The efforts of governors and state legislators to block consumers who want to use PPACA Navigators to help them sign up for health care could have “profound effects,” a consumer advocacy group contends in a report released today.
“This is Navigator suppression, and it perpetuates the systematic denial of affordable health care to huge numbers of the most vulnerable individuals in our society, especially those in minority and lower-income populations,” said Ethan Rome, executive director for Health Care for America Now (HCAN).
The National Association of Insurance and Financial Advisors (NAIFA), however, said they could understand the decision of states to act.
"While the thousands of Navigators hired will help consumers enroll through a state or federally-facilitated marketplace, consumers will require assistance that goes far beyond registering for a plan," said NAIFA President-Elect John Nichols said.
According to Nichols, agents and brokers do much more than sell insurance. They explain critical differences in plan options and coverage, which may involve substantial research and fact-finding about the client’s needs. They advocate on behalf of their clients, helping people when they have trouble getting procedures approved or claims processed.
"They also review coverage on a periodic basis, suggesting changes when appropriate and counseling on ways to reduce costs," Nichols said. "When purchasing a plan from a marketplace, the companies that sell health insurance should immediately assign consumers an agent. The healthcare system is complex, and coverage does not begin and end with enrollment. Consumers benefit from the expertise that brokers and agents provide in servicing the plan throughout the year. They need to be involved, or customer service surely will be a casualty of healthcare reform.”
HCAN officials said Jay Angoff, a partner at Mehri & Skalet in Washington, is considering filing lawsuits that would stop the recalcitrant states from interfering with the Navigators and acting to stop the states from delaying the work of the Navigators.
Angoff is the former insurance commissioner of Missouri, and the first head of the Health and Human Services Department’s Office of Consumer Information and Insurance Oversight (OCIIO). OCIIO is the office responsible for implementing the insurance reform provisions. He did not return phone call seeking comment.
Those participating in today's conference call said it is unlikely HHS would file its own lawsuits to stop the interference because it is so busy implementing the many pieces of the law, the Patient Protection and Affordable Care Act (PPACA).
Rep. Jackie Speier, D-Calif., ranking minority member of the House Subcommittee on Energy Policy, Healthcare and Entitlements of the House Energy and Commerce Committee, discounted the utility of filing lawsuits. Speier said on the conference call that courts would likely not find the suits “ripe for litigation” because the provisions of the law involved have not yet taken effect.
Speier said the feedback she is getting from her district is that when the exchanges are launched Oct. 1, enrollment will probably be slow “as we start out and then gain as times on.”
Speier predicted that the exchanges “will probably see a takeup rate that is quite high.” She said that in her polling of young people, she "was surprised at how important this is to the 20-somehtings; I was surprised at how readily this will be embraced.”
Sabrina Corlette, a health policy expert at Georgetown University, called the state laws "unprecedented." She said they were unnecessary given Medicare's positive history with counselors similar to the Navigators. "It's not to say there aren't legitimate concerns about fraud, or con artists taking advantage of Obamacare," she said. "It's just that these state laws are really barking up the wrong tree … There is no credible evidence whatsoever that Navigators will be a source of fraud."
Corlette said the criminal background check some of the state laws are requiring, as well as additional training are imposing an additional hurdle to the Navigators’ starting their work.
“They are already required to undergo training, training that is quite extensive and includes the providing of a lot of educational material. This involves piling on information they already have.
“All it does is make it more difficult for people to have access to important information on health care options,” she said.
As to background checks, Corlette said the organizations to which the Navigators are associated “had to be vetted through an extensive process.” And, she said, “some of the checks are being required incredibly late in the game, and will not be complied with in time to allow these people to start doing their job on time.”
The HCAN report, entitled. “Anti-Obamacare States Try to Throw Navigators Off-Course,” describes some of the state tactics used to block the work of navigators and undermine successful implementation of the law.
The report said the excessive requirements being used by officials in at least 13 states to block consumers from using Navigators include such requirements as residency rules, extra fees, additional and unnecessary training requirements, superfluous certification exams, and prohibitions against navigators talking with consumers about the benefits offered by different plans.
The states are Arkansas, Florida, Georgia, Iowa, Illinois, Indiana, Maine, Missouri, Montana, Ohio, Tennessee, Texas and Wisconsin. According to the report, these states are home to 17 million uninsured people eligible for coverage under PPACA.
The report said that, “Many years of experience with Medicare counselors in the State Health Insurance Assistance Program (SHIP) — the model for the navigator program — suggests that these and other requirements are not warranted,” Rome said.
“These excessive requirements will disrupt the enrollment process and make it harder for people to buy insurance and get the health care they need,” Rome said.
The report said the range of state laws and regulations being used by the 13 states that oppose PPACA show clearly that opponents “are resurrecting the civil rights resistance tactics of the 1960s, when state officials obstructed laws ending school segregation and guaranteeing voting rights.”
The report charged that the tactics are the same ones that have been used in recent years to suppress voter registration and turnout among minority, low-income and elderly residents, as well as college students.
“The same dynamic is unfolding in 2013 as millions of Americans from many of the same demographic groups are poised to use the new ACA marketplaces to obtain affordable health insurance,” the report said.
In reacting to the report, Joel Wood, senior vice president for government affairs for the Council of Insurance Agents and Brokers (CIAB), said that the CIAB “doesn’t count ourselves among those who want to obstruct the functioning of state or federal exchanges.”
But, he cautioned, “it's a fact that thousands and thousands of people stand to make a living off of steering individuals to state and federal exchanges through the Navigator program.”
Wood said that, “it's mind-boggling but probably not surprising that ‘consumer activists’ don't want the Navigators to meet a sufficient level of training and meet professional criteria.”
However, he cautioned, “There is tremendous potential for abuse of confidential, personal financial information, and there are tricky statutory obligations that limit what Navigators can and cannot do.”
Wood adds that there is “the additional intersection of the ACA” with state insurance laws and regulations.
“It hasn't been that long since the abuses of federally-funded ACORN activists were revealed,” Wood said. “Amid the feeding frenzy of easy federal money, it's perfectly rational for states to protect consumers as long as that's the goal -- not obstruction for its own sake,” he said.