Role of Health-Law 'Navigators' Under Fire

May 20, 2013, 7:25 p.m. ET - Wall Street Journal

Role of Health-Law 'Navigators' Under Fire

By LOUISE RADNOFSKY

Lawmakers across the country are tussling over the Obama administration's plans to create a small army of assistants to guide millions of Americans as they sign up for new health-insurance options available this fall.

Backers of the health-care overhaul face an uphill battle to spread the word about the law, in the face of consumer research that suggests most uninsured people know little about it and are skeptical about the value of health insurance generally. Some Democrats have openly worried that the administration is doing too little to make sure the enrollment process goes smoothly.

That is where the "patient navigators" are supposed to come in. But their role has come under question from Republicans who have criticized the administration's plans to educate people on the new legislation. Health and Human Services Secretary Kathleen Sebelius has already drawn fire for conversations with health-industry executives in which she encouraged them to help the nonprofit organization leading the campaign to publicize the law's benefits. Critics said that it was inappropriate for the government to turn to outside groups.

The health-care law envisioned each of the 50 states running a marketplace where people without insurance could comparison-shop for policies and apply for subsidies to help them pay premiums. To smooth the process, each of the states was to set up a program that would enlist nonprofits, professional associations and unions to act as navigators.

Part of the plan has already changed because 34 states won't be running their own marketplaces and are leaving part or all of the job to the federal government. In those states, Washington took on the task of granting money for hiring navigators.

Critics see the navigators as potential competitors to insurance brokers, and say that they are effectively federal government employees who should be subject to rigorous screening.

The Republican-led House Committee on Oversight and Government Reform is planning to grill the Department of Health and Human Services about the program in a hearing Tuesday. At a private briefing with federal officials last month, committee aides say they were told there would be no criminal background checks for navigators or requirements that they hold a high-school diploma.

"Because navigators and assisters will have access to personal and sensitive information such as Social Security numbers and tax returns, we believe they should be held to the same hiring standard as U.S. Census and [Internal Revenue Service] employees," who get Federal Bureau of Investigation background checks, wrote Rep. Darrell Issa (R., Calif.), the chairman of the committee, and two other Republican members in a letter to the department.

The department says its standards are thorough and include several provisions designed to ensure that navigators are independent from the insurance industry. Individual navigators will receive "extensive" training on privacy and security as part of their preparation and will be subject to federal regulations governing data protection, an HHS spokeswoman said.

Many states are contemplating or have already passed legislation adding requirements for navigators. Some would bar navigators from advising consumers unless they obtain a separate state license.

"The main issue is making sure that people who interact with consumers actually know what they are talking about," said Wes Bissett, senior counsel for government affairs to the Independent Insurance Agents and Brokers of America, an industry group that is promoting the restrictions on navigators.

Backers of the health-care law say the navigators will largely be working with lower-income people, and in many cases helping them to sign up for federal subsidies or government programs such as Medicaid—not the typical work of a health-insurance broker.

"Applying for financial assistance is also a complicated business, and brokers don't have a lot of experience with that," said Tricia Brooks, a research assistant professor at the Georgetown University Health Policy Institute.

Supporters of the law say the real issue is a shortage of money for navigators. Congress directed state exchanges to set up their own navigator programs and didn't specifically set aside federal funding for them. That left Health and Human Services to cobble together $54 million to share among the 34 states where the marketplaces are under federal direction. Some 28 million uninsured people live in those states.

North Carolina will have only $2.2 million for its navigator program. Groups that receive grants from that allocation may try to stretch it by using volunteers to act as navigators, but some are already wondering if it is worth the trouble to apply in the face of a state bill requiring separate certification, said Adam Linker of the North Carolina Justice Center's Health Access Coalition.

"At this point we're going around begging groups that already know a lot about health insurance," said Mr. Linker.

Write to Louise Radnofsky at louise.radnofsky@wsj.com

A version of this article appeared May 21, 2013, on page A4 in the U.S. edition of The Wall Street Journal, with the headline: Role of Health-Law 'Navigators' Under Fire.