Introduction

Jacqueline Saulsberry, a service coordinator at the Illinois Eye Institute, gathers information from patient Shameka Lewis-Coolidge during an appointment in Chicago. More than 100 nonprofits and related organizations have been recruited by the federal government as “navigators” who can assist the 30 million uninsured people gaining coverage under the Affordable Care Act. M. Spencer Green/AP

To discourage folks from signing up for coverage on the Obamacare exchanges, Republican lawmakers in several states have pushed through bills making it difficult for people to get free help from specially trained “navigators” authorized by the Affordable Care Act.

At the top of the list of special interest groups supporting such legislation: groups representing insurance agents and brokers, who, of course, charge for their services. They view the navigators as a threat to their income.

Nowhere have the agents and brokers found more friends than in the Missouri legislature, which last summer passed a bill making it unlawful for anyone other than a licensed agent or broker to give advice to any state resident about choosing a health plan.

As I wrote last June, Missouri lawmakers passed the bill even though it was in apparent violation of federal law, which states that individuals and organizations that complete a certain level of training can serve as navigators to help people choose plans that are best suited for them. Lobbyists for agents and brokers weren’t happy that the federal law doesn’t require navigators to be state-licensed, and they really weren’t happy with the part requiring that navigators’ services be free to consumers and small businesses. While navigators cannot actually sign someone up for coverage as agents and brokers can do, they can help folks complete eligibility and enrollment forms, and provide unbiased information about available options.

In a big win for consumers in Missouri and elsewhere, a federal court in Kansas City late last month blocked the GOP-sponsored law, ruling that it was indeed a violation of federal law.

“The Court is of the view that any attempt by Missouri to regulate the conduct of those working on behalf of the (federally operated health insurance exchange) is preempted,” wrote U.S. District Judge Ortie Smith.

Ironically, had state GOP lawmakers allowed Missouri to set up and run its own exchange, their anti-navigator law might have passed the court’s muster.

“The ACA provides states an opportunity to create exchanges,” Judge Smith wrote. “It also provides an avenue for states and HHS (the U.S. Department of Health and Human Services) to jointly operate an exchange. Missouri has opted not to be in the health insurance exchange business. Having made the choice to leave the operation of the exchange to the federal government, Missouri cannot choose to impose additional requirements or limitations on the exchange.”

While the ruling was specific to Missouri, it is expected to have ramifications in states that passed similar laws. And don’t expect Missouri to challenge Judge Smith: both Missouri Governor Jay Nixon and Attorney General Chris Koster are Democrats. The only comment Missouri Insurance Commissioner John M. Huff , a Nixon appointee, has made is that his department is reviewing the ruling.

The state’s agents and brokers, however, are not ready to throw in the towel. Clearly anticipating that Nixon and Koster would not appeal Smith’s ruling, the Missouri Association of Independent Agents a few days ago filed a “motion to intervene” in the case. This means that MAIA wants the court to recognize it as a party in the case so that it will have legal standing to challenge the ruling.

If you read deep into MAIA’s filing, you will find all the evidence you need of what this is really about: money. On page 10 of the group’s 13-page motion is this: “The interests of MAIA and its members are of a different quality than those of the Defendant (the state of Missouri), involving potential direct economic harm and the ability of MAIA members to serve insurance consumers.”

MAIA and its allies are not putting all their eggs in the judicial basket, though. They’re once again trying to protect the economic interests of agents and brokers in the Republican-controlled Missouri legislature. And once again they’re making some headway.

Last week two new bills that would benefit agents and brokers advanced in the state senate. One would require navigators to take a state-approved exam and undergo a background check. The other would allow people to sue navigators for up to $50,000 for unlawfully disclosing personal information about them. The Republican sponsors of the bills said they wanted to protect Missourians from fraud. Democrats responded that the bills were just new attempts to erect barriers for people trying to buy health care on the exchange.

Undoubtedly one of the reasons GOP lawmakers are interested in protecting the agents and brokers from any “economic harm” is their willingness to open their checkbooks for Republican candidates during campaign season. According to the National Institute on Money in State Politics, 75% of the contributions MAIA made through its political action committee went to Republicans in 2012, with 85% of its contributions going to incumbents the group wanted to see reelected. Pretty good evidence of how things really work in the “Show_Me” state.