Insurance regulators in Oklahoma are trying to get detailed data on the performance of Affordable Care Act Navigators in their state. 

The Oklahoma Insurance Department has sent the state’s ACA navigators a letter asking them for data on consumer encounters and enrollment numbers, according to John Doak, the state’s insurance commissioner.

The department sent the letter to 223 navigator organizations and individuals acting as navigators. Oklahoma organizations and individuals have received about $5.2 million in ACA exchange navigator grants since 2013, Oklahoma officials say.

Senate HELP Hearing

Sen. Lamar Alexander, R-Tenn., reported last week, at a hearing on individual health insurance organized by the Senate Health, Education, Labor and Pensions Committee, that some navigators seem to have done little to help consumers in health coverage.

The Centers for Medicare and Medicaid Services recently said it would address concerns about navigator productivity by tying their grants for the 2018 open enrollment period to their success at meeting their enrollment goals for the 2017 coverage year.

(Related: CMS Ties 2018 Navigator Grants to 2017 Performance

Oklahoma uses the federal government’s HealthCare.gov exchange enrollment system. The 2018 open enrollment period for individual major medical coverage is set to start Nov. 1 in the HealthCare.gov states and end Dec. 15.

Doak, who appeared as a witness at the Senate HELP Committee hearing along with other state insurance commissioners, testified at the hearing that he believes that, in some cases, navigators have been handling work that should be done by licensed insurance agents and brokers.

Others at the hearing, including Lori Wing-Heier, the insurance commissioner for Alaska, said that rural areas in some states have few insurance agents and brokers, and that navigators have been helpful at reaching consumers with specialized needs, such as consumers who speak languages rarely spoken by insurance agents.

The History

Congress created the ACA public exchange system in an effort to give consumers an easy, web-based way to shop for commercial health insurance coverage, and to distribute health insurance subsidies.

HealthCare.gov screen shot (Image: CMS)

(Image: Centers for Medicare and Medicaid Services)

ACA drafters created the navigator program, or ACA exchange ombudsmen program, in an effort to provide extra help for consumers who were uncomfortable with using the Internet, or who had complicated situations that made applying for coverage through the Internet difficult. Navigator organizations, and navigator organization workers, are supposed to be independent from insurance companies. Navigators organizations and navigator workers may be able to be licensed insurance agents who get commissions for selling some types of insurance products, but they are not supposed be getting commissions for selling health insurance, and they are not supposed to make recommendations about which plans consumers should buy.

Some states have created other types of programs, such as application counselor programs, to increase the number of people available to provide consumers with live-human enrollment help.

The National Association of Health Underwriters and Health Agents for America have questioned whether


The Navigators’ View

Representatives for the navigators have argued that using simple enrollment activity statistics may give a misleading view of a navigator organization’s performance, because navigators are supposed to help consumers understand the ACA public exchange system, not simply sign up for coverage; may help consumers sign up for sources of coverage other than exchange plan coverage; and may help consumers who face unusually complicated family situations, or unusually severe barriers to signing up for coverage.

The ACA navigators’ defenders see the new performance-based grant allocation program as a Trump administration strategy for holding down 2018 exchange plan enrollment levels, not as an effort to improve navigator efficiency and productivity.


A Wild Card

Seema Verma, the new administrator of the Centers for Medicare and Medicaid Services, ran a company that had a contract to train navigators in Indiana.

Verma may have ideas about Navigator performance based on what she saw at her own firm’s navigator training programs.

— Read HealthCare.gov 2017: What About Marketing Money?  on ThinkAdvisor.


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