Opposing Obamacare Navigators

October 22, 2013

The implementation of the Patient Protection and Affordable Care Act (PPACA aka ACA aka Obamacare), has been a rough road, complete with legal, legislative, and practical challenges. The ACA provides for “Navigators,” organizations that assist consumers in determining eligibility for, and enroll in insurance plans through Health Insurance Marketplaces. See subsection (i) of 42 U.S.C.A. § 18031 which establishes the Navigators.

Energy and Commerce Letters

Compass_RoseIn August, House Committee on Energy and Commerce members sent a letter to organizations receiving Navigator funding. The letter requested information regarding

  • the work that would be performed with the Navigator grant;
  • the training process for any employees or volunteers;
  • the processes for reviewing the work of employees or volunteers;
  • the organization’s means for safeguarding any information collected as part of the work done using the Navigator grant;
  • whether the organization has been contacted by any insurance company relating to the Navigator grant; and
  • all documentation and communications relating to the Navigator grant.

Responses were due September 13th. The Department of Health and Human Services sent a response letter to the Committee on behalf of the organizations, pointing out the suspicious timing of the request, “given its potential to interfere with the Navigators ability to carry out their crucial efforts in assisting Americans who lack health insurance.”

Two organizations that received funds from Health and Human Services withdrew from the program. The West Virginia Parent Training and Information declined, saying only that it was “due to unforeseen circumstances.” The  Cincinnati Children’s Hospital Medical Center had to decline the money due to new legislation in Ohio limiting eligibility for the program.

I ran the following search in Ohio Enacted Legislation:

HEALTH CARE NAVIGATOR ELIGIBILITY

The first result is 2013 Ohio Laws File 9 (Sub. H.B. 3) defines “insurance navigator,” setting out parameters for what navigators can do, and what they cannot do in Ohio. Unsurprisingly, the subsection laying out what Navigators “shall not do” under the amended Ohio Statute 3905.471 is substantially larger than the “may do” subsection.

You can also find plenty of recent discussion and analysis about the Navigator program on Westlaw in secondary sources with the following Terms and Connectors query:

a.c.a. p.p.a.c.a. obama-care “affordable care act” /250 navigator & DA(last 3 months)

Results include:

HEALTH CARE REFORM NEWS—STATE-CREATED REQUIREMENTS FOR MARKETPLACE NAVIGATORS MAY HARM PPACAENROLLMENT, Wolters Kluwer Health Law Daily, 2013 WL 5546993

MEDICARE AND MEDICAID GUIDE LETTER NO. 1780 ISSUE NO. 1787, Medicare and Medicaid Guide, 2013 WL 5523795

HEALTH CARE REFORM NEWS—HHS AWARDS $67 MILLION FOR “NAVIGATORS” TO ASSIST CONSUMERS USING NEW INSURANCE MARKETPLACES, Wolters Kluwer Health Law Daily, 2013 WL 4110601

UNDERSTANDING STATE RESISTANCE TO THE PATIENT PROTECTION AND AFFORDABLE CARE ACT: IS IT REALLY JUST POLITICS AS USUAL?. Journal of Health & Biomedical Law, 9 J. Health & Biomedical L. 27 (2013)