Investing in the Insurance Navigator Workforce to Advance Health Equity

Continued and increased political and financial investment is needed to support insurance Navigators’ equity work serving vulnerable communities in the United States.

The Obama Administration launched the federally funded Insurance Navigator Program (“Navigator Program”) as part of the Affordable Care Act. The Program’s purpose was to address barriers in access to health care through providing enrollment assistance, outreach, and education for consumers eligible for health insurance in states with federally facilitated marketplaces. In 2021, the Biden Administration invested $80 million in the Navigator Program for the years 2021-24, the largest funding allocation ever for this Program; this represents a significant change, as since its inception, the Navigator Program has experienced progressively lower funding and limited political support, undermining the work it was meant to do. The extra funding came amidst increasingly higher enrollment rates, with over 12 million consumers selecting a marketplace in 2021, up 5% from the previous year.

As investigators, we had personal interests in studying the work of insurance navigators. I, Dr. Van Eijk, am a medical anthropologist and I have been concerned about people having to delay or forego treatments because they lacked health insurance. Having worked as a public health nurse, I, Dr. Kett, had witnessed the negative consequences for clients when Navigators were unavailable due to cuts in hours or personnel. Working with the Center for Health Workforce Studies at the University of Washington, we had an opportunity to explore Navigators’ equity work more deeply.

Navigators support historically uninsured populations in accessing health care by providing insurance enrollment support and education, helping with denied claims, and assisting with more complex needs such as language translation. Yet the work of Navigators remains undervalued, and we wanted to learn how Navigators and the organizations they work for do this equity work with limited budgets and political support.  

What We Found

In 2020, we interviewed 24 directors and other professionals at organizations funded as federally certified Navigator Programs. Through these interviews, we learned more about the work Navigators do and how organizations have strategized to continue providing services despite severe funding cuts. Specifically, we learned:

• Navigators’ equity work goes beyond their required enrollment responsibilities due to gaps in the system. Navigators spoke of the ways they provided comprehensive support to clients who faced multiple barriers in navigating the health system and had complex social needs. They described the importance of doing “a lot of legwork” up front as part of helping consumers enroll in insurance, manage the inadequacies of the health system, and use their insurance post enrollment. They addressed technology barriers and helped people get medication covered or find a new provider, and handle denied claims. Beyond such support, Navigators also offered additional social and health referrals, including to housing, legal services, and food banks.
• Financial instabilities undermine this health equity work. The progressive budget cuts and competitive short-term funding cycles made it difficult for organizations to retain experienced Navigators to continue the work. Organizations had to provide services at significantly reduced capacity – in 2020, only 30 navigator organizations were funded, down from 104 in 2016. Organizations felt forced to stop outreach and education in rural or hard-to-reach communities. Stand-alone community-based organizations were particularly vulnerable to having to lay off staff or cut Navigator hours; they also spent more time lobbying for and managing funds from private donors or government officials that were often specific to one county or population.

Moving forward – what is needed to ensure navigators can continue to advance health equity in vulnerable communities?

Our study demonstrates the equity work that Navigators do, the breadth of their skills and services, and their unique abilities to serve vulnerable communities through their knowledge of these communities’ structural social, cultural, and health needs. The study also illustrates that financial instability challenges Navigators’ work. Many are from the communities they serve, and they are the reason Navigator Programs can offer linguistically and culturally sensitive services; Navigators’ holistic approaches result in consumers walking away with insurance and additional resources to meet their needs. Yet, the episodic funding approach fails to offer Navigators needed job security and long-term support. What can be done to help them?

1. Comprehensive long-term support of Navigators is needed as part of public health’s efforts to advance health equity. Without systematic support, the Navigator Program will continue to be required to operate at reduced capacity. Such shortages only further perpetuate existing inequities due to limiting access to the additional services and resources Navigators provide.
2. Increased political and financial investment will help stabilize Navigator organizations. This will facilitate their ability to train, hire, and keep Navigators and communicate value and commitment to this workforce and the communities they serve. The Biden Administration’s funding commitment is a strong start, but more work is needed to establish long-term certainty of funds.

Want to learn more about what we found and the implications for public health? Read our paper here: Lack of Consistent Investment in Federal Insurance Navigator Program Undermines Navigators’ Equity Work in Vulnerable Communities.

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Marieke S. van Eijk, PhD, is an Associate Teaching Professor in Medical Anthropology at the University of Washington. Their work addresses the role of the health workforce in advancing health equity and the impact of the US health insurance system on patient care and community wellbeing. 

Paula M. Kett, PhD, MPH, RN, is a Research Scientist at the Center for Health Workforce Studies at the University of Washington. She seeks to address health inequities through equity- and systems-oriented research focused on the public health and perinatal health care workforce.