The actions have drawn less attention than congressional efforts to cut off funding for the law, or earlier state decisions to refuse to set up online insurance marketplaces or reject an expansion of Medicaid, which sharply limited the law’s reach.
But the moves could impede Obama’s most significant domestic accomplishment, which, despite having withstood a Supreme Court challenge and a presidential election, still faces doubts about its viability. And they could affect implementation at a crucial time, just as some of the major provisions of the law, also known as Obamacare, are set to go into effect.
Under the law, millions of uninsured Americans will be able to shop for health plans and apply for subsidies to buy them, beginning Oct. 1. The policies will take effect in January, when most Americans will be required to have insurance or face a penalty.
Advocates worry that continued resistance by some states could hinderefforts to coax many of the nation’s 50 million uninsured to sign up for coverage.
“There is a very palpable concern . . . that anti-Obamacare state government people will find ways to gum up the works,” said Leonardo Cuello, director of health reform for the National Health Law Program. Political foes of the health-care law are “constantly putting up barriers to progress being made,” he added.
Critics of the law say that they oppose the Affordable Care Act for political and pragmatic reasons and that it’s important to try to prevent the law from firmly taking root. In Congress, Republican Sens. Marco Rubio (Fla.) and Ted Cruz (Tex.) are fighting an uphill battle to stop the flow of federal money to the program.
In the states, much of the activity involves “navigators,” a workforce of tens of thousands of people who will be deployed by the administration to provide in-person or over-the-phone assistance for people signing up for insurance.
Navigators are seen as critical to the success of the law, because signing up for coverage could be confusing. But opponents say the navigators may not have enough training to be effective guides and could steer consumers toward inappropriate policies. And they are uneasy about the navigators’ access to private information, such as income data and Social Security numbers.
More than a dozen states have imposed licensing rules and limits on these helpers, with the encouragement of professional insurance agents and brokers, who lobbied heavily for the restrictions.
In Ohio, for example, navigators won’t be allowed to compare and contrast plans for customers. And in Missouri, which has a Democratic governor but a Republican legislature, they are required to immediately cut off contact with any customers who at some point have talked to a professional broker or agent.