In his State of the Union address, President Obama mentioned fixing a broken health care system. Unfortunately, the president provided no specifics about how to fix errors already experienced during the implementation of the Affordable Care Act (ACA), such as securing ethical and well-screened insurance navigators who handle personal information of health insurance enrollees.
Dropping the ball on consumer protections, the federal government’s inadequate screening and training process for navigators exposes consumers to serious risks of fraud and identity theft. Fortunately, states are addressing these neglected privacy and fraud concerns, adopting stricter requirements for health insurance navigators — the people who provide enrollment assistance to consumers seeking coverage. Arizona, Colorado, and Virginia recently introduced legislation requiring navigator background checks, and states like Texas are implementing additional training for health insurance navigators.
Prior to open enrollment, members of Congress rightfully raised questions about the navigators’ preparedness to handle enrollment issues. Those worries materialized almost immediately, when alarming evidence surfaced of misconduct on the navigators’ part. At the Urban League of Dallas, a navigator encouraged an applicant to lie to receive lower premiums. Another navigator told an applicant not to report income he made in cash, explaining, “Don’t get yourself in trouble by declaring it now.”
More troubling was Health and Human Services (HHS) Secretary Kathleen Sebelius’ admission that, due to the absence of a federal background check requirement, it is “possible” for a convicted felon to become a navigator.
Following the public exposure of navigator misconduct, members of Congress questioned Gary Cohen, a Center for Medicare and Medicaid Services (CMS) administrator, who acknowledged the need for better navigator training to handle issues like applicants with underreported income.
Many consumers rely on paper applications for health insurance rather than attempt to navigate the quagmire that is healthcare.gov. Sensitive consumer information is therefore made available to insurance navigators, including income and social security numbers. To make sure sensitive consumer information is not abused by the people entrusted to provide assistance, 13 states require some form of background check for navigators.
Furthermore, some states are expanding training requirements for navigators. Texas, for example, requires an additional 20 hours of training. While some people contend these efforts are attempts to obstruct the ACA, Insurance Commissioner Julia Rathgeber believes the training equips navigators “to safeguard a consumer’s most sensitive and personal information.”
In December, rather than act with the states to address the gaping holes in navigator training, screening and oversight, HHS awarded another $58 million to the ACA’s navigator outreach and enrollment efforts to supplement the $150 million in previous grants.
Stubborn, forced continuance of federal policies despite serious red flags is unfortunately a growing trend in Washington. Americans have already experienced this persistence numerous times with the ACA: the botched rollout of the exchanges and healthcare.gov; the mounting pressure from the federal government to expand a broken Medicaid system; and even the initial passage of the law, which was pushed through Congress “so you can find out what is in it.” Such a cavalier mentality endangers citizens and feeds into the unsuccessful reliance on Washington bureaucrats to fix issues after they arise, rather than before they occur.
Desperate to see the ACA succeed, the federal government let consumer and fraud protections go by the wayside and expanded a program with known shortcomings. The reckless implementation and failure to provide adequate fraud and consumer protection measures illustrate precisely why large, centralized government control fails to adequately meet the needs of a diverse people.
Similarly, states underscore the importance of federalism when they are left to pick up the pieces of the ACA’s mess. Consumer and fraud protection should never be a secondary concern; thankfully states are able to take matters into their own hands to ensure navigators are prepared to ethically assist health insurance applicants.
Edward Walton is a legislative analyst on the American Legislative Exchange Council Task Force on Health and Human Services. To learn more, visit www.alec.org