For insurance exchanges, states need ‘navigators’ — and hiring them is a huge task

Maine and Iowa have already passed bills along those lines. Wesley Bissett, who is coordinating the lobbying nationwide on behalf of the Independent Insurance Agents and Brokers of America, said he is in discussions with lawmakers in seven more states.

Consumer advocates counter that the brokers are trying to squelch potential competition for new customers.

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Claire McAndrew, a senior health policy analyst with Families USA, an advocacy group that has helped organize support for the law, added that even proposals that seem innocuous — such as prohibiting navigators from offering advice — could have a chilling effect.

To do their job well, McAndrew said, navigators will need to explain to clients how the various insurance plans compare in terms of fitting the client’s budget or including the client’s existing doctors in the plan’s network. That’s not the same as recommending one plan over another, she said — but “it’s a subtle distinction.”

Consumer groups also note that the law already requires navigators to pass a certification exam, and they say further obligations, such as taking out a surety bond, would prove too onerous for the kind of small nonprofits most likely to have ties to hard-to-reach populations.

A case in point is the National Tongan American Society in Utah, which helps immigrants in Salt Lake City find health-care services and check whether they qualify for Medicaid or Medicare. The organization’s president, Fahina Tavake-Pasi, said she is keen to get her group certified as a navigator.

“Pacific Islanders are so often overlooked because of our language and cultural barriers,” Tavake-Pasi said. “Our organization is in the churches. We have a weekly radio show for Pacific Islanders. We know how to get the word out to our people, and they trust us.”

Nonetheless, she added, “we only have a staff of four, and we’re already working 60 hours a week and getting paid for 30. If we have to come up with the money for a bond, we couldn’t even provide the services we offer right now.”