'Navigators' key to insurers selling plans on exchanges

As insurers continue preparing to sell policies on new health insurance exchanges, much of their success may hinge upon something completely out of their control--exchange "navigators."

The health reform law requires the creation of a new type of employee called navigators, who will help the 30 million or so consumers shopping for coverage on online marketplaces find the most appropriate health plan. Thousands of these navigators will work for states' exchanges--California alone estimates it will need 21,000 navigators, reported The Washington Post.

The navigators are an essential ingredient to payers' success in exchanges because new consumers will have very different demographic profiles and health needs, including a lower level of education, more ethnic diversity and languages other than English as their primary language, than the currently insured population. They also haven't used healthcare very often and so aren't familiar with common insurance terms or policies, FierceHealthPayer previously reported.

But insurance brokers and agents are pushing back against these navigators, saying they won't have adequate knowledge or experience about each plan. They are, therefore, trying to prohibit navigators from advising consumers about which plans to choose.

"What you don't want is for our agents to be cut out and to have this force of untrained, unlicensed individuals giving advice with no financial responsibility," Ryan Young, head of government relations for the Independent Insurance Agents and Brokers of America, told the Post. "Consumers are going to get hammered."

Virginia, Ohio and Utah are now considering strict standards for navigators that could prevent them from giving advice, ensure they obtain a state license and require them to post surety bonds to pay for liabilities if they provide faulty guidance. Maine and Iowa already passed bills implementing similar requirements for their navigators.

If more states enact such laws regulating navigators, they could render this new workforce somewhat useless in guiding consumers through the complex process of buying health coverage, which could in turn lead to insurers selling fewer policies.

To learn more:
- read the Washington Post article