What If It’s Illegal for the Navigators to Navigate?
…[C]onsumer outreach and enrollment assistance in the marketplaces, also known as exchanges, will be vital to achieving one of the law’s core purposes: substantially reducing the number of people without health insurance in the United States. To help with outreach and enrollment, the law requires that every state marketplace establish a “navigator” program to support consumers…
[However], 18 states with federally facilitated exchanges (including state-partnership exchanges) have enacted, or are currently considering, legislation that imposes state-specific requirements on navigators…An additional five states — Illinois, Michigan, Missouri, North Carolina, and Pennsylvania — are currently considering pending legislation or have sent such legislation to the governor to be signed.
Most of the bills require a navigator to obtain state licensure or approval before operating in the state. Many also establish training requirements, require criminal background checks, and authorize disciplinary measures against navigators. Some bills also subject navigators to existing insurance law (such as privacy and unfair trade practices standards) or require navigators to secure financial protection against wrongdoing.
More from the Commonwealth Fund blog.
When citizens need a navigator to help navigate the government, someone should ask whether the government should be simplified.
Barriers to entry into an industry that consumers are required to participate in is a dangerous game. Expect high prices, low quality and fraud.
These are the two of the main causes of outrageous government costs and service that we see time and time again. Licensing and compulsory participation limit choice.
Also, the disconnect between taxpayer -> government -> contractor. Third-party decision-making increases costs.
I would recommend getting into the navigator industry.
State specific licensing will also limit competition and jack up prices.
Importance is uniformity in all of this and evidence of what type of regulations are absolutely necessary.
Sounds like they could have saved a lot of trouble by simply requiring “navigators” to be licensed insurance agents.
I have a feeling that they’ll want them to have special government credentials.
“special” meaning “extraordinary”
Basically, the federal MLR regulations make it where insurance agents have little incentive to advise potential enrollees on which plan is best for them. Now, states are proposing laws that make it difficult to advise potential enrollees on the plan that’s best for them. I guess this means potential enrollees are on their own!
I don’t see any reason why people who purchase insurance through an exchange should be offered fewer consumer protections than people who purchase health insurance on the open market.
Especially as the exchange navigators have access to much more sensitive information than the average broker.
Government should treat people doing the same job equally. Either get rid of the licensing regs for everyone or apply them across the board.
I must agree with this.
A possibility, but not examples.
“Some requirements may prevent the application of the federal navigator program. A state law that prohibits navigators from offering advice about the benefits, terms, and features of a particular health benefit plan could prevent a navigator from facilitating enrollment and helping individuals make informed decisions, as required under federal law. For example, would state restrictions prohibit a navigator from “advising” a consumer with HIV about which plans cover certain antiretroviral drugs or “recommending” that a consumer consider plans that includes her providers in its network?”
This example is a scare tactic. The only thing that a navigator cannot be, according to the OCare statute, is someone who works for a health insurance company.
Brokers routinely advise on the best plan given a person’s health. All 50 states have licensing laws. At minimum they simply require that people selling health insurance pass competency tests and/or a criminal background check. The tests require that they show that they know the law and have a vague idea of what they are talking about. Do you know what an HMO is? What is coinsurance? That kind of thing.
OCare doesn’t require navigators to demonstrate any competency or pass a background check even though they will have access to all kinds of personal information. Cynics observe that the navigator program is primarily a slush fund to pay off the non-profits that supported OCare.