Navigator requirements threaten reform enrollment

Insurers could potentially see fewer enrollments if they sell plans on health insurance exchanges in certain states that are working to prevent consumers from learning about and accessing the marketplace.

Although the reform law established the new role of navigators to assist consumers with signing up for exchange plans, many states are blocking navigator efforts, reported The Atlantic. For example, Florida won't allow navigators to work in county health departments, while Texas mandated additional requirements for navigators, including that they must be fingerprinted, pay a state licensing fee and take extra coursework.

And groups in Ohio and West Virginia rejected their portion of a $67 million grant to hire navigators, primarily because those states implemented such strict restrictions on navigators. In fact, Ohio had no navigators available to help consumers when the exchanges opened because the state required they obtain approval from the insurance department before they started working.

In all, 13 states--Arkansas, Florida, Georgia, Iowa, Illinois, Indiana, Maine, Missouri, Montana, Ohio, Tennessee, Texas and Wisconsin--have passed laws or regulations that prevent these navigators from guiding consumers in exchange-related matters, FierceHealthPayer previously reported.

Some of the states claim navigators' outreach activities could lead to more fraudulent activity. Some Republican lawmakers also are worried that navigators will have access to consumers' private information.

But experts consider navigators who offer in-person help an invaluable resource, particularly as the federal HealthCare.gov website suffers from so many technical troubles.  In-person assistance was central to Massachusetts's reform implementation, as only a few consumers signed up for coverage through the state's website and many more consumers received help from providers and social workers acting as navigators, according to The Atlantic.

"Most people signed up through hospitals and community health centers when they showed up for care in person. They were assisted by hospital personnel," John McDonough, a professor at the Harvard School of Public Health who helped Massachusetts implement its 2006 healthcare reform law, told The Atlantic. "There are people with literacy challenges, people who are intimidated by the process. That's why the navigators [for Obamacare] are considered to be so important."

To learn more:
- read The Atlantic article

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