Obamacare 'navigators' run into GOP opposition

Phil Galewitz | Kaiser Health News

On the same day that officials at Little Dixie Community Action Agency in Hugo, Okla., won a $580,000 federal grant to help consumers sign up for coverage under the federal health law, they received a warning from the state's top insurance regulator.

Commissioner John Doak said that if the new insurance guides known as "navigators" perform any of the duties of state-licensed insurance agents, "we will put a stop to it." He also called the $1.6 million award to hire and train navigators in Oklahoma — part of $67 million nationwide — "a waste" because it would duplicate the work of better-trained agents.

Oklahoma is among at least 17 Republican-controlled states that have taken steps to restrict navigators, a special category of workers created under the health law to help consumers learn about their options in the new online insurance marketplaces. Proponents of the law fear that actions will dampen enrollment.

Some states such as Indiana are requiring navigators to pay as much as $175 for licensing that would include a state exam and a criminal background check.

Others, such as Missouri and Georgia, have passed laws limiting what navigators can say and do. Last week, the Florida Health Department announced that local public health offices, where uninsured people often go for services, cannot have navigators on the premises.

Officials in these states say they're concerned the navigators, who are required by the federal government to get 20 hours of online training and pass an exam, will know too little to be helpful. They also worry about navigators' access to private information, such as income data and Social Security numbers.

But the law's proponents see the restrictions as simply the latest GOP effort to impede the rollout of the law known as Obamacare. Last month, the Obama administration characterized a U.S. House committee's demand for extensive documentation from groups that won navigator awards as "a shameful attempt to intimidate."

"This is just the latest obstacle that opponents of the Affordable Care Act are using to try to slow down implementation," said Christine Barber, senior policy analyst with Community Catalyst, a Boston-based non-profit helping states with enrollment.

"It's having a chilling effect already, as some organization are nervous to help with enrollment because of all the obstacles placed in their path," she said.

At least four groups have declined federal grants as a result of state restrictions, while others are rethinking their roles. A West Virginia agency returned $365,000 after it was asked extensive questions about its hiring and personnel practices by the Republican West Virginia attorney general. "There were unforeseen circumstances," said Pat Haberbosch, executive director of West Virginia Parent Training and Information.

Children's Hospital Medical Center in Cincinnati, also declined its grant after the state barred groups that negotiate with health plans. And Texas-based Cardon Outreach is turning back $800,000 to hire navigators in Florida, Oklahoma, Utah and Pennsylvania because of state scrutiny, according to an Associated Press report.

Navigators are considered crucial to the success of Obamacare because they're supposed to help consumers sort through a maze of insurance options and figure out whether they're eligible for federal subsidies or perhaps free or low-cost coverage through Medicaid. Polls show many people know very little about these options.

This is not the first time the federal government has paid organizations to help people make insurance choices. For nearly a decade — and without controversy — the Department of Health and Human Services has funded non-profit groups to help educate seniors about enrolling in private Medicare drug plans.

Experts say it's premature to say how big an impact the state restrictions will have or how aggressively the laws will be enforced. Missouri passed a law that requires navigators to pass an exam and pay a licensing fee. But state regulators have since said that the 20 hours of required federal training will be accepted in lieu of state training and an exam, and have also limited the licensing fee to $25.

"Our law looks really bad, but we are hoping it will not have a very big impact," said Lisa D'Souza, a health law and policy fellow at St. Louis University.

She said she worries most about a provision barring navigators from giving advice about health plan benefits even though federal rules require them to help consumers understand that benefits vary. "It seems to be a complete contradiction," D'Souza said.

A Texas law requires regulators to get involved only if navigators draw complaints; otherwise, no new rules are expected in the first year of open enrollment.

In addition to prohibiting navigators from helping consumers compare benefits, Oklahoma's insurance commissioner said navigators cannot help people "complete or sign applications for insurance," or "initiate an inquiry about a person's existing coverage," or "discuss the terms of a proposed contract of insurance with a prospective policyholder."

Oklahoma navigators say they're unsure what they can do.

"This has raised concerns," said Rhonda Teague, planning director at Little Dixie, who said the group has no intention of interfering with brokers who typically don't seek out the uninsured.

James Mills, assistant general counsel for the Oklahoma Insurance Department, says his agency is simply trying to clarify the distinct roles of agents and navigators, but adds, "Obamacare is not something our state wants."

He said navigators can show people information about health plans and their benefits, and help consumers fill out online applications. They can also tell older people that their premiums will be higher than those of younger people. But showing them why they may be better off choosing a silver plan instead of a gold plan to save money "would be going too far," he said.

David Roos, executive director of Covering Kids & Families of Indiana, said that state's licensing fees are a burden to groups trying to help the uninsured. "These rules won't help expand coverage," he said. "They will slow productivity."

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a non-profit, non-partisan health policy research and communication organization not affiliated with Kaiser Permanente.