Darrell Issa and his Republican colleagues hate the "navigators" helping Americans enroll in Obamacare. But Medicare navigators, it turns out, are another matter altogether for the GOP.
The GOP Loves Medicare Navigators
Funding for Medicare Navigators (SHIP)Credit: National Health Care Forum
December 16, 2013

On Monday, the GOP-controlled House Oversight and Government Reform Committee chaired by Rep. Darrell Issa (R-CA) released a damning report about the so-called Obamacare "navigators." That Issa's inquisition railed against the Affordable Care Act's use of dozens of dozens of community groups, hospitals and other non-profit organizations who have received $67 million in federal grants to help Americans enroll in new health insurance plans comes as no surprise. After all, while Congressional Republicans burdened the navigator groups with requests for mountains of documents, GOP dominated states like Texas and Missouri passed draconian regulations making their task impossible--or even illegal.

But what it surprising is that nowhere in Issa's jeremiad against ACA navigators does the report mention the word "Medicare." That omission is doubly glaring. After all, the Obamacare navigator program was modeled on the very same outreach approach Medicare has been using to enroll millions of American seniors in private insurance and prescription drug plans for 20 years. And as it turns out, the Bush administration used--and praised--the very same approach when it launched the $400 billion Medicare Part D prescription drug benefit.

Writing in the National Journal, Catherine Hollander of the National Journal explained that the use of navigators by the Department of Health and Human Services is nothing new under the sun:

But the navigator program has a precedent, one that suggests the concerns may be overblown: the State Health Insurance Assistance Program, which was enacted through the Omnibus Budget Reconciliation Act of 1990 to offer free counseling to Medicare beneficiaries. SHIP counselors were the model for Obamacare's navigators. "The notion that this is some unheard of ... incursion into people's lives is about as far from reality as it could be," says Sara Rosenbaum, a professor at George Washington University's School of Public Health and Health Services. "This is exactly what Medicare SHIPs do all the time."

SHIP staff members played a key outreach role after Congress passed the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. The legislation introduced prescription-drug benefits-- Part D, which was a complicated addition to the coverage offered under Medicare available through enrollment in private plans. In the spring of 2005, just half a year before open enrollment began, 66 percent of seniors polled by the Kaiser Family Foundation said they didn't think they had enough information to understand how the benefit would affect them. Enter SHIPs.

Enter SHIPs, indeed. In August 2008, Laura Summer and Jennifer Thompson of the Georgetown University Health Policy Institute authored an evaluation of the Medicare Part D outreach program for President Bush's HHS titled "Best Practices to Improve Take-Up Rates in Health Insurance Programs." Based in part on a survey of 660 counselors, program managers, and others who worked with beneficiaries, Summer and Thompson found:

Based on a careful analysis of all of the articles reviewed, two predominant findings emerge regarding efforts to promote successful take-up in health insurance programs. The first is that individuals are more likely to enroll in insurance programs and maintain their coverage when extensive personal assistance, geared to the needs of the individual, is available. The second major finding is that simpler enrollment and renewal processes increase the likelihood that individuals will obtain and retain coverage. Studies of publicity campaigns find much weaker evidence of effectiveness. In gauging the success of assistance efforts, the amount and type of assistance provided appears to be relevant as is the source of assistance. Individuals are more likely to seek and accept help from organizations and individuals that they trust and that provide culturally or linguistically appropriate assistance.

Mike Leavitt, President Bush's HHS Secretary during the disastrously bungled roll-out of the Medicare Rx benefit agreed with the crucial role of Medicare navigators. As he put it in a July Washington Post op-ed:

Before the program was implemented, only 21 percent of seniors had a favorable opinion of it, and 66 percent didn't understand what the reform would mean for them.

So we spent 18 months devising and implementing a campaign to explain the prescription drug benefit, prepare seniors as well as partners -- such as community groups, churches, pharmacies, insurance plans and state and local governments -- and then sign people up. A national bus tour supported each phase. The summer before enrollment (the same period that the ACA is in now) we logged more than 600,000 miles and visited 48 states. As secretary, I made 119 stops in 98 cities. I learned that with a program like the ACA, you can't count on Washington to sell it. You have to reach people where they live, work, pray and play.

As it turned out, the Bush administration was trying to reach eligible seniors where they lived, worked, prayed and played by partnering with many of the very same organizations Obama HHS Secretary Kathleen Sebelius is turning to now.


In May 2004, the Bush administration announced it would be working with the Access to Benefits Coalition (ABC) to help roll out the Medicare drug discount card program that spring and enroll seniors in private prescription plans by 2006. "Seniors and persons with disabilities need to take advantage of the real savings and real money that is on the table for them," then HHS Secretary Tommy Thompson said. "Seniors with low incomes can save significantly through the discounts and the $1,200 to pay for their prescriptions. It's an opportunity they can't afford to pass up."

To help in the enrollment effort, HHS is making an additional $4.6 million available to organize and fund community-based organizations to help low-income beneficiaries learn about the Medicare drug discount card program and how to enroll. These funds are in addition to the $21 million previously made available to the State Health Insurance Assistance Programs (SHIPs), which provide one-on-one assistance to Medicare beneficiaries through trained volunteer counselors who are provided training from CMS...

HHS and the Access to Benefits Coalition (ABC) also have committed to working together in a complementary fashion as they target low-income seniors with education and enrollment programs. And HHS' Administration on Aging (AoA) and Indian Health Service (IHS) are reaching out to their constituencies to make sure they sign up for the program.

"We have an energetic coalition from the public and private sectors that wants to make sure seniors take advantage of the substantive savings the Medicare-approved cards provide," Secretary Thompson said. "We want to be aggressive in reaching out to these beneficiaries so they don't miss out on this meaningful benefit to help pay for their medicines."

And just who were the members of the Access to Benefits Coalition?

Many were the usual suspects. AARP, which supported both Bush's Medicare Part D and Obama's Affordable Care Act, was one obvious partner. The "public-private partnership of over 70 diverse organizations dedicated to ensuring that lower income beneficiaries know about and can make optimal use of new Medicare prescription drug benefits" also included the National Hispanic Council on Aging, an organization which is also now an Obamacare navigator. The conservative 60 Plus Association, whose celebrity spokesman Pat Boone would later call Barack Obama "a president without a country" who is "waterboarding America" over "socialistic health care and a host of other ultraliberal causes," also received dollars from the Bush HHS. Other Bush administration Medicare Rx partners might seem a little more surprising. Take, for example, ACORN.

If you have any question as to whether the President Bush and his Republican allies put their money where their mouths were when it came to Medicare navigators, you shouldn't. In 2003, the Bush administration allocated $12.5 million to the State Health Insurance Assistance Program. The SHIP budget quickly jumped to $31.7 million in 2005 and $32.7 million in 2006, reaching $54.5 million by 2008. And if you have any lingering doubt as to whether Republicans value the SHIP program for enrolling the elderly in Medicare and other programs, just visit Governor Rick Perry's Texas Department of Aging and Disability Services. And what does the Texas SHIP program do?

The Health Information Counseling and Advocacy Program (HICAP) is the SHIP in Texas for Medicare beneficiaries. HICAP has approximately 450 local staff and volunteer counselors working throughout the state in 28 Area Agencies on Aging (AAA). The Texas Department of Insurance (TDI) provides training, publications, and resource materials, as well as technical insurance expertise. The Texas Legal Services Center (TLSC) provides specialized legal back-up to local counselors, training on public benefit programs, document preparation, and a statewide toll-free legal assistance hotline for persons eligible for Medicare at (866) 979-4343. The Texas Department of Aging and Disability Services coordinates the network and the statewide partnership. Call us ! We can help. Texas Department of Insurance: 1-800-252-3439, 1-800-735-29889 (TDD); Legal Hotline for Texans: 1-800-622-2520, 1-866-979-4343, or 1-800-526-9953 (TDD); local counseling offices in your area: 1-800-252-9240.

But the six million uninsured Texans looking to obtain coverage under the Affordable Care shouldn't expect any such help. Like GOP leaders in other states, Rick Perry has made the navigators' jobs virtually impossible. Georgia Insurance Commission Ralph Hudgens could have been speaking for Darrell Issa and the entire Republican Party when he described how his state was blocking access to navigators for Obamacare that the Medicare program had been using for over 20 years:

"Let me tell you what we're doing. Everything in our power to be an obstructionist."

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