Anti-PPACA states cannot sabotage navigators

The efforts of governors and state legislators to block consumers who want to use PPACA Navigators to help them sign up for health care could have “profound effects,” a consumer advocacy group contends in a report released today.

“This is Navigator suppression, and it perpetuates the systematic denial of affordable health care to huge numbers of the most vulnerable individuals in our society, especially those in minority and lower-income populations,” said Ethan Rome, executive director for Health Care for America Now (HCAN).

The National Association of Insurance and Financial Advisors (NAIFA), however, said they could understand the decision of states to act.

“While the thousands of Navigators hired will help consumers enroll through a state or federally-facilitated marketplace, consumers will require assistance that goes far beyond registering for a plan,” said NAIFA President-Elect John Nichols said.

According to Nichols, agents and brokers do much more than sell insurance. They explain critical differences in plan options and coverage, which may involve substantial research and fact-finding about the client’s needs. They advocate on behalf of their clients, helping people when they have trouble getting procedures approved or claims processed.

“They also review coverage on a periodic basis, suggesting changes when appropriate and counseling on ways to reduce costs,” Nichols said. “When purchasing a plan from a marketplace, the companies that sell health insurance should immediately assign consumers an agent. The healthcare system is complex, and coverage does not begin and end with enrollment. Consumers benefit from the expertise that brokers and agents provide in servicing the plan throughout the year. They need to be involved, or customer service surely will be a casualty of healthcare reform.”

HCAN officials said Jay Angoff, a partner at Mehri & Skalet in Washington, is considering filing lawsuits that would stop the recalcitrant states from interfering with the Navigators and acting to stop the states from delaying the work of the Navigators.

Angoff is the former insurance commissioner of Missouri, and the first head of the Health and Human Services Department’s Office of Consumer Information and Insurance Oversight (OCIIO). OCIIO is the office responsible for implementing the insurance reform provisions. He did not return phone call seeking comment.

Those participating in today’s conference call said it is unlikely HHS would file its own lawsuits to stop the interference because it is so busy implementing the many pieces of the law, the Patient Protection and Affordable Care Act (PPACA).

Rep. Jackie Speier, D-Calif., ranking minority member of the House Subcommittee on Energy Policy, Healthcare and Entitlements of the House Energy and Commerce Committee, discounted the utility of filing lawsuits. Speier said on the conference call that courts would likely not find the suits “ripe for litigation” because the provisions of the law involved have not yet taken effect.

Speier said the feedback she is getting from her district is that when the exchanges are launched Oct. 1, enrollment will probably be slow “as we start out and then gain as times on.”

Speier predicted that the exchanges “will probably see a takeup rate that is quite high.” She said that in her polling of young people, she “was surprised at how important this is to the 20-somehtings; I was surprised at how readily this will be embraced.”

Sabrina Corlette, a health policy expert at Georgetown University, called the state laws “unprecedented.” She said they were unnecessary given Medicare’s positive history with counselors similar to the Navigators. “It’s not to say there aren’t legitimate concerns about fraud, or con artists taking advantage of Obamacare,” she said. “It’s just that these state laws are really barking up the wrong tree … There is no credible evidence whatsoever that Navigators will be a source of fraud.”

Corlette said the criminal background check some of the state laws are requiring, as well as additional training are imposing an additional hurdle to the Navigators’ starting their work.

“They are already required to undergo training, training that is quite extensive and includes the providing of a lot of educational material. This involves piling on information they already have.

“All it does is make it more difficult for people to have access to important information on health care options,” she said.