Health Forward Foundation

Proposed Licensing of Health Reform ‘Navigators’ Draws Mixed Reaction

Insurance agent John McDaniel (right) listened Tuesday as representatives of several Kansas City-area organizations discussed applying for a federal health-reform grant. McDaniel said he wanted to learn more about local plans to use “navigators” in guiding consumers through the new health insurance marketplaces.

KANSAS CITY, Mo. – Social safety-net advocates and the insurance industry are at odds over a legislative provision that would establish state oversight of workers helping to implement the federal Affordable Care Act in Missouri.

The dispute centers on the last section of a 76-page omnibus health-insurance measure that passed the General Assembly on the final day of this year’s session, which ended last week.

The bill would require state licensing of “navigators,” or workers who assist consumers in signing up for insurance through the online marketplaces scheduled to be established by Oct. 1 as part of the 2010 federal health-reform law.

Scott Lakin, director of the Regional Health Care Initiative, a program of the Mid-America Regional Council in Kansas City, said insurance agents and brokers pushed the licensure requirement as a “power play to protect their turf.”

But Larry Case, executive vice president of the Missouri Association of Insurance Agents said, “I find that comment rather curious.”

Lakin once served as the top insurance regulator in Missouri and Case said it was odd that someone with that experience would object to “common sense consumer protections” aimed at keeping unscrupulous actors out of the field.

But Lakin said the navigators should be of little concern to insurance agents. He said the new health insurance marketplaces would mostly serve customers with low incomes or previously unable to afford coverage that agents have traditionally not courted.

But Case said insurance agents must pass a state exam for every line of insurance they sell, whether it’s for property, health, or something else. He said navigators should at least have to demonstrate some knowledge of insurance terminology and concepts.

The Kansas Legislature has discussed similar legislation in the past, said Sheldon Weisgrau, director of the Health Reform Resource Project in Topeka. But at this point, he said, training provided by the federal government will be sufficient for navigators to work in Kansas.

If signed by Gov. Jay Nixon, the Missouri measure would leave it to the state Department of Insurance, Financial Institutions, and Professional Registration to establish the licensing criteria.

Nixon is likely to sign the bill because of the numerous other health insurance provisions in the measure, said Andrea Routh, executive director of the Missouri Health Advocacy Alliance.

For instance, she said, it includes telemedicine provisions championed by bill sponsor Sen. Shalonn “Kiki” Curls, a Kansas City Democrat.

That language would prohibit insurers from charging larger deductibles, copayments or coinsurance amounts for consults handled through telemedicine as opposed to in-person appointments.

Insurance agents worked closely with Curls on the navigator section, Case said, including agreeing to take out language that would have required navigators to post a bond or demonstrate some other financial means to cover any mistakes they made.

Case argued that state licensing of navigators is consistent with language in the health-reform law that requires navigators to comply with state licensing requirements.

Routh said a Washington, D.C., law firm might challenge the Missouri legislation and other measures like it around the country. The argument would be that these laws violate restrictions against states interfering with implementation of the Affordable Care Act.

“That would be helpful to all of us,” Routh said at a Tuesday meeting, “but stay tuned.”

Routh was briefing Lakin and representatives from about two dozen organizations that are preparing a joint application for federal funding to help deploy navigators on both sides of the state line in the metropolitan area.

The application is due to the Centers for Medicare & Medicaid Services by June 7. Open enrollment for new health insurance marketplaces begins Oct. 1.

The consortium plans to submit a grant request seeking nearly $754,000 to support 11 navigators throughout the region from Sept. 1 until July 31, 2014.

Applicants based the funding request on census estimates of approximately 270,000 uninsured individuals in surrounding counties in Missouri and Kansas.

Approximately $54 million is available to the 33 states where the federal government is either partly or totally running the marketplace.

John McDaniel, part-owner of an insurance agency in downtown Kansas City, sat in on the meeting.

Afterwards, he expressed skepticism about the navigator system, where the workers will guide consumers through the sign-up process without providing advice on which product to buy.

“My experience has been,” McDaniel said, “is that you have to sell insurance to people.”

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