"Would you like to sign up for health care or see what we have?" Thelma Juarez of Little Rock asked Friday during a training exercise for people who will guide Arkansans through the Health Insurance Marketplace, commonly known as the insurance exchange.
Linda Scott of North Little Rock, a trainee who was playing the part of a healthy uninsured person, answered curtly: "No."
Juarez and Scott were at the Pulaski Technical College Business and Industry Center in Little Rock last week for training as "guides," one of four types of in-person assisters, or IPAs, who will help Arkansans navigate the exchange. The trainees acted out several scenarios they could experience in the field, such as interaction with people who have no fixed address, speak little English, think they don’t need insurance or have a negative view of health care reform.
"You’ve got to remember all of the political games that came with this program before it came in our lap," said Pulaski Tech instructor Tina Ward, one of the instructors providing training for the guides. "People have misconceptions, there’s myths out there, there’s untruths, there’s truths — and then there’s fear.
"One of the things that the IPAs will have to do … is dispel all the fear before they can even get in and offer the full program. So it’s important that they know that, because you’re going to get some resistance."
The state’s 22 two-year colleges are providing training for a little more than 500 guides who are expected to be in place before enrollment in the exchange begins Oct. 1. Coverage will begin Jan. 1, when the federal mandate for almost all Americans to have health insurance takes effect under the Affordable Care Act.
The guides will be employed by various Arkansas-based organizations that have entered into contracts with the state Insurance Department. The federal government has awarded the state $17 million in grants to cover the contracts, which the state is awarding based on an estimated wage for the guides of $12 per hour, although the individual vendors will set the actual wages.
The federal government also paid for Arkansas to develop a curriculum for the first phase of training and to train the instructors. The two-year colleges created the curriculum, within federal guidelines, and in June the authors of the curriculum conducted training for the instructors who would in turn train the guides. The training for the trainers was conducted at Pulaski Tech, the lead college of the training program.
Arkansas is one of the first states to have a curriculum in place.
"They’ve already been receiving phone calls from other states wanting to know about our curriculum," said Michael Ekbladh, the training program’s coordinator at Pulaski Tech. "We’re ahead of the ball."
Ekbladh said he would love to see Arkansas’ curriculum become a model for other states.
About 145 people in Arkansas have completed the first of three phases of training to be guides. The first phase is a general overview, the second phase will be provided online by the federal government and the third phase will be state-specific.
Cynthia Crone, director of planning for the exchange, said the third phase of training will address the private option, Arkansas’ plan to use federal Medicaid dollars to subsidize the purchase of insurance through the exchange for Arkansans earning up to 138 percent of the federal poverty level. The plan still needs approval from the federal government.
"That curriculum (for the third phase) will also be developed by community colleges, but … we won’t be able to finalize it until we see what phase two is," Crone said.
In addition to the guides, the IPAs will include navigators, who will be hired directly by the federal government; certified application counselors, who will be employees of entities such as hospitals, community health centers and consumer nonprofit organizations; and professional insurance agents and brokers.
Juarez, who is fluent in English and Spanish, said she wants to be a guide because she wants to help break down the language barriers that might pose difficulties for Spanish language speakers.
"I just want to look out for my community," she said. "I want them to get the same benefits as anyone here."
In her exercise with Scott, Juarez responded to the latter’s brusque "No" by calmly and politely explaining the penalties that will apply to people who remain uninsured. Scott asked what would happen if she could not afford insurance.
"There’s different plans for everyone, and the great thing about this is, it makes it affordable for everyone," Juarez said. "You do all the choosing; I don’t do any. It’s whatever benefits you. This is all about you, and it’s going to work with your income."
Scott ultimately admitted to being "somewhat" interested and agreed to talk with Juarez again.
The rest of the class applauded; Ward praised Juarez’s persistence.
"She hung in there" she said.