States that use a federally-facilitated exchange (FFE) rather than create their own exchange can't make it more difficult to operate those exchanges , a federal district court in Missouri ruled Thursday. Barred activities include limiting the work of navigators and requiring they obtain a state license. Any state laws that "make the operation of the FFE more difficult or onerous run afoul of the [Affordable Care Act]'s purpose and are subject to preemption," the court said. Seventeen states have issued laws that impose licensure requirements on navigators and other counselors and assisters and restrict their activities. Strict state navigator laws stemmed from consumer protection concerns and political opposition to the Affordable Care Act, Health Affairs noted. Blog Post