health navigators 1581: Francis Drake, having completed the first circumnavigation of the world a few months earlier, is knighted by Queen Elizabeth aboard his ship, the Golden Hind

Do we need navigators on the high turbulent seas of the Affordable Care Act?

affordable care act

The Department of HHS as part of the Affordable Care Act mandated a Navigator program to help people enroll in insurance plans.  Why they did this is no mystery.

They estimated that licensed insurance brokers would ‘gain the system’ to their advantage. I wonder what the evidence is for that?

There is much evidence which justifies  these concerns found on the internet just by searching for “Medicare enrollment”.  A search will take you to many sites for health insurance, besides Medicare….most seem to be profit driven Medicare advantage of private insurance companies of varying credibility.  The actual CMS or Medicare.gov sites are buried several pages down in the search results.

CaliforniaHealthLine (a publication of the California Health Care Foundation) reports:

Individuals who work in the Affordable Care Act's "navigator" program for the law's health insurance exchanges must be affiliated with certain community organizations, such as churches. The workers must undergo at least 30 hours of training to before they can be qualified as a "certified application counselor," the rule issued by CMS states.

CMS Releases Final Rule for Affordable Care Act's 'Navigator' Program

Under the ACA, exchanges that will be operated solely by or in partnership with the federal government are required to have at least two certified navigator entities, one of which must be a not-for-profit. HHS has allocated $54 million in funding grants to train and pay navigators in the 37 states with federally run exchanges.

Navigator workers must provide "fair, impartial and accurate information that assists consumers with submitting the eligibility application, clarifying distinctions among [qualified health plans] and helping qualified individuals make informed decisions during the health plan selection process." They also must provide additional assistance to:

  • Consumers with disabilities, limited proficiency in English; or
  • Consumers who are unfamiliar with health insurance.

Lawmakers in recent months have raised concerns about the workers' level of training and access to consumers' personal and potentially sensitive data. In particular, some GOP leaders have stepped up their scrutiny of the navigator program and a separate "in-person assisters" program in states that will operate their own exchanges. The ACA prohibits federal funding for the assisters program because it does not have to meet the same criteria as the navigators program.

More Details of the Final Rule

Under the final rule, traditional insurance agents cannot be selected and trained as navigator workers, who must not be affiliated with the insurance industry ("Healthwatch," The Hill, 7/12). Navigator workers and in-person assisters can provide information only about specific topics.

  • The exchanges' qualified health plans and insurance affordability programs;
  • The tax implications of enrollment decisions;
  • Eligibility for premium tax credits; and
  • Cost-sharing reductions.

Jones, Groups See Fraud Potential in Covered California Enrollment

California Insurance Commissioner Dave Jones (D) and consumer advocacy groups are concerned about the potential for fraud and identity theft when individuals enroll in the California Health Insurance Exchange.

Privacy, Fraud Concerns

Jones and consumer groups say that the exchange is not doing enough to ensure that people hired as enrollment counselors -- individuals who will provide consumers with in-person assistance in signing up for health plans -- are adequately screened and monitored.

The network of more than 21,000 enrollment counselors could have access to consumers' personal and financial information, such as ID cards and medical histories.

According to Jones, the exchange does not have a plan for investigating any complaints that could arise once the counselors begin their work.

Jones said that it will be possible for the counselors to "obtain information that will allow them to build the trust they have with the individual they're working with and potentially sell them all manner of bogus products, steal their identity, gain access to certain assets they might have ... The list is virtually endless."

He added, "We can have a real disaster on our hands."