My Day in Columbia, Missouri

  ·  Health Policy Hub   ·   Robert Restuccia

It was a beautiful spring day to be in a conference room, but inside, people’s energy did not wane.

I felt like I was in a room of scientists – listening to presentations, brainstorming ideas, evaluating new approaches – all with the goal of improving their results. 

These “scientists” were not looking to cure cancer – but what they were doing could be just as important to someone’s health. They were enrollment assisters, discovering the best ways to get the people of Missouri health insurance coverage. They came from all over the state, brought together by Dara Taylor, Carrie Rogers and Wells Wilkinson, the Community Catalyst staff who help create and support a community of enrollment assisters as part of the Expanding Coverage Initiative of the Missouri Foundation for Health.

As specialists, enrollment assisters take on the hardest cases:  people who speak English as a second language, individuals with disabilities, or those who live in remote communities without internet access. They take the complex rules of the ACA and make them understandable to regular people.   

Fully engaged, the assisters were passionate about their work because they understand it makes a difference in people’s lives. Patty Hendren, an enrollment assister from Randolph County Caring Community Partnership, told a story of how she helped a farmer get health insurance just a day before his house burned down, leaving his daughter with severe burns. The next day he had a heart attack and was rushed to the hospital. But because this family had health insurance, they could get the care they needed and did not need to worry about the medical bills.

For me, this meeting was a flashback. I have worked in health advocacy for 30 years. What I remember most are the stories of helping people. Over 20 years ago, Florence Allen called to ask for my help. Her son was the innocent bystander of a gang shooting. He was brought to a major teaching hospital in Boston with a stomach wound and had surgery that required a colostomy. He was discharged after three weeks with instructions to return in a month to have his colostomy closed. When he returned, he was told he owed $3,000, which he could not afford. Uninsured, he went a year with a colostomy he did not need despite the fact he could have been enrolled in a program that would have covered the hospital bill. The colostomy bag was removed three days after he got assistance through Massachusetts’ free care pool, which, while helpful, offered a short-term fix rather than insurance coverage.

Over the last 20 years, we have made a lot of progress in providing health coverage to people. The ACA has helped 20 million people gain insurance. But it’s not a perfect law. For some, it is not easy to sign up, choose a health plan and stay insured. There are loopholes, complex rules, and physical and emotional barriers that need to be addressed. This is why enrollment assisters play such a critical role. Given that the ACA is a federal law, you would think the government would support enrollment assistance to help guide consumers through these challenges. Unfortunately, that is not the case.  Federal financial support for enrollment assistance is built into the Affordable Care Act. However, the amount distributed over time is variable. It will not be enough to sustain the growing capacity needed not only to help consumers gain health insurance coverage, but also to learn how to use their coverage.

In Missouri, the Missouri Foundation for Health has stepped up to the plate by investing in outreach, education and enrollment through support of the Cover Missouri Coalition and on-the-ground enrollment assistance. The foundation understands the vital role assisters play.

It is ironic that while we spend billions of dollars supporting cancer research and the training of medical professionals, this other vital function that saves lives by connecting people to health coverage is severely underfunded.