in September, has been hampered by other job responsibilities and the government shutdown.

“It's rigorous,” he said. “When you finish a chapter, you have to take a test, and you can only miss one or two questions (out of up to 20 questions on 12 tests). If not, you have to start all over again.”

Luis Fábregas is a Trib Total Media staff writer. Reach him at 412-320-7998 or

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