The Great American Smokeout Day is Today
Originally posted on https://www.cancer.org
The American Cancer Society marks the Great American Smokeout on the third Thursday of November each year by encouraging smokers to use the date to make a plan to quit, or to plan in advance and quit smoking that day. By quitting — even for one day — smokers will be taking an important step towards a healthier life – one that can lead to reducing cancer risk.
This year, we’re celebrating quitters and their supporters with a series of fun characters designed for social sharing on Facebook, Twitter and Pinterest. We’ve also got lots of other resources and information to help you quit for good.
Have a question about how to quit smoking? Want to know how lawmakers can help in the fight against tobacco use? Sharecare & the American Cancer Society team up to host a Great American Smokeout Twitter Chat. On Wednesday, Nov. 20 and Thurs. Nov 21, ask your question on Twitter and Facebook using the hashtag #quitforgood. Go online Thurs, Nov 21, 11 am to 4 pm EST to see the answers roll in from the American Cancer Society and other experts!
Get tips on how to kick your smoking habit during the American Cancer Society’s Great American Smokeout on Thursday, Nov. 21st from 1-2pm ET during Everyday Health’s #HealthTalk: https://www.everydayhealth.com/healthtalk/great-american-smokeout.aspx
Tobacco use remains the single largest preventable cause of disease and premature death in the US, yet about 43.8 million Americans still smoke cigarettes — Nearly 1 in every 5 adults. As of 2010, there were also 13.2 million cigar smokers in the US, and 2.2 million who smoke tobacco in pipes — other dangerous and addictive forms of tobacco.
Why Quit?
The health benefits of quitting start immediately from the moment of smoking cessation. Quitting while you are younger will reduce your health risks more, but quitting at any age can give back years of life that would be lost by continuing to smoke. View sources.
More Information About Quitting
Quitting is hard, but you can increase your chances of success with help. The American Cancer Society can tell you about the steps you can take to quit smoking and provide quit-smoking programs, resources and support that can increase your chances of quitting successfully. To learn about the available tools, call us at 1-800-227-2345. You can also find free tips and tools below.
- Guide to Quitting Smoking
- What are the Benefits of Quitting?
- Desktop Helpers
- Resources and Tools
- Cigarette Cost Calculator
- Expert Voices Blogs on Tobacco and Smoking
- Latest News About Tobacco and Smoking
- QUIZ: Do You Need Help Quitting?
- Fight Back Against Tobacco
- Get the new Quit For Life Mobile app from Alere Wellbeing, available for iPhone and Android
Groups defend small self-insured plans
Originally posted November 14, 2013 by Allison Bell on www.benefitspro.com
Defenders of self-insured health plans testified on Capitol Hill today that the plans are tools for employers to get more control over benefits programs, not get-out-of-federal-health-regulation free cards.
The witnesses — including Robin Frick, a Madisonville, La., benefit plan administrator, who spoke on behalf of the National Association of Health Underwriters, and Michael Ferguson, the president of the Self-Insurance Institute of America, appeared at a hearing on self-insurance organized by the House Small Business Committee health subcommittee.
Some health policy watchers, including Linda Blumberg of the Urban Institute, who also testified at the hearing, have suggested that young, healthy small groups could use self-insurance simply to escape from Patient Protection and Affordable Care Act requirements, and that a flight toward self-insurance could destabilize the small-group health insurance market.
Frick told subcommittee members that most PPACA market protection rules will apply to self-insured groups as well as to insured groups.
"Further, some protections, like non-discrimination testing, already apply to all self-funded plans," Frick said, according to a written version of his remarks posted on the committee website.
The U.S. Department of Health and Human Services is giving more flexibility to insured plans in some areas, such as employee participation requirements, than to self-insured plans, Frick said.
Ferguson gave a list of some of the many PPACA rules that apply to non-grandfathered self-insured plans, including the ban on annual and lifetime benefits limits, preventive services coverage requirements, benefits summary requirements, disclosure requirements, external claim denial review requirements, limits on waiting periods, and an emergency services coverage mandate.
Many of the PPACA provisions that exempt self-insured groups, such as PPACA health insurance rate rules, are irrelevant to self-insured groups, because the self-insured plan sponsors already have an obvious incentive to try to hold down administrative costs, Ferguson said.
Workers stressed over finances
Originally posted November 15, 2013 by Maria Wood on www.lifehealthpro.com
Employees are more aware of their financial shortcomings, but with that increased awareness comes greater strain on their psyches. That was the major takeaway of a recent survey by Financial Finesse, a provider of fiscal education.
The third-quarter “Trends in Employee Financial Issues” survey revealed that 19 percent of employees report “high or overwhelming” levels of financial stress, up from 13 percent in the same quarter of last year. Similarly, 41 percent expressed uncertainty regarding their ability to achieve future financial goals, a significant jump from 34 percent in the third quarter of last year and 33 percent in Q3 2011.
What has them so worried? The U.S. economy and stock market were cited by 43 percent of employees as the major stumbling blocks to a secure financial future. That’s an increase from 42 percent Q3 2012 and 40 percent in 2011’s third quarter.
Employees in the upper age range – 45 and older – were the most anxious. According to the survey, 84 percent of those 45 or older admitted to some level of financial stress, up from 80 percent a year ago and 74 percent in the third quarter of 2011. Financial Finesse researchers attributed that escalation to the immediate and conflicting pressure those in that age group may be facing, such as paying for college for their children and caring for aging parents while at the same time trying to save for retirement and confronting higher health-care costs.
Awareness and action
The overall employee financial wellness score dipped below five (4.9) for the first time since the first quarter of 2012. Yet that decline, emphasized the Financial Finesse researchers, is not due to worsening cash and debt management – areas where employees are maintaining good habits. (For example, 88 percent said they pay their bills on time each month, the same percentage as the previous quarter.) Instead, the researchers conclude it is due to employees heightened awareness of their financial challenges.
Consequently, they are taking steps to address their concerns, at least at the older age bands. Forty-eight percent of employees who took a financial wellness assessment were 45 or older in the latest survey, an upward arc from 44 percent in the same quarter of last year and 43 percent in Q3 2011.
It’s also translating into improved retirement planning. When queried if they were on target to replace at least 80 percent of their income, or goal, in retirement, 19 percent answered yes compared to 18 percent a year ago and 12 percent in the third quarter of 2011. The older one gets the more they have made that calculation, with the highest percentages seen at 55-64 (23 percent) and 65 and older (33 percent).
Rising participation in work-based retirement plans was also charted, with the percentage climbing from 87 percent in Q3 2012 to 90 percent in the latest survey. More employees said they have used a retirement calculator: 39 percent in Q3 compared to 34 percent in the prior year.
Survey: Employees still under-informed on ACA, wellness
Originally posted November 8, 2013 by Tristan Lejeune on ebn.benefitnews.com
Only 15.1% of workers at large employers say they are “knowledgeable” or “very knowledgeable” about health care reform and the Affordable Care Act’s public exchanges, and nearly one in five can’t say for sure if their company has a wellness program or not, according a recent survey. The poll’s results, released this month, speak to a population that has confidence in the communication efforts of their benefits administrators, and that points out some serious shortfalls in that communication.
The survey, which spoke with 400 employees at companies with north of 2,000 each, found that only 29.5% could correctly identify times when they can make changes to their health plans, like open enrollment, according to the Jellyvison Labs. Jellyvision, which created ALEX, a virtual employee benefits counselor, says all but one of the employers involved in the survey offer health insurance, but employees still demonstrate large education gaps on their own benefits.
More than 90% of surveyed workers say it’s at least “somewhat important” to understand ACA and its implications, but less than a fifth actually consider themselves knowledgeable. The good news is employee confidence in their employers’ ability to communicate the necessary information is high: nearly 80% think their companies can properly bring them up to speed, and more than one in three rate their confidence levels on this point at eight or higher on a 10-point scale.
Some 77.6% of those polled agree that it is at least “somewhat important” for their organizations to offer a wellness program, but almost one-fifth don’t know with any certainty whether or not their company does so.
“One of the most important things we learned from this data,” says Josh Fosburg, vice president of business development for the Jellyvision Lab, “is employees aren’t getting everything they need to know about their employers’ wellness programs and other benefits. For instance, nearly half of employees in our survey think they have to pay something in order to take advantage of the wellness programming that will help them manage their weight, stay on top of their prescribed medications, or cease smoking. That’s bananas.”
Jellyvision says employers need to “up their communications game” in order to help employees take advantage of everything included in their benefits offerings.
Doctors urged to treat obesity like any other ailment; New guidelines say do whatever it takes to get the pounds off
Originally posted November 13, 2013 by Nanci Hellmich on www6.lexisnexis.com
There's no ideal diet that's right for everyone, but that shouldn't stop the nation's doctors from helping their heavy patients battle weight issues as aggressively as things like blood pressure, according to new obesity treatment guidelines released Tuesday.
The guidelines, from three leading health groups, say that doctors need to help obese patients figure out the best plan, whether it's a vegetarian diet, low-sodium plan, commercial weight-loss program or a low-carb diet.
Still, the most effective behavior-change weight-loss programs include two to three in-person meetings a month for at least six months, and most people should consume at least 500 fewer calories a day to lose weight, the recommendations say.
The guidelines are designed to help health care providers aggressively tackle the obesity epidemic. "The overall objective is quite a tall order: to get primary care practitioners to own weight management as they own hypertension management," says obesity researcher Donna Ryan, co-chairwoman of the committee writing these guidelines for the Obesity Society, American Heart Association and American College of Cardiology.
The recommendations are part of a set of heart disease prevention guidelines released Tuesday.
Nearly 155 million U.S. adults are overweight or obese, which is roughly 35 pounds over a healthy weight. Extra pounds put people at a higher risk of heart disease, stroke, many types of cancer, type 2 diabetes and a host of other health problems.
Health care providers should encourage obese and overweight patients who need to drop pounds for health reasons to lose at least 5% to 10% of their weight by following a moderately reduced-calorie diet suited to their food tastes and health status, while being physically active and learning behavioral strategies.
"The gold standard is an intervention delivered by trained interventionists (not just registered dietitians or doctors) for at least 14 sessions in the first six months and then continue therapy for a year," says Ryan, a professor emeritus at the Pennington Biomedical Research Center in Baton Rouge. If this kind of intensive therapy is not available, then other types of treatment, such as commercial weight-loss programs or telephone and Web-based programs, are good "second choices," she says.
Medicare began covering behavioral counseling for obese patients last year, and under the Affordable Care Act, most private insurance companies are expected to cover behavioral counseling and other obesity treatments by next year.
"There is no ideal diet for weight loss, and there is no superiority between the many diets we looked at," Ryan says. "We examined about 17 different weight-loss diets."
Pat O'Neil, director of the Weight Management Center at Medical University of South Carolina, says, "The diet you follow is the one that's going to work for you. That's good information for the public to have."
The report advises health care providers to calculate body mass index (a number that takes into account height and weight) at annual visits or more frequently, and use it to identify adults who may be at a higher risk of heart disease and stroke. Evidence shows that the greater the BMI, the higher the risk of coronary heart disease, stroke, type 2 diabetes and death from any cause, the report says. "BMI is a quick and easy first step," Ryan says.
The guidelines are being published simultaneously in Circulation, a journal of the American Heart Association; the Journal of the American College of Cardiology; and Obesity: Journal of the Obesity Society.
6 wellness tips for flu prevention
Originally posted on benefitnews.com
The flu costs businesses approximately $10.4 billion in direct costs for hospitalizations and out-patient visits for adults, according to the Centers for Disease Control and Prevention. In addition to encouraging workers to get immunized, employers can further minimize employee sick days and slow the spread of illness by communicating best practices in wellness and nutrition. Share these six preventive tips from Dr. Bruce Underwood, a certified nutrition and preventive care specialist with Healthy Futures, Inc., to keep workers and their families healthy this season.
No matter whether an individual decides to get immunized for influenza, primary prevention should be their priority for avoiding illness. Dr. Underwood explains that a good basis for our immune system is to get a good night’s sleep, generally between six to eight hours every night.
The surgeon general recommends all adults walk at least 10,000 steps or about 4 miles every day. If we over-exercise, then our immune system is weakened for a few days, explains Underwood. However, if we don't exercise at all our immune system is also weak.
As the following three slides prove, we need vitamins, minerals, amino acids, and fatty acids for our bodies to work well. Overall, Underwood recommends eating a wide variety of foods in amounts that allow you to maintain an ideal body weight.
One of the most important vitamins for immune health is vitamin C. The upper safe limit for Vitamin C is 2,000 mg for adults, according to the National Institute of Health. Underwood and other experts recommend 1,000 mg of the vitamin as a good daily dose. Dietary sources of the vitamin come mainly from fruits and vegetables, but can also be found in certain cuts of meat, especially liver. Studies have shown that our bodies expend Vitamin C to mitigate toxins such as cigarette smoke and pollution. The antioxidant has also helps relieve the physical and psychological effects of stress on people.
5. Zinc
The mineral Zinc is also necessary in stressful situations. By ingesting 10 to 40 milligrams of Zinc each day, individuals can also help build up their immune system. Underwood advises people to keep their daily dosage under 100 mg per day, however, as too much of the metal might cause fever, coughing, stomach pain, fatigue, and many other problems. Meats, seafood, dairy products, nuts, legumes, and whole grains offer relatively high levels of zinc.
For one year, White House revives health plans canceled under ACA
Originally posted November 14, 2013 by Tristan Lejeune and Brian M. Kalish on https://ebn.benefitnews.com
President Barack Obama announced that Americans whose health care plans have been canceled because they fall short of Affordable Care Act standards have been granted a one-year reprieve. With the decision, state governors and insurance commissioners would have the authority to keep would-be canceled plans active until the end of 2014.
“The Affordable Care Act is going to work for the American people,” Obama said from the White House briefing room in remarks that opened with sympathy and support for the typhoon-ravaged Philippines. Obama acknowledged that his team “fumbled the roll-out of the health care law,” but he hopes that extending existing plans will help win “back the confidence of the American people.”
The decision, which helps live up to a promise Obama made when pushing for passage of health reform, is couched as an administrative fix that says following ACA will not require insurance companies to upgrade their plan for individuals who have been in these existing plans so far. In what the White House is calling “an extension of grandfathering principle” Americans should now all be able to re-enroll in their current coverage so long as it is still offered by their provider.
“Two important things we require from insurance companies,” says the administration, “one is they notify consumers what protections these renewed plans do not include. And two, they notify consumers that they will have new options available on the marketplace that offer better coverage, and tax credits are available for many people.”
Insurers and participants in the individual and small group markets will not be considered noncompliant in these plans next year. This is a policy “targeted and very targeted” to those individuals who are in those policies today, it is not allowing to be sold to people not in plans. IN other words, the policy change only applies to extant plans; all new plans must comply with Obamacare in full.
Next year is an election cycle for 33 senators and the entire House of Representatives. This move will widely be seen as trying to appease voters furious about having their plans canceled after pledges were repeatedly made that exactly that would not happen.
State authorities can still decide to consider plans non-compliant next year and insist insurers get up to speed.
Obama said that Healthcare.gov enrollment is “absolutely not” where he wants it to be, “but there’s no question that there’s great demand for high-quality health care,” and he urged health care consumers not to try to throw out the baby with the bathwater and return to the landscape circa 2009.
“It’s important that we pretend that that’s not a place worth going back to,” Obama said. “And that’s why I will not accept proposals that are just a brazen attempt to overturn the law and go back to a broken system.”
He added: "This fix won't solve every problem for every person but it will help a lot of people. Doing more will require work with Congress."
Manage chronic diseases with smartphones and smart-tech inhalers
Originally posted November 5, 2013 by Kathleen Koster on benefitnews.com
If people with chronic conditions only spend about an hour a year with their physician, how can they stay adherent with medication and their disease education for the 8,759 hours they’re outside the doctor’s office? The most promising answer is through mobile devices.
Health plan providers and plan sponsors can use mobile devices to monitor and engage participants with notifications, such as medication reminders, when it is most convenient for them. Backsliders know where they are failing through self-monitoring in real time and coaches monitoring their results can intervene when necessary.
“People need to be thinking about lifestyle choices when they're living life. People don't live their life at a desk," says David Bjork, president of Telcare, Inc. He adds that lifestyle changes occur in the "between" moments, such as before and after work, during lunch or at home. Disease management programs and outreach need to encourage healthy behavior at all times.
Bjork insists that the current disease management strategy and methodology need to evolve; most of today’s programs identify people who are most expensive in claims data last year and manages them in order to save money for the future. However, he says, employers need to look at diseases from the wide mouth of the funnel and help people earlier before they escalate into high-risk categories and become high health plan utilizers.
Mobile technology is no different, says Bjork. Mobile outreach is deployed to focus on the most expensive, high-risk patients in a population. New solutions have emerged that collect data from more patients and track a wide range of peoples’ activity, biometric data or clinical metrics. And he believes more will come.
“The problem is that disease management as we know it has failed,” said Jonathan C. Javitt, MD, CEO and chief medical officer at Telcare, Inc. during a presentation at the Care Continuum Alliance Forum in Scottsdale, Ariz. These antiquated outreach programs too often identify the high-cost individuals from last year without taking into account who will be high cost this year or the year after that. He believes mobile solves this problem by engaging everyone in a population and can monitor and intervene with people in real-time before they become high risk.
Bjork agrees that tier-models focusing on certain diagnosis groups with high levels of utilization are missing an opportunity because certain disease states or condition states are left completely unguarded. For instance, disease management programs that focus on diabetes should also target obesity since that often leads to diabetes.
Mobile solutions for diabetes allow individuals to manage their blood sugar levels by sharing blood glucose levels through the cloud to the care management coach or vendor can monitor their levels behind the scenes. Mobile outreach can help manage pre-diabetes and weight as well by tracking a participant’s activity.
Carolina Advanced Health uses an online database to collect participant metrics and monitor them in a team-based approach with nutrition experts, care managers and pharmacists through disease registries. Participants self-collect their glucose levels through a mobile platform, which sends the data to health professionals. If the care team notices a blip in blood glucose levels after lunchtime, a nutritionist can call the patient immediately and ask them about their activity and meals that day to determine what caused the increase. The system educates the patient while monitoring their health metrics in real-time.
Self-management can get good results, explained Thomas Warcup, medical director at Carolina Advanced Health, but “when you add a team you get greater results because you’re watching the data on a real-time basis.”
Bjork believes mobile outreach like this is just the beginning. He predicts the mobile outreach for diabetes will fan out to managing other diseases. For example, blood pressure levels, asthma, and weight will all be observed in a more mobile way.
"We will start having methodologies for monitoring people in their own settings to manage behavior and intervene early on and not wait for the first episode to occur," he says.
One smart-tech inhaler gathers data whenever a patient uses it, helping understand what triggers an asthma attack and how to avoid one. Propeller Health’s inhaler shows when and where the patient uses it and combines this data with weather information (such as wind and UV index) as well as traffic information. With this data, they can map a city for an asthmatic patient so they can avoid bad air locations and prevent potential asthma attacks.
Make Tax Day Also Enrollment Deadline, One Health Expert Says
Originally posted November 7, 2013 by Julie Appleby on kaiserhealthnews.org
With one small fix, the administration could satisfy calls from some members of Congress to extend the time people have to enroll in new health insurance through online marketplaces, a health policy expert says.
The fix would not create problems in the industry and would move the deadline to a point when many people have a little extra money, says Brian Haile, senior vice president for health policy at tax preparation firm Jackson Hewitt.
Haile says pushing the current March 31 deadline to April 15 would ensure more people have cash from tax refunds to buy insurance – and would not really change the effective date of coverage beyond the current deadline.
That’s because there is a mid-month cutoff for coverage to begin on the first day of the following month. Policies for those who sign up at the end of March or on tax day would be the same: May 1.
While no specific new open enrollment end date has been proposed by lawmakers, several members of Congress of both parties are considering legislation amid the ongoing difficulties with healthcare.gov, the federal insurance website operating in 36 states.
Insurers are generally opposed to an extension, saying they based their premium rates for next year on the idea that the enrollment period would end March 31. Delaying the penalty for not having coverage or extending the open enrollment period could result in higher premiums in the future, the industry’s trade lobby has warned.
Actuaries say that insurers assumed in their premium calculations that most people would sign up by mid-December for coverage to begin Jan. 1, granting them an entire year of premium revenue.
Insurers also are concerned that the problem-plagued federal healthcare.gov website has increased chances that the people who soldier through the hassles of enrolling are likely to be those with costly medical conditions who were shut out of coverage previously. Healthy customers are needed to balance the risk – and cost — in the insurance pool. Add to that the talk of extending enrollment deadlines, and insurers see more revenue slipping away, eaten up by medical inflation and fewer months to collect premium payments during the year.
Looking at expected medical inflation for next year, every month’s delay probably corresponds to an average of two-thirds of 1 percent higher cost for the insurers, said David Axene, fellow of the Society of Actuaries. “That starts to creep into the amount of margin built into rates.”
Haile, a former director of the Insurance Exchange Planning Initiative of Tennessee, argues that granting a short enrollment extension could help insurers pick up additional younger or healthier consumers. Some of those customers may have been sitting on the sidelines because they are strapped for extra cash until they get their tax returns.
Insurers “are not going to lose revenue, but will pick up some young invincibles,” Haile said.
Although federal officials are not talking about changing the enrollment period – they see getting the website fixed as the top priority — the administration has moved to resolve an issue about timing. The problem was that even though the law allows the enrollment season to continue until the end of March, anyone purchasing a policy after Feb. 15 would have faced a penalty. So the administration granted an extra six weeks for people to avoid a penalty in 2014 for not having coverage. The tax penalty is $95 or 1 percent of household income, whichever is greater.
Why employers need to pay attention to ACA's insurance exchanges
Originally posted November 06, 2013 by Al Karr on www.federaltimes.com
When the Affordable Care Act first passed, most self-insured employers thought they wouldn't need to pay much attention to the new health insurance exchanges (or marketplaces) created by the law. After all, they were intended to help uninsured people get access to insurance, and their employees were obviously insured. And President Obama did promise that if people liked their employer coverage, they would get to keep it. So there wasn't really anything for self-insured employers to worry about, right?
Well, it turns out that things aren't that simple. Employers do need to pay attention to the exchanges that have launched in their states — either by the state or the federal government — because even if their employees don't use them, the functioning of the exchanges depends pretty heavily on some critical interactions among exchanges, employers, and their employees.
Most employers are aware by now that the requirement for large employers to offer coverage has been delayed for one year. But there are still many provisions in the ACA that place burdens and obligations on employers related to the exchanges. Most importantly, all employers (regardless of whether they currently offer insurance) must still provide notification to their employees describing the exchanges, and explaining the implications of applying for a tax credit on the exchange. There are also regulatory processes for exchanges to verify with employers information that individuals provide on exchange enrollment applications.
So employers are starting to realize that they really do need a communications strategy for how to tackle exchange education with their employees. Simply mailing the required notification form to all employees and calling it a day won't cut it.
Confused employees
Employees are going to have questions — lots of them. Some have been following the health care reform discussion, and those that hadn't been following it probably are now, thanks to the major issues the federal exchange has been having since its launch on October 1. Employees are seeing TV ads, print ads in magazines and newspapers, in addition to the media coverage on the exchange launch. And policy experts have noticed that some of these advertisements are totally devoid of any mention that the exchange is Obamacare or the ACA, and most don't mention anything at all about the individual mandate and that the exchanges are how to fulfill the mandate.
Employees could come into contact with navigators, certified application counselors, or in-person assisters (individuals hired by exchanges to assist with enrollment), all of which will be emphasizing the exchanges and the individual mandate, but probably don't know much about employer-sponsored plans in general, let alone each individual's circumstances regarding employer-sponsored coverage.
Recent polls have shown that as many as half of Americans believe the ACA was either repealed, or held unconstitutional, so these messages will no doubt be confusing for employees to hear. Despite all of the media coverage of the disastrous exchange launch, there are still people out there who might know about exchanges, but don't know what the ACA means to them.
Employers should be taking action now to devise a communications strategy aimed at their employees that is relevant to their workforces and fits appropriately within their company cultures. We all know that employees don't read the volumes of (boring) information employers provide during open enrollment season. Educating employees about exchanges is going to require a different and more ongoing approach. Some of the tactics employers should consider include:
- Human resources staff should be meeting with executive leadership to devise and invest in an employee communications strategy
- Contracting with a call center to do outbound calling to every employee
- Requiring all employees to meet face-to-face with an HR staff member
- Producing short videos about the exchanges for use in company communications
- Requiring attendance at "all staff" meetings
- Creating one-pagers to post on company intranet sites or to distribute through company newsletters
Navigators
One thing that has been discussed by some employers, but that may not be the best thing to rely on as a sole tactic, are the navigators. While a lot of organizations have become navigators, there is general agreement among policy makers that the program itself is woefully underfunded. And since some exchanges are run by states themselves, and the federal government runs others, it’s anticipated that the number of navigators hired and the training they will receive will vary from state to state. Also, there is no statutory requirement that navigators be trained on the nuances of employer-sponsored coverage, so there is no guarantee that they will be able to answer employees' questions about the coverage they are offered at work.