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Navigators help needy through healthcare maze

Three years ago, Bill Botts traded in his long, grueling days as a legal aid lawyer for a life of retirement and travel.

These days, he’s back to grueling work—this time, spending 14 hours per day enrolling Fredericksburg-area residents in health insurance under the Affordable Care Act. Botts is one of a handful of federally trained navigators, who steer people towards the best insurance options available.

Botts spends his only day off each week lying on a heating pad, trying to rest his aching back. But the other six days, there’s little time for rest.

And Botts’ days are only getting busier. Time is running out for people to sign up for insurance on state or federal exchanges. Across the country, open enrollment ends March 31.

After that date, people can sign up for coverage this year only if they have a life-changing event such as a birth, divorce or job loss.

At first, consumers seemed hesitant of the exchanges—and glitches with the federal government’s enrollment website made the process daunting. But since January, the area’s navigators have been swamped.

Those navigators include Botts, who is employed through ENROLL Virginia and eight volunteers who work out of a Fredericksburg office.

The area also has eight paid navigators based at the area’s three hospitals. They are certified by the federal government and paid through federal grants.

When the navigators’ work began last fall, the region’s health district included 38,000 uninsured people. About 15 percent of adults in the city of Fredericksburg and its five surrounding counties are uninsured, according to the Virginia Atlas of Community Health.

And their stories are “heartrending,” Botts said. “It’s really sad; a lot of these people are sick and suffering.”

At Mary Washington Hospital, navigators typically work with people who are in the middle of some type of health crisis, said Kathleen Bourgault, vice president of revenue cycles for Mary Washington Healthcare.

“This really is not a political issue,” she said. “It’s about helping individuals access health care.”


Quite a few people who use the hospital don’t have insurance, Bourgault said. Some can qualify for charity care, where the hospital writes off the cost of treatment. But many work out a plan to repay the bills in installments.

“We need to get paid so we can continue to provide services,” Bourgault said. “The charges at hospitals are high oftentimes to make up for people who don’t have insurance.”

Without insurance, people often delay routine or preventative care and wind up in the hospital with a crisis, said Wendy Bennett, president of Advanced Patient Advocacy.

One of her agency’s navigators helped a woman who came to Mary Washington’s emergency room in need of critical care. The woman had cancer but no insurance, so she wasn’t taking her medicine and was skipping doctor appointments.

The navigator got the woman and her husband both on a plan through the exchange. After subsidies, the couple paid $2.22 per month, Bennett said.

“Now the hospital is going to get paid,” she said. “And the woman is going to get the right treatment and not end up in the emergency room.”

“It’s better for the hospital. It’s better for the patient. It’s better for everyone,” Bourgault said.

Since October, the hospital-based navigators have helped 3,300 people, Bennett said. Some people were able to get Medicaid and others enrolled in the marketplace.

Botts and his volunteers have helped about 1,250 people with applications, and enrolled about 500 of those. Others enrolled themselves after getting information from the navigators.

Through February, 102,000 Virginians have signed up for insurance on the marketplace, Botts said.


Not every uninsured person is getting help, though. About a quarter of the people who come to Botts for assistance fall into the Medicaid gap.

Subsidies help people who make 100 percent to 400 percent of the poverty line. That means that an individual who makes between $11,490 and $45,690 would qualify for tax credits.

In a family of four, an income between $23,550 and $94,200 would qualify for credits.

Those who make less would qualify for Medicaid, under expanded federal guidelines. But states can choose whether to expand Medicaid, and Virginia lawmakers are deadlocked over the issue.

The General Assembly begins a special session Monday to take up the expansion issue, which is tied to the state budget.

At Micah Ecumenical Ministries in Fredericksburg, which works with the homeless and those at risk for homelessness, most of the clients who need insurance don’t make enough money to qualify for the tax credits, Director Meghann Cotter said.

Often they go without health care because the wait at the area’s free clinics is too long, she said.


Micah is seeing another fallout from the health care act: Some newly homeless people coming for help after losing hours at their jobs. The Affordable Care Act requires most employers to provide health insurance to employees who work 30 hours or more.

So some employers have chosen to slash hours, leaving workers without enough money to pay rent, Cotter said.

“We’re having people become homeless because they used to work 40 hours a week,” she said. “But rather than invest in health care, the employers are cutting down to 29 hours.”

And some people who bought individual health care coverage have lost their plans because the plans no longer qualify under stricter federal guidelines.

Botts acknowledged that there are some people who aren’t being helped by the health care reform. But each day, he sees many people whose lives are changed for the better.

His office receives anywhere from 12 to 50 calls each day and has logged more than 1,300 messages since mid-December. The majority of people have been able to enroll, he said.

“Obamacare has been so vilified and it’s been described as a train wreck that doesn’t help people and actually hurts people,” Botts said.

“I come home at night and turn on the news and what they’re describing about Obamacare seems alien to me because I’ve spent the day with people who are hungry for it and who are being helped by it.”


Botts and his volunteers try to go to community places to meet people and teach them about the new health insurance options.

They go to public libraries, community health centers, churches and the Rappahannock United Way’s free tax preparation sites.

And an intern from the University of Mary Washington provides translation. The navigators have seen a lot of immigrants, Botts said.

On a recent morning, he saw families from Peru, South Sudan, China and Honduras.

“Most of us in the office are retired, a time when people like to travel,” Botts said. “We joke that you can sit in the navigators’ office and see the world.”

Botts, who retired in 2011 as the director of Rappahannock Legal Services, will continue working after open enrollment ends, helping people who have questions and those with life-changing events that would qualify them for enrollment.

And while it’s not quite the retirement he pictured, Botts finds the new job rewarding.

“I thought legal aid for 38 years was the best life you could hope for,” he said. “But this is more satisfying and more uplifting than I could ever imagine.

“You don’t appreciate what it means to have access to health care and health insurance until you see so many who don’t. They hug you and they start crying or saying, ‘God bless you.’”

Amy Umble: 540/735-1973


Mary Washington Healthcare will host an Affordable Care Act Patient Navigator Town Hall meeting at 6 p.m. Tuesday in the Fick Conference Center on the second floor of Moss Free Clinic building on the Mary Washington Hospital campus, 1301 Sam Perry Blvd.

The event will feature information on enrolling for health insurance and will offer step-by-step help. Participants can also sign up for one-on-one appointments with a navigator.

Participants should park and enter through the rear of the building. Refreshments will be served.

For details, email or or call 741-2541.

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