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HHS will push back against state restrictions on Obamacare ground troops

Navigators are funded by the health law to help consumers understanding their insurance options. (Photo by Robyn Beck/AFP/Getty Images)
Navigators are funded by the health law to help consumers understand their insurance options. (Photo by Robyn Beck/AFP/Getty Images)

After a number of states have passed laws limiting the reach of Obamacare “navigators,” the Obama administration is getting ready to push back.

HHS has signaled it will soon take on restrictions that states have placed on the federally funded program meant to educate consumers about health insurance.

There are different designations of Obamacare-related in-person help: navigators, in-person assisters and certified application counselors. Each designation has varying responsibilities, but the general idea is that they’re supposed to help people understand their insurance options under the health care law, though they can’t actually enroll anyone in coverage.

A little more than 100 navigator groups in states with federal-run health insurance exchanges shared $67 million for this enrollment period. States running their own marketplaces have significantly larger pots of money dedicated to in-person help.

Given how little understanding there is of the health care law and insurance itself, the navigators have a pretty important job. But like everything else related to the health care law, there has been a political fight over the navigators, which are often health clinics and community groups.

Congressional Republicans last summer mounted aggressive inquiries into the groups awarded federal navigator grants, and a bunch of states passed laws limiting who can serve as navigators and what they’re allowed to do.

Researchers at the Commonwealth Fund, which is supportive of the health care law, last summer identified 17 states that passed laws regulating navigators beyond what federal law allows. Typically, these are states with stronger opposition to the health care law. This has created some confusion about what the navigators are actually allowed to do, according to Obamacare supporters and the navigators themselves.

So, what exactly is the Obama administration planning to do? That’s not entirely clear just yet, but the administration made brief mention of forthcoming plans in a lengthy rule issued last week.

“We also intend to specify in future rulemaking certain types of State laws applicable to Navigators, non-Navigator assistance personnel, and certified application counselors that HHS would consider to prevent the application of the provisions of title I of the Affordable Care Act,” wrote the Centers for Medicare and Medicaid Services. Title I of the ACA deals with expanded health insurance coverage.

CMS officials declined to comment on the new policy before it’s formalized, but they defended the navigator program.

“Navigator grants are given to trusted community organizations that have a track record of working in their communities,” CMS said in a statement. “Navigators around the country are actively helping consumers learn about their health insurance options, enroll in the Marketplaces and find the plan that is best for themselves and their families.”

Jay Angoff, a former Obama administration health official who’s leading a legal fight against state navigator restrictions, said he’s hopeful that the new federal policy will lay out clear ground rules.

“To the extent that HHS says that it is going to go ahead with instructing states that there are certain things they can’t do, it’s a good place for HHS to start,” Angoff said.

Earlier this year, Angoff helped two Missouri navigators successfully challenge state navigator restrictions. A federal judge ruled that Missouri couldn’t put additional requirements on navigators because it had ceded operations of its exchange to the feds.

Angoff says the Missouri decision could serve as a legal basis for knocking down other state navigator restrictions. The Missouri attorney general has appealed the ruling.

Jason Millman covers all things health policy, with a focus on Obamacare implementation. He previously covered health policy for Politico.



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