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Doak to Senate Panel: Audit the ACA Navigators

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John Doak, the Oklahoma insurance commissioner, today gave members of a Senate panel advice that would please many health insurance agents and brokers: He called for the Senate Committee on Health, Education, Labor and Pensions to investigate the Affordable Care Act Navigator program.

“I would ask for the full Senate committee to do an audit of the Navigator program,” Doak told Sen. Tammy Baldwin, R-Wis., a Senate HELP Committee member. “Are they doing the job they’re supposed to be doing? Where’s the checks and balance there?”

Doak was one of five state insurance commissioners who appeared as witnesses at a Senate HELP hearing in Washington on stabilizing the individual major medical insurance market. The hearing is one of four the committee has scheduled on the topic for this week and the next. The other witnesses at today’s hearing were Mike Kreidler of Washington state; Julie Mix McPeak of Tennessee; Lori Wing-Heier of Alaska; and Teresa Miller, who recently left her post as Pennsylvania’s insurance commissioner to take over as head of the state’s Health and Human Services Department.

(Related: How to Watch the Senate Individual Health Rescue Hearings)

The ACA drafters hoped the Navigator program would create independent, nonprofit ombudsmen who would help consumers use the new ACA public health insurance exchange system. The idea was that the ombudsmen would show consumers the difference between a premium and a deductible, and how to use exchange websites, without trying to sell the consumers insurance.

Agents and brokers have complained for years that the Navigator ombudsmen have competed with them for business, and given consumers advice about complicated, sensitive matters without having the proper training or liability insurance.

As of Tuesday, none of the 20 witnesses scheduled to appear at the Senate HELP individual health hearings was appearing as an agent or broker.

Doak, however, has worked in the past as an insurance broker for Aon. One of the other commissioner witnesses, Wing-Heier, has worked as an independent broker and as a corporate risk manager.

Doak brought up the topic of agents and brokers at the hearing. Oklahoma has agents and brokers in each of its 77 counties, he said.

“They’re trained insurance professionals that should be the ones helping folk,” Doak said.

The Senate HELP Committee streamed the hearing live on the web. A recording of the video, and written versions of the witnesses’ testimony, are available here.

Here’s a look at seven other idea that came up at the hearing.

1. Make using an existing ACA rule waiver program earlier.

The ACA itself includes a provision, Section 1332, that lets states apply for waivers from some ACA rules in an effort to increase access to coverage, improve the quality or reduce the cost.

The Centers for Medicare and Medicaid Services, the U.S. Department of Health and Human Services arm in charge of the Section 1332 waiver program, has been helpful, Wing-Heier said.

But one problem is that, even though CMS is helpful, it has not created a form that a state can use to apply for a waiver and know whether its waiver proposal meets CMS guidelines, Wing-Heier said.

Officials at CMS then take six months to make a decision on the waiver program application, she said.

She said one thing officials could do to stabilize the individual major medical market is to create a clear process a state can use to apply for an individual market stabilization-related waiver.

2. Keep existing ACA subsidy programs in place until and unless new market rules replace the current ACA rules.

Doak, a Republican, is strongly opposed to the ACA, but he said the individual major medical market, as it is now structured, needs the ACA reinsurance program, which helps shield insurers against some of the cost of covering individual policyholders with catastrophic claims, and the ACA cost-sharing reduction subsidy program, which helps low-income exchange plan users pay their co-payments, coinsurance amounts and deductibles.

The other commissioners at the hearing, including both ACA opponents and ACA supporters, said they also agree on the need to keep the current stabilization programs in place at least until 2019.

3. Recognize that changing an insurance plan takes time.

The commissioners emphasized that insurers and regulators need a chance to comment on any proposed changes, and adequate time to implement any proposed changes.

“Insurers, right now, are already planning for 2019,” Kreidler said.

Any indication that policymakers will impose sudden changes or continue the current state of uncertainty about the market rules will chase more carriers out of the individual market, Kreidler said.

4. Consider letting individuals team up to buy health coverage.

Sen. Rand Paul, R-Ky., argued that the individual market works as poorly as it does partly because consumers have no ability to team up to buy coverage, and to enjoy the same kind of regulatory framework large, self-insured employers enjoy.

Another challenge is that health insurers have increased their overall profits to $15 billion per year, from $6 billion per year before the ACA started, largely because of strong profits in the group market, but then cherry pick and refuse to stay in the individual market, Paul said.

In the past, many insurance regulators and insurers have argued that various types of health plan purchasing coalition proposals would lead to antiselection programs, but Doak told Paul he thinks the purchasing coalition idea has some merit.

5. Remember that each state has its own problems.

Wing-Heier pointed out that Alaska has built-in cost problems because it has a small number of people in its individual market, many of those people have chronic conditions, and care is expensive.

Wing-Heier said Alaska has tried to find ways to merge its individual market with individual markets in other states, to benefit from putting its residents in a larger individual market risk pool.

“Our experience has been so bad that nobody’s wanted us,” she said. “We have not been an attractive risk.”

6. Invest in advertising for the individual major medical open enrollment period for 2018.

The Trump administration has proposed cutting overall advertising spending 90%, focusing on digital advertising, and cutting the Navigator organizations’ funding 40%.

Miller, Kreidler and Wing-Heier that stronger advertising and marketing support will help increase individual health enrollment, and that increasing enrollment will improve the stability of the individual market, by improving the average health level of the insured population.

7. Be open-minded about Navigators.

Oklahoma may have agents and brokers in every county, but Alaska has few agents and brokers outside the big cities, and it has few agents and brokers who can speak the many languages that the uninsured residents of Alaska speak, Wing-Heier said.

States like Alaska need Navigators to fill in outreach gaps, she said.

—Read 4 ACA Change Paths That Just Got More Popular on ThinkAdvisor.

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