Congress should eliminate the navigators provision from the Patient Protection and Affordable Care Act (PPACA), and, if that is not possible, regulators should require that navigators be licensed health insurance producers, a state regulator says.

John “Okie” Doak, the Oklahoma insurance commissioner, has blasted the navigators provision of PPACA in a comment submitted to the Exchanges Subgroup at the National Association of Insurance Commissioners (NAIC), Kansas City, Mo., which recently posted draft documents discussing the PPACA health insurance exchange and navigators programs.

If Congress cannot delete references to navigators from PPACA, “any person placing insurance through the exchanges authoriazed by the Patient Protection and Affordable Care Act must be licensed by the state insurance department as an agent or broker,” Doak writes in the comment letter.

THE NAVIGATORS

PPACA is supposed to bring the exchange and navigator programs to life in 2014.

Republicans and some Democrats are trying to block implementation of parts or allCompass of PPACA.

If the health insurance exchange provision, the navigator program provision and related provisions take effect as written, PPACA will create a new health insurance purchase tax subsidy program in 2014. Consumers and small groups will be able to use the subsidies to buy health coverage through the exchanges.

An exchange is supposed to help consumers and small groups shop for high-quality health coverage. In some states, states or exchange managers could set standards for coverage sold through an exchange that might be tougher than the state or federal minimums.

Navigators are supposed to be nonprofit, impartial advisors who will help the exchange users learn how to buy coverage through an exchange and facilitate the purchase of coverage through an exchange.

PPACA states that the navigators could include a wide variety of organizations, such as trade, industry, consumer or professional organizations. The navigators also could be licensed insurance agents or brokers, Exchanges Subgroup officials note in the draft.

PRIVACY CONSIDERATIONS

If navigators are simply ombudsmen who provide general advice about the exchanges and health coverage, then they could operate without being licensed as producers, Doak says.

But “facilitating enrollment is not the equivalent of actually enrolling someone in a qualified plan,” Doak says. “Actual enrollment will of necessity require the gathering of financial [information] and a

review of the potential products available to that applicant in and out of the exchange. While health conditions may not affect an applicant’s ability to purchase insurance, their health may affect their choice of product.”

Personal health and personal financial information are sensitive, and they must be handled by professionals accountable to licensing authorities, Doak says.

State and federal agencies already have laws on the books regarding the need for producers to protect confidential information and experience with taking action against producers who violate the laws, Doak says.

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