House Lawmakers Grill CMS Over Health Exchange Navigators

Margaret Dick Tocknell, for HealthLeaders Media , May 22, 2013

The role of navigators, expected to help millions of uninsured make their way through the health insurance market, came under fire Tuesday by members of Congress who raised questions about oversight and the role of the IRS in the implementation of healthcare reform.

A meeting of the House Committee on Government Oversight and Reform called ostensibly to discuss the role that navigators and assistors will play in the enrollment process for new health insurance marketplaces included statements and questions about role the IRS is expected to play in the implementation of healthcare reform.

The meeting veered further off topic into concerns over the fundraising efforts of Kathleen Sebelius, the secretary of the Department of Health and Human Services.

Rep. Jim Jordan (R-OH), chair of the Subcommittee on Economic Growth, Job Creation, and Regulatory Affairs, set the Republican tone in his opening comments. "In light of the revelations of the IRS targeting conservative groups… it is crucial for the American people to understand that Obamacare tasks the IRS with enforcing nearly 20 new tax laws. That's amazing to me. The very organization charged with enforcing Obamacare was systematically targeting conservative groups that came into existence because they oppose Obamacare."

Jordan stated that the IRS role in enforcing Obamacare is tied to the navigator and assistor program through the premium subsidies that will be available to qualified individuals. "If [they] incorrectly fill out a person's health insurance application, and that person receives subsidies to which they are not entitled, then the IRS will go after the individual."

He went on to note that as part of "Obamacare, the IRS is building the largest personal information data hub that the federal government has ever attempted."

On the Democratic side reaction was swift and pointed. "Until recently I thought that the difference between us and a Banana Republic was that in this country once a law is passed or the Supreme Court has spoken, the law was the law even when our side lost," said Rep. Eleanor Holmes Norton (D-DC).

"Republicans are still fighting the Affordable Care Act as if it is not the law of the land… Today's hearing is merely an effort to continue to obstruct the law and the right of citizens to health insurance."

Amid the posturing on both sides of the aisle, the sole witness, Gary Cohen, deputy administrator and director for the Center of Consumer Information and Insurance Oversight for the Centers for Medicare & Medicaid, soldiered on. His five-minute statement focused entirely on how navigators are expected to help millions of uninsured make their way through the complicated health insurance market.

While the marketplaces hold the promise of being places where consumers will be able to easily compare costs, benefits, and cost-sharing to select a plan that is right for them, Cohen stated that "ensuring that consumers and businesses participate in the marketplaces requires that they learn about the benefits that these marketplaces have to offer and that they get the help they need to take advantage of those benefits. This is a significant undertaking. We know quite a bit about the uninsured American we need to reach: many have never had health insurance, so the transaction of selecting, applying, and enrolling in healthcare coverage will be unfamiliar…20% have not completed high school. To effectively reach these populations…information must be provided by people connected to the community in an appropriate manner."

He noted that navigators and assistors will operate much like insurance brokers and agents and agents already do today—educating consumers about the marketplaces and insurance affordability programs, comparing plans, helping consumers receive eligibility determinations, and enrolling in coverage.

Felons as navigators?
Rep. James Lankford (R-OK), chair of the Subcommittee on Energy Policy, Healthcare, and Entitlements, asked about basic requirements to become a navigator. "Has HHS mandated criteria for individuals who would be navigators? Could felons, individuals convicted of identity theft, or high school dropouts become navigators and handle sensitive and personal information? Is there an expectation that a navigator will have any prior knowledge of the health insurance market? Is there an oversight plan?"

In his statement, Cohen noted that HHS has extensive experience providing outreach and enrollment assistance in Medicaid, the Children's Health Insurance Program (CHIP), and Medicare. "CMS designed navigator and in-person assistance grant programs that will allow qualified and well-trained individuals and organizations help consumers find and enroll in healthcare coverage, while adhering to standards and requirements designed to ensure that taxpayer money is used appropriately."

HHS has earmarked about $54 million to fund navigator in federal or state marketplaces. Cohen said the opportunity is open to the self-employed as well as community and consumer-focused non-profits. Trade, industry, and professional associations, commercial fishing industry organizations, ranching and farming organizations, chambers of commerce, unions, and licensed insurance agents and brokers may also apply.

The CMS Office of Acquisitions and Grants Management will oversee the review and evaluation of the grant applications. Grantees must also complete a 20-30 hour training program and pass an exam.

"I'm a dentist and I don't see how 20 hours of training will get this done. That's inadequate. What are the checks and balances on the education component?" asked Rep. Paul Gosar (R-AZ). "Is someone visiting with that navigator or is [the training] all online? What stops a convicted felon from becoming a navigator?"

"It's online just as it is in many states for insurance agents and brokers," responded Cohen. "If you look at the type of organizations that will apply for these grants I don't think felons will be a problem."

In his final comment Rep. Jim Jordan again turned his attention to the IRS. "The American people want to know what role the IRS will play in their healthcare and the implementation of the Affordable Care Act. As an American, does the IRS role in this scandal trouble you?

"The IRS has a significant role in enforcing tax provisions of the Affordable Care Act, but there's more to the ACA than just tax questions" noted Cohen. He added that he didn't see a connection between the navigator programs and the IRS monitoring conservative groups.

Concerns about Sebelius's fundraising
Rep. Lankford (R-OK) then turned to media reports that Secretary Sebelius is soliciting funding for the assistor program from health plans, hospitals and pharmaceutical companies to donate to nonprofits responsible for outreach efforts. "These actions unduly pressure private companies to financially support implementation and promotion efforts. Fearing HHS retribution if they don't contribute. The secretary must stop using unethical methods to fund the law's implementation."

"I have no knowledge of her calls," responded Cohen. He added that public-private partnerships are often used to help fund projects.

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