As enrollment in health care law looms, some states erect roadblocks

McClatchy Washington BureauSeptember 18, 2013 


Texas Attorney General Greg Abbott, April 2013.

RON T. ENNIS — Fort Worth Star-Telegram/MCT

— The individuals and groups tasked with helping people enroll for health insurance coverage under the Affordable Care Act are facing a stiff head wind of restrictive laws, regulations and outright obstruction in some Republican-led states.

In Florida, health officials won’t allow these so-called “navigators” onto county health department properties to help uninsured people sign up for coverage in the new state insurance marketplaces.

In Georgia, state Insurance Commissioner Ralph Hudgens recently told a gathering of Republican supporters that the state would do "everything in our power to be an obstructionist" of the Affordable Care Act.

Navigators also have drawn the ire of congressional Republicans, who’ve asked 51 navigator groups nationwide for detailed information about their activities, funding and staffing just as the groups are training and preparing for the launch Oct. 1 of the marketplace open-enrollment period.

In a recent hearing on the health law, Rep. Frank Pallone, D-N.J., called the Republican requests “despicable.”

“This is an egregious abuse of the committee process and an attempt to intimidate community organizations and overwhelm them with information requests at a crucial period so that they don’t implement the program,” Pallone said.

Rep. Michael Burgess, R-Texas, was unapologetic.

“Why wouldn’t we have questions about the vast sums of money that have been pushed out the door relatively hastily to these navigator groups,” Burgess said. “Why wouldn’t we have questions as to their credentials . . . their ability to provide what they’ve been required to provide?”

The Obama administration responded to the Republicans on behalf of the navigator groups, but the political scrutiny and heightened legislative oversight have taken a toll. Several navigator organizations around the country have returned their Affordable Care Act funding and dropped out of the program because of complications involving state laws.

Trained to be impartial consumer-outreach workers who are prohibited from recommending one health plan over another, navigators are crucial to meeting the Obama administration’s goal of enrolling 7 million Americans in health coverage through the marketplaces next year.

But that undertaking has been complicated by the navigators’ late start, their limited funding and widespread public confusion about Obamacare. Tough state laws regulating the navigators have added to the challenge.

In Missouri, Georgia and Ohio, navigators can’t give advice about the benefits, terms and conditions of marketplace health plans. Consumer advocates say those laws conflict with federal guidelines that call for the navigators to help people compare and understand the differences among health plans offered in the marketplaces.

For that reason, the Center for Health Law Studies at Saint Louis University has asked Missouri not to enforce its provision.

Navigators in Louisiana, Missouri and New Mexico can’t assist people whose current coverage was purchased from an insurance agent or broker, which greatly limits the universe of people they can help.

State law requires Nebraska navigators to inform people who already have insurance that they can seek similar assistance from insurance agents and brokers.

In Georgia, navigators can’t initiate contact with anyone who currently has insurance. A similar law is pending in Pennsylvania.

“They’re basically telling them who they can and can’t talk to,” said Mark Dorley, a health policy researcher at George Washington University who studies navigator laws.

At least 16 states have passed laws requiring licensing or certification of navigators beyond the federal requirements, and five have similar laws pending, Dorley said.

Republican officials say the state certification laws protect the public from navigators who could be poorly trained, have criminal backgrounds and possibly misuse or reveal consumers’ personal health information.

Texas Attorney General Greg Abbott was among 13 Republican attorneys general who called for stricter state regulation of navigators. In a recent statement, he said the health care law’s guidelines for navigators to safeguard people’s personal information were “weak, lack clarity and fail to impose the accountability necessary to protect Texans’ privacy rights.”

On Wednesday, the Obama administration announced that the federal marketplace call center will refer privacy and consumer-fraud complaints to the Federal Trade Commission for investigation.

Obamacare supporters argue that navigators will provide the same type of assistance as workers who help enroll seniors in the Medicare program. Those workers haven’t faced the same kind of scrutiny as navigators nor have they been a major source of consumer complaints.

Insurance agents and brokers, who view the navigators as competition because they provide similar services, have lobbied states to enact tougher oversight laws for navigators.

“All these bills do is make clear that state regulators have jurisdiction, that they can reach navigators the same way that they can reach health plans and health insurance agents,” said Wes Bissett, senior counsel for government affairs at the Independent Insurance Agents & Brokers of America.

Health care advocates and Democrats charge that many of the regulations go too far and are thinly veiled attempts to obstruct the law and sabotage marketplace enrollment efforts while protecting the professional turf of agents and brokers.

“I think these laws have been more intended to just be an obstacle to successful implementation of the Affordable Care Act,” said Tricia Brooks, a senior fellow at the Center for Children and Families at Georgetown University.

In states that will run their own marketplaces, navigator licensing laws are far less restrictive, Brooks said. “It’s really only in states where there will be federally run exchanges that these laws are popping up,” she said.

A report to be released Thursday by the Center for American Progress, a left-leaning research center, summarizes the various laws in states that will have federally run marketplaces.

In Atlanta, Bill Rencher, a navigator in training, said the politically charged atmosphere had everyone’s attention.

“I’m a little concerned,” said Rencher, the health access program director at Georgia Watch, a statewide consumer advocacy group. “I think there’s definitely going to be some very active oversight going on that we all need to be aware of. We definitely have a lot of work ahead of us, and the partisanship around this is not making it any easier.”

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