Tina Barnhart, a health care navigator for Wheatland Memorial Healthcare in Harlowton, has signed up nearly 10 percent of the town's population for private, subsidized health insurance under the Affordable Care Act.
HARLOWTON — Tina Barnhart has learned a few important lessons about helping people sign up for subsidized private health insurance.
The trick is to be specific about insurance plans, and how much they cost, thanks to the federal subsidies. Just don’t mention Obamacare, or even refer to it by its less familiar but official title, the Affordable Care Act.
“If they know it’s Obamacare, they want nothing to do with it,” Barnhart said. “Because I tried to do that at the beginning.”
Because of what she’s learned — and because she is an unusually enthusiastic health care “navigator” — Barnhart has managed to sign up nearly 10 percent of Harlowton’s population for insurance under the ACA. As of Thursday, she had gotten 100 people signed up, and two more were coming in Friday.
Of those 100 people, she said, probably 95 of them had never had insurance before. The population of Harlowton is estimated at just under 1,000.
Barnhart is the health care navigator for Wheatland Memorial Healthcare in Harlowton, which includes a clinic and a 25-bed critical-access hospital. She was trained by and her position is partly funded by the Montana Health Network, a Miles City-based cooperative that serves small hospitals and clinics in Eastern Montana.
Mike Zwicker, CEO of the hospital in Harlowton, said Barnhart was his first choice when there was talk of training a health care navigator for Wheatland County.
Chris Hopkins, a vice president with the network, said he didn’t have numbers with which to compare the success rate of various navigators, but “as a percentage, I would say she (Barnhart) is probably the best.”
“Sometimes when they’re off the clock, they’re off the clock,” Hopkins said of the navigators. “But Tina likes to talk to people and likes to help people. She’s done a great job of engaging the community.”
That’s the other key to her success. She helps many people who come to her office in the hospital seeking help, but she rarely misses an opportunity to talk to people in other settings as well.
Basketball games are good places to start a conversation about health insurance. Standing in line at the grocery store is another good one.
“The post office is a great place to talk to people about health care because they’re getting their bills,” she said.
She wears her hospital name tag everywhere she goes, which is another good conversation starter. One recent client was a woman in her 50s, whom Barnhart had known for years.
They were both buying groceries at the Midtown Market in Harlowton when they struck up a conversation. Barnhart told her what her job was and the woman said she needed health insurance but couldn’t possibly afford it.
She said she had lots of bills and a variety of longstanding health problems, and she was sure she couldn’t find an insurance policy for less than $700 a month. Barnhart talked her into coming into the hospital, where they looked at various plans and deductibles.
In the end, thanks to federal subsidies based on her income, the woman found a policy with a monthly premium of $5, a $700 deductible and a $5 co-pay on generic prescriptions. Not surprisingly, Barnhart said, “She jumped on it. She was so excited.”
Some of Barnhart’s clients have policies for which they pay nothing. Her 23-year-old son pays $1.67 a month, with a $3,900 deductible and a $5 prescription co-pay.
In addition to being a navigator, Barnhart continues working at her old job in the hospital’s business office, where one of her duties is trying to collect on medical debts. So she’s thrilled to see people coming in with insurance cards now.
“Some of these people have never had insurance as long as I’ve been here,” she said. Counting the years she worked at the hospital as a certified nursing assistant, she’s been there for 10 years.
The Montana Health Network is one of three groups in Montana that were awarded federal grants last summer to become health-care navigators. They, in turn, trained people like Barnhart to become navigators in rural hospitals and clinics.
Her training included 60 hours of online federal training, followed by testing, fingerprinting, background checks, state training and eventual licensing. For the federal training, she had to score 90 percent or higher on each of 22 small tests and then one big test at the end.
“The federal training was difficult,” Barnhart said. “It was pretty intense. They went through every aspect of the health care law.”
No one could possibly become familiar with all the intricacies of the voluminous act, she said, “but you take lots of notes and find lots of helpers.” And she still does two hours of teleconference training every Friday. By coincidence, Barnhart was the first navigator in Montana to be licensed.
Uninsured people who wanted to qualify for a federal subsidy to help pay their premiums must buy private insurance through the marketplace.
The deadline for doing so is March 31. After that, there won’t be another open enrollment until next October. It was reported last week that about 22,500 Montanans had signed up for health insurance policies through the online marketplace as of March 1.
That means about 2.5 percent of the state’s population had chosen a plan through the marketplace, compared with the national average of about 1.33 percent.
What makes Barnhart’s track record even more remarkable is that a recent national survey estimated that only about a quarter of those of purchasing polices through the marketplace were previously uninsured.
Her success wasn’t much of a surprise to Mike Zwicker, CEO of Wheatland Memorial Healthcare. When the Montana Health Network announced it was looking for people to train as navigators, Zwicker said, “she was the first person to come to mind.”
He said he knew she had a lot of “unused talents,” and he was aware of her wide knowledge, her positive attitude and her outgoing personality.
“She’s made this navigator program invaluable, not just locally but setting the standard statewide,” Zwicker said.
Barnhart is originally from Wyoming and has lived in Harlowton for 25 years. In addition to her full-time job at the hospital — more than full time since she added navigator to her resume — she spends two hours every morning delivering the Billings Gazette to all 150 of its subscribers in Harlowton.
Barnhart said she understands why people were so critical of Obamacare, at least initially, in the wake of its disastrous rollout on the Internet, starting Oct. 1. But people need to know the system is working now and that good, cheap coverage is available to those who’ve never had insurance before, she said.
Barnhart sits down with virtually every client and helps them enroll online. She can get a person enrolled in as little as a half hour, she said, though some complicated cases have taken two hours or more. Still, for what they get, that’s not an unreasonable sacrifice, she said.
“I show them the whole picture,” she said, referring to the Affordable Care Act, “not the Obamacare black hole.”
“If you can get people past that fear and talk dollars with them, they want to hear more,” she said.
On nearly every occasion, she said, “they’re relieved. They’re happy it’s not a nightmare, because it’s not.”
