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Health Care Reform:

Health Insurance & Affordable Care Act

White House Moves to Ease Insurance Fraud Fears

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“Our law looks really bad, but we are hoping it will not have a very big impact,” said Lisa D’Souza, a health law and policy fellow at St. Louis University.

She said she worries most about a provision barring navigators from giving advice about health plan benefits even though federal rules require them to help consumers understand that benefits vary. “It seems to be a complete contradiction,” D’Souza said.

A Texas law requires regulators to get involved only if navigators draw complaints; otherwise, no new rules are expected in the first year of open enrollment.

In addition to prohibiting navigators from helping consumers compare benefits, Oklahoma’s insurance commissioner said navigators cannot help people “complete or sign applications for insurance,” or “initiate an inquiry about a person’s existing coverage,” or “discuss the terms of  a proposed contract of insurance with a prospective policyholder.”

Oklahoma navigators say they’re unsure what they can do.  

“This has raised concerns,” said Rhonda Teague, planning director at Little Dixie, who said the group has no intention of interfering with brokers who typically don’t seek out the uninsured.

James Mills, assistant general counsel for the Oklahoma Insurance Department, says his agency is simply trying to clarify the distinct roles of agents and navigators, but adds, “Obamacare is not something our state wants.”

He said navigators can show people information about health plans and their benefits, and help consumers fill out online applications. They can also tell older people that their premiums will be higher than those of younger people. But showing them why they may be better off choosing a silver plan instead of a gold plan to save money “would be going too far,” he said.

David Roos, executive director of Covering Kids & Families of Indiana, said that state's licensing fees are a burden to groups trying to help the uninsured. "These rules won’t help expand coverage," he said.  "... they will slow productivity."

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communications organization not affiliated with Kaiser Permanente.

Wed, Sep 18 2013

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