

States requirements on Obamacare enrollment helpers could violate federal rules. (Photo by Daniel Acker/Bloomberg)

Welcome to Health Reform Watch, Jason Millman's regular look at how the Affordable Care Act is changing the American health-care system — and being changed by it. You can reach Jason with questions, comments and suggestions here. Check back every Monday, Wednesday and Friday afternoon for the latest edition, or sign up here to receive it straight from your inbox. Read previous columns here.

If you think back to the time before the rollout of Obamacare's coverage expansion, there was one controversy that fired up opponents and supporters of the law more than any other: the role of in-person enrollment aides.

These so-called "navigators" were funded by the Affordable Care Act to help people understand their new insurance options, but the navigator groups soon become embroiled in a political battle. House Republicans launched an investigation into these organizations last summer, while the administration and ACA supporters condemned the investigation as a politically motivated effort to stunt enrollment. At the same time, a number of states passed restrictions on what navigators could do and who could participate in the program.

There have been some major developments for the navigator program since then. A federal judge in January blocked a Missouri law that would require navigators to get licenses. And last month, the administration issued new rules trying to crack down on these state laws.

In all, 19 states have laws placing additional requirements on navigators, and 15 of those appear to violate the new federal guidelines, according to Georgetown University Health Policy Institute researchers. These include things like limits on what advice navigators can offer, requirements to carry surety bonds or banning certain health-care providers from aiding enrollment because they receive payments from insurers.

Three of those states are considering legislation this year that would add more navigator requirements, while another three states could enact restrictions for the first time, the researchers wrote for the Commonwealth Fund.



(The Commonwealth Fund)

So, what sense can be made of these conflicting state laws and federal requirements? That's not clear just yet — and that potential confusion could leave would-be enrollment helpers in a lurch.

“That’s why this is a really potentially tricky situation for consumers and individual groups that are trying to be navigators,” said Georgetown's Justin Giovannelli, who co-authored the report. “They are potentially stuck in the middle.”

Here's why the fight over navigators matters: A number of surveys have shown that in-person help played a big role in getting people to sign up for health insurance this past year. Some of that may have been because of the Web site problems this past year, but there's also the fact that understanding health insurance isn't easy.

Navigator groups in Missouri managed to successfully challenge the state law through the court system. With new clarity from the federal government, it could take similar lawsuits to knock down other state laws limiting navigators' reach, Giovannelli said.

Enrollment doesn't get much easier in Obamacare's second year. People will be renewing plans or shopping for new coverage, all while the Congressional Budget Office set an unofficial enrollment target of 13 million in the exchanges in 2015. The administration has announced $60 million in funding for navigator groups this coming year, slightly down from the $67 million it awarded for 2014 enrollment. In Year Two, Obamacare is still going to need all the help that it can get.

Top health policy reads from around the Web:

A company learns blaming Obamacare comes with risk. "A giant food service company unexpectedly reversed course Thursday after bumping thousands of college cafeteria workers from its health plan earlier this year and pointing a finger at President Barack Obama's overhaul. Sodexo's experience could serve as a cautionary tale for other employers trying to pin benefit reductions on "Obamacare." The company's cutbacks fueled a union organizing drive and campus protests. Julie Peterson, Sodexo's vice president for benefits, said the company will make changes for next year to restore eligibility for many of those affected." Ricardo Alonso-Zaldivar for the Associated Press.

Your doctor is watching you. "You may soon get a call from your doctor if you’ve let your gym membership lapse, made a habit of picking up candy bars at the check-out counter or begin shopping at plus-sized stores. That’s because some hospitals are starting to use detailed consumer data to create profiles on current and potential patients to identify those most likely to get sick, so the hospitals can intervene before they do. Information compiled by data brokers from public records and credit card transactions can reveal where a person shops, the food they buy, and whether they smoke." Shannon Pettypiece and Jordan Robertson for Bloomberg.

Hospices have lax federal oversight. "The typical hospice in the United States undergoes a full government inspection about once every six years, according to federal figures, making it one of the least-scrutinized areas of U.S. health care — even though about half of older Americans receive hospice care at the ends of their lives. By contrast, nursing homes are inspected about once a year, and home health agencies every three years. ... It is impossible to say precisely how many hospice companies might be cited for violations if there were more scrutiny, but a significant portion of them appear to be providing scant care, Medicare statistics and interviews show." Peter Whoriskey in the Washington Post.