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Life Health > Health Insurance > Health Insurance

PPACA: Could Navigators Be Temporary?

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A company that helps states administer Medicaid programs says it thinks navigators may have only a temporary role in the new health insurance exchange system.

David Casey, a senior vice president at MAXIMUS Inc., Reston, Va., makes that case in a comment letter submitted to the National Association of Insurance Commissioners (NAIC), Kansas City, Mo.

The Exchanges Subgroup at the NAIC plans to hold a teleconference Thursday to consider a collection of white papers it is developing.

The white papers cover the health insurance exchange provision, navigators provision and related provisions in the Patient Protection and Affordable Care Act of 2010 (PPACA).PPACA compass

PPACA opponents are trying to block implementation of part or all of the act.

If the act takes effect as written, state-supervised health insurance exchanges will help low-income and moderate-income individuals use federal tax credits to buy health insurance through a one-stop shopping process.

The exchanges will also sell coverage to small employers.

PPACA calls for navigators – individuals or entities that would not be compensated by insurers – to help individuals use the exchange system.

Drafters of an NAIC white paper concerning the role of navigators and insurance producers in an exchange system seem to assume that navigators will be a permanent part of the exchange system, Casey writes in the MAXIMUS comment letter.

“The white paper discusses the creation of a significant infrastructure that exchanges must establish and maintain such as training, continuing education and licensing,” Casey says. “An approved training program and oversight is needed for sure – but licensing may be over-burdening the system.”

Some policymakers seem to think that navigators will participate in the system for only a short period, Casey says.

PPACA implies that the navigator program will be short-lived because initial funding will be provided in the

form of a grant, Casey says.

“If navigators only play a short-term role, then it might not be necessary to develop the elaborate infrastructure to regulate them that is contemplated in the white paper,” Casey says.

Also in the comment letter, Casey says MAXIMUS believes PPACA prohibits agents or brokers who are receiving any compensation from health insurers from serving as navigators.

Brokers could collect commissions from health insurers for helping small businesses buy health coverage through the exchange system, Casey says.

In that situation, however, the producer would be a producer, not a navigator, Casey says.

Individuals who receive funding from the NAIC to represent consumer interests in NAIC proceedings say in their comment letter that like the current white paper draft that focuses on exchange governance.

The consumer reps want the exchange boards to exclude practicing health care providers, insurance producers, health insurers and others who would be directly affected by exchange policy decisions, the reps say.

Exchange boards should use advisory or auxiliary boards to give those stakeholders the ability to shape exchange policy decisions, the reps say.

“If a state elects to permit conflicts of interest by not prohibiting insurers, insurance producers, or practicing health care providers from serving on a governing board, these conflicted parties should not outnumber the consumer and small business slots that are available,” the reps say.

The “consumer slots” on an exchange board or stakeholder advisory committee should be open to consumer advocates as well as consumers who are likely to buy exchange coverage, the reps say.

Other Exchanges Subgroup coverage from National Underwriter Life & Health:


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