Thanks to The Center for Public Integrity, we now have a substantial story that tells us about the latest Obamacare turf wars. As we well know, turf wars among professionals are all about protecting incomes, and when the bottom line is involved, the fighting gets fierce. This one is over who’s best to advise those 24 million souls who will buying insurance in the state insurance exchanges this fall and beyond.
Traditional insurance agents and brokers who’ve sold health insurance for years have been arguing since the debate on the Affordable Care Act began that they are best to help confused consumers sort through the myriad options they’ll confront. The crafters of the ACA thought otherwise, and called for a system of navigators fanning out all over America to get folks signed up. Secretary of Health and Human Services Kathleen Sebelius wants seven million people enrolled in state exchanges by the end of March 2014, when the open enrollment period for signing up is over. And when there are money and quotas involved, there are bound to be, shall we say, questionable sales practices. This happened when the Medicare prescription drug law took effect in 2006. Given the high stakes, there’s no reason to think this effort will be any different.
Since the Affordable Care Act passed in 2010, insurance brokers and agents have embarked on a state capitol strategy to stymie the navigators, and their quiet campaign has largely eluded the press (not surprising, given diminished statehouse reporting). Their campaign has resulted in laws in 16 states over the past year to restrict the activities of the navigators who are supposed to help people enroll in the exchanges. Tom Corwin, a staff writer for the Augusta Chronicle, has covered the story in Georgia’s capital, and in one piece quoted Katie Keith who has tracked state laws for Georgetown University’s Health Policy Institute. “I will say [these laws] are strikingly similar across the states, which does suggest that somebody is pushing them,” she told Corwin.
That somebody, according to the Center for Public Integrity, is an influential group called the National Conference of Insurance Legislators (NCOIL), made up of state lawmakers who hold hearings, debate policy, pass resolutions, craft model laws, and send articles, research reports, and alerts to fellow state legislators. They also hobnob with members of the insurance industry who pay big bucks to attend the group’s conferences and events. It’s the kind of symbiotic relationship that’s prevalent among the regulated and the regulators. Only in this case it’s the legislators who pass the insurance laws.
A member of the group, North Dakota state representative George Keiser, told the Center that insurance agents and brokers approached him with concerns about the navigators early in 2012. Keiser crafted a resolution, which the NCOIL group adopted this spring. The states that have passed broker-backed legislation pretty much have followed Keiser’s resolution. It calls for states to require their own training and licensing requirements for navigators, bars them from recommending specific insurance plans, and calls for background checks. Georgia’s law, for example, requires navigators to undergo background checks and prohibits them from giving advice about the benefits, terms, and features of a particular health plan. Federal officials have said states can impose extra requirements as long as they are not a “hindrance” to the navigators doing their jobs. Georgia requires navigators to have 35 hours of training.
The CPI piece is timely in view of Secretary Sebelius’s recent announcement of $67 million in grants to help 105 organizations–like Mercy Hospital and Medical Center in Illinois and Planned Parenthood of Northern New England in New Hampshire–set up navigator programs. The grant money was borrowed from a special fund to promote health prevention that was also created by the ACA. Navigators are to receive at least 20 hours of training and pass a certification test. How good this training will be and how much is really necessary is anyone’s guess at this point. Navigators can be paid employees or volunteers, says Washington and Lee law professor Timothy Jost. “I don’t think anything in the law prohibits an agency from paying navigators an incentive for signing people up, as long as none of it comes from an insurance company, but I think it would not be a good idea,” he told me. “It would encourage navigators to go for signing up as many as possible rather than making sure the people they sign up understand what they are doing.” Precisely. That’s the incentive old fashioned brokers and agents have. They earn commissions. The more sales, the greater their income.
Here’s where we in the press come in. Both the CPI story and government’s release of the names of the groups offering navigator programs give us an opening for good and helpful reporting. There are at least two ways journos can take this story. For one, in the states that don’t have their own requirements for regulating navigators, it’s a good bet the brokers and the NCOIL will still be hard at work trying to make sure they do. That’s a political story that raises the question of whether navigators need more training and more restrictions.
Another angle for reporters is basic consumer stories. In my experience, I have found good and bad insurance brokers. Even when it comes to more neutral types–that is, those who don’t have a sales commission to worry about like the Medicare counselors in the State Health Insurance Assistance Program (SHIP) program–there are good and bad advisers. One way for reporters to sift the good from the bad is to understand the products that each group will be pushing. Once you do that, visit the groups in your area that have received navigator grants. Interview officials, learn about the compensation for the navigators as well as their goals and sign-up quotas (if there are any). Learn what the training requires–do navigators need more of it, as brokers claim? Sit in on a call from a consumer asking for help. What is it that shoppers don’t understand? Are the navigators providing decent answers? While this may sound like a bit of hard, time-consuming work, it’s a way to move beyond the spin and the politics that are sure to surround the state exchange enrollment process.
Follow @USProjectCJR for more posts from this author and the rest of the United States Project team. And for Trudy Lieberman’s resource guide to covering the ins and outs of buying insurance on the state exchanges, see Open Wide, from CJR’s new July/August issue.
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Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for CJR's Covering the Health Care Fight. She also blogs for Health News Review and the Center for Health Journalism. Follow her on Twitter @Trudy_Lieberman.