Welcome to Health Reform Watch, Sarah Kliff’s regular look at how the Affordable Care Act is changing the American health-care system — and being changed by it. You can reach Sarah with questions, comments and suggestions here. Check back every Monday, Wednesday and Friday afternoon for the latest edition, and read previous columns here.
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In the face of mounting Republican opposition, two organizations have dropped out of a key Obamacare program meant to enroll millions of the uninsured in coverage.
Republican legislators in Washington began investigating "navigators," the thousands of outreach workers funded by the health law, who are fanning out across the country to give Americans face-to-face help with signing up for Obamacare's new programs.
At the same time, states have passed a wave of new laws that restrict who can participate in the navigator program or what activities these organizations, often nonprofits, health clinics or community groups, can perform.
Some health law advocates are worried that these measures will have a chilling effect on a crucial group of health law workers, just weeks before enrollment in the programs begins.
"The prospect that millions of Americans will soon gain affordable health coverage is so threatening to Obamacare opponents that they are now persisting in unprecedented obstruction of the law," says Ron Pollack, president of pro-health law group Families USA.
The federal government awarded $67 million to more than 100 organizations across the country to hire and train navigators last month. At least two of those groups have since turned their grants back to the federal government.
Cincinnati Children's Hospital Medical Center has turned back a $124,419 grant to enroll uninsured people at their main hospital and two satellite locations. Spokesman Terry Loftus said that the hospital decided to decline the funding after Ohio enacted new restrictions in late July that significantly limited who could participate in the program.
"We had to withdraw because of an Ohio law which makes us ineligible," Loftus says. "It says you can't be a navigator if you negotiate with health insurers. As a medical provider, we can't be a navigator. We have notified the Center for Medicare Services."
Without the federal grant, Loftus was uncertain what type of outreach work the hospital would be able to perform.
"We certainly work with our own patient families on questions that might come up, but beyond that, I don’t know of any specific outreach program related to this matter specifically," he says.
Seventeen states have so far passed laws that place restrictions on navigators above and beyond those in the federal health law, according to analysts at the Commonwealth Fund. Most of the legislation requires navigators to obtain a state license or authorizes certain disciplinary measures that can be taken against the outreach workers.
West Virginia Parent Training and Information also sent back an award, theirs for $365,758. It was meant to fund "outreach to people with disabilities, people with limited English proficiency and/or limited literacy, people of low socioeconomic status, and people in rural areas," according to a federal description of the project.
Executive director Pat Haberbosch says that the grant was declined "due to unforeseen circumstances" and declined to comment further.
West Virginia attorney general Patrick Morrissey has been a leading critic of the navigator program. He organized in August a letter signed by 13 attorneys general to Health and Human Services that described the navigator program as a "security disaster waiting to happen."
"HHS will be giving its stamp of approval to every counselor who interacts with a consumer," he and the 12 other attorneys general wrote in that letter. "HHS needs on-the-ground plans to secure consumer information, follow up on complaints and to work with law enforcement officials to prosecute bad counselors."
Morrissey also sent a separate letter to the West Virginia Parent Teaching and Information to solicit specific information from the group in his state. He included eight detailed questions that asked the group to specify whether their navigators would "inform consumers of their data privacy rights" and whether they would require criminal background checks.
The letter, dated Aug. 23, requested a response no later than Sept. 10.
Congressional Republicans have also requested similar information from all navigator grantees, sending a letter Aug. 30 instructing the organizations to answer a series of detailed questions over the course of two weeks.
Health and Human Services responded to that letter Monday morning, answering the questions on behalf of the groups it has funded.
“We are concerned about the timing of your inquiry given its potential to interfere with the Navigators ability to carry out their crucial efforts in assisting Americans who lack health insurance,” Jim Esquea, assistant secretary for legislation at HHS, wrote in that letter.
“In an effort to address your remaining questions about the Navigator Program and enable the Navigators to focus on training staff to begin to assist uninsured Americans, we are providing the following responses to the questions posed in your letter to awardees.”
KLIFF NOTES: Top health policy reads from around the Web.
Can Congress actually fix the doc fix this year? "Something unusual happened just before Congress left for its summer break. The House Energy and Commerce Committee voted 51-0 for a bill that would overhaul the way Medicare pays doctors. The bill would, among other things, repeal something called the sustainable growth rate formula, or SGR, and eventually replace it with a system that would pay doctors based on how healthy they keep their patients." Julie Rovner for NPR.
IBM is moving retirees to a private health exchange. "IBM plans to move many retired workers off its health plan and give them money to buy coverage on a health-insurance exchange. The move is part of a corporate trend away from providing traditional retiree health benefits as costs rise. The company says it acted after projections showed that costs under its current plan for Medicare-eligible retirees will triple by 2020 and that the increases would be paid by retirees through premiums and out-of-pocket costs." David Koenig for the Associated Press.
Even in states declining the expansion, Medicaid is expected to grow. "South Carolina officials say they welcome the prospect that more than a half-million state residents — out of a population of 4.7 million — could soon gain access to affordable coverage, even without the expansion of Medicaid eligibility. And they are working to remake Medicaid so that it does not just pay claims but produces measurable improvements in the health of poor people." Robert Pear in the New York Times.