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On the Third Hand: Poor People Don't Have Secretaries

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The Patient Protection and Affordable Care Act of 2010 (PPACA) will probably create a lot of dumb, annoying rules and programs, and some of them will be horrible for you personally.

If you hate PPACA, or parts of PPACA, then you should use whatever legal means are at your disposal — campaigning for candidates for elective office, donating to political action committees, sending comment letters to lawmakers and regulators, filing lawsuits, posting on message boards, etc. etc. — to fight PPACA.

But I really think that one part of PPACA that agents, brokers and others in the industry should support is the Navigator program, even though the U.S. Department of Health and Human Services (HHS) is going out of its way to make the Navigator program as annoying as possible, and even if the program stays annoying.

Sure, producers, regulators and others should fight to protect the idea that Navigators ought to show that they have the expertise to help people understand and shop for health insurance — but they ought to fight equally hard for the principle that someone ought to help poor people and sick people understand and use whatever health insurance programs, free care programs or related programs are out there

Some of LifeHealthPro’s dearest readers believe that government should have no role in paying for peacetime health care provided outside of disaster zones and zones affected by epidemics. I would love to give those folks a chance to test their ideas on a group of U.S. residents structured in a way that would avoid antiselection. If, say, we could put all U.S. residents and providers born on the first of a month in a “pure free-market health finance zone,” and somehow put 3% of all medical facilities in the zone, I think that would be a great experiment. 

Turning a state into a free-market zone is more difficult, because of antiselection problems, but it looks as if some states will be doing what they can to turn themselves into free-market zones.

But, even in those zones: It seems as if making a neighborly effort to connect suffering families with providers who are willing to help them would be a nice thing to do.

In the Rube Goldberg health care maze that we actually have: It seems really mean to send people among us who are least equipped to cope with bureaucracy and paperwork out alone to do what they can to get to the top of Mount Health Care Assistance.

CNN, for example, just ran a story about a Florida woman, Leslie Elder, who recently died of Hodgkin’s lymphoma. She originally had private coverage but lost it when she began to get conditions such as cancer. CNN has been covering the woman’s efforts to qualify for Medicaid and Social Security Disability Insurance benefits for 4 years.

Elder and her husband reportedly had no idea that PPACA had created the Pre-existing Condition Insurance Plan (PCIP) program to provide standard-price coverage for uninsurable people just like her.

Think about it: A woman might be dead partly she and her husband were too tired and broken down to read articles about PPACA very well, and none of the insurance agents who read the CNN stories about Leslie Elder or hospital patient assistance coordinators she might bothered to tell her that she should apply for PCIP coverage.

I personally know some uninsured people myself, and I think one thing that unites them is that no commercial insurance producer who is not a candidate for sainthood would really want to deal with them. They are creative, wonderful people who know a lot about some topics that interest them but who have not filed taxes in years, can’t actually afford to get help with filing taxes, lost any receipts or other documents that might be useful in preparing a tax form years ago, have no idea what a deductible or a co-payment is, and would be deeply offended if any of us personal friends or acquaintances tried to butt into their lives and bring order to their finances.

But those uninsured people are people, and, whatever the faults of those people and of programs like PCIP might be, I think they deserve to have help with finding and getting into those programs while those programs exist. Ditziness shouldn’t be a fatal condition, and parental ditziness should not doom the parents’ children. Few children have any say whatsoever over their parents’ tax forms.

Of course, HHS Secretary Kathleen Sebelius is going way, way out of her way to stick it to agents and brokers, even though a sizable minority of producers have backed PPACA, and even though producers tend to oppose PPACA with rational arguments rather than arguments that PPACA is bad because Barack Obama is a Muslim space alien Manchurian candidate who caused Hurricane Isaac and has oozed Muslim space alien Manchurian candidate cooties all over the Democrat Party.

I think Sebelius dumped a bucket of ice water over anyone in the insurance industry who’s at least sympathetic to the goals of PPACA in July, when she sent Rep. Adam Kinzinger, R-Ill, a letter in which she states that HHS sees no reason for the PPACA Navigators — the people who are supposed to help consumers, especially uninsured consumers, figure out the new bureaucracy created by PPACA — to have any kind of insurance department license.

Sebelius said the Navigator ombudsmen need not have producer licenses because they’ll simply be explaining how health insurance and the new PPACA health insurance exchanges work, not helping the consumers choose coverage.

Of course, in other settings, such as when regulators are looking at people who help consumers understand products such as annuities, life insurance policies and Medicare plans, the federal government tends to take a much broader approach to deciding who needs to have professional licenses. It seems reasonable for Sebelius to say that a Navigator needs a different kind of license than an ordinary health insurance agent, but it seems as if the only reason to say the Navigators need no insurance department supervision at all is to help the cash-strapped nonprofit consumer groups that want to get the Navigator contracts at the expense of, say, a spinoff from a traditional insurance agency that might be well-equipped to offer Navigator services on an exchange-fee-paid basis and also to get the Navigator service employees licensed as producers.

On the one hand: The people at those nonprofit groups seem like nice people. They seem as if they could do a great job of helping people like my uninsured friends deal with Medicaid and CHIP. I think they are a lot more on the same Ramen-noodle-eating wavelength than a lot of traditional producers would be.

But, on the other hand: Some of the half-starved, Ramen-noodle eating, third-floor-walkup inhabiting employees at the nonprofit groups may not necessarily be all that better informed or better organized than the clients. Maybe those folks really should get more attention from state insurance departments than traditional producers would, not less.

On the third hand: I think producers and producer groups should still do everything in their power to make the Navigator program as strong as it can possibly be, no matter how annoying they find it and how self-defeating HHS officials may sometimes be, because making sure poor people and sick people know about the help that’s available to them is a noble, important thing to do. If producers keep talking about effective ways to do things calmly and patiently, maybe the program organizers who don’t seem to be listening will suddenly wake up and listen and things will get better.