State regulations overseeing the implementation of the Affordable Care Act could hinder enrollment of individuals in Medicaid or commercial health plans, Bloomberg News reported.
If that is the case, lack of enrollment could increase the financial exposure of hospitals, since it is likely they won't cut their rate of treating uninsured patients as earlier projections indicated.
Most of the regulations have been approved by Republican-controlled statehouses, where the ideological opposition to the ACA runs the highest, although Bloomberg noted that they are also backed by some insurance agent lobbies that fear competition could cost commissions.
In Missouri, for example, so-called navigators who would help enroll individuals into Medicaid and through the insurance exchange face much higher hurdles to become certified than they do under the ACA. The state requires them to undergo a licensing exam and nearly 40 hours of training--about double the amount of time federal guidelines require, Bloomberg reported. The cost is $25, according to the Insurance Journal. But the state's examination handbook says would-be navigators have to pay $41 to take the licensing exam and provide two forms of identification. If they have to cancel an exam, they must give 48 hours of notice or forfeit the fee.
In Georgia, navigators must receive a license from the insurance commissioner, pay a $50 application fee, complete 35 hours of training, pass an exam, and undergo a criminal background check. In addition, they must renew their licenses annually, pay another $50 and complete 15 more hours of training.
Those legislative efforts have been likened to "voter intimidation," Sara Rosenbaum, a health law professor at George Washington University in Washington, D.C., told Bloomberg. "In many, many cases these laws may be a direct interference with outreach assistance and that's going to be quite serious."