Bethesda, MD -- A new Health Policy Brief from Health Affairs and the Robert Wood Johnson Foundation discusses the challenges facing so-called navigators and assisters as they help consumers understand and select health insurance policies from the Affordable Care Act's new exchanges, or Marketplaces. The enrollment process is complex, and navigators and assisters have been trained to both enroll people and assist them with subsidy applications. However, some critics of the Affordable Care Act (ACA) have raised concerns about insufficient training and privacy safeguards.
Some of the topics covered in this brief include:
- What's the background? The brief outlines the functions of navigators and assisters, who provide one-on-one help by explaining how the Marketplace and its federal premium subsidies work. Those states that run their own exchanges can use ACA establishment grant funds to set up their navigator programs; however, only separate operational funds can be used to pay individual navigators. Yet those funds will not be available until January 1, 2014, precluding navigators from working during open-enrollment season when they are needed most. To address this gap, the Department of Health and Human Services (HHS) created the assisters program, which is very similar to the navigators program but does not face the same restrictions on how individuals can be paid.
- What's the debate? Much of what navigators do overlaps with the work of health insurance agents and brokers (who receive commissions and fees from insurance companies for every policy they help sell). Some brokers and agents, feeling undercut by assisters and navigators, have lobbied state legislatures to pass laws requiring navigators to receive additional training. In addition, a group of 13 state attorneys general have recently voiced their concerns about navigator training and access to sensitive consumer information--and members of the House of Representatives have begun investigating the navigator and assister programs.
- What's next? With the rough launch of the federally run exchanges, navigators and assisters are essential to successfully enrolling millions of Americans. In addition to navigators and assisters, HHS will also rely on not-for-profit organizations to provide outreach and education. Meanwhile, the battle over state laws imposing additional requirements on navigators will play out over the next few months as navigators and assisters begin their work. HHS may need to provide clearer guidance on when state laws prohibit navigators from fulfilling their duties.
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