The Role of Navigators and Producers in an Exchange - Many Questions Few Answers
The concept of an unlicensed navigator replacing the role of a broker, or otherwise providing support to patients, has created angst among many health care experts, who are concerned about consumers receiving inconsistent or inaccurate advise about their health care coverage options. The emerging role of the navigator is getting a great deal of attention these days from many different stakeholders due to the Patient Protection and Affordable Care Act (PPACA).
Recently, the National Association of Insurance Commissioners (NAIC) issued the second draft of the White Paper that compares the role of the navigator envisioned under health care reform to the traditional roll of the broker in health insurance marketplace.
The NAIC “B” Committee’s White Paper takes a close look at the unanswered questions surrounding the role of the “navigator” in the health care industry system, which is vitally important to brokers. Obviously, how the federal government or the states “sanction” the future role of navigators will have a direct impact on brokers in the post-PPACA insurance marketplace.
The Role of the Navigator
Under PPACA, state exchanges will be required to award grants to navigators who will perform the following roles:
- Conduct public education activities to raise awareness of the availability of qualified health plans;
- Distribute fair and impartial information concerning enrollment in qualified health plans, and the availability of premium tax credits and cost-sharing reductions in accordance with federal tax laws;
- Facilitate enrollment in qualified health plans;
- Provide referrals to any applicable office of health insurance consumer assistant or health insurance ombudsman, or any other appropriate state agency or agencies, for any enrollee with a grievance, complaint, or question regarding their health plan, coverage, or a determination under such plan or coverage; and
- Provide information in a manner that is culturally and linguistically appropriate.
Navigators will likely be comprised of representatives of trade associations, business associations, and other community-based organizations; they also may be brokers. However, PPACA prohibits navigators from accepting remuneration from an insurer. The Secretary of Health and Human Services (HHS) is charged with establishing standards for navigators.
Unanswered Questions
The NAIC analysis raises several important questions that must be addressed by policymakers over the coming months relating to the functions and roles of a navigator, which include:
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Licensing/certification requirements.
- How will navigators be identified?
- How shall these navigators be regulated and by whom?
- Should the states license or certify navigators?
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Enrollment. The law provides that navigators will conduct public education activities and distribute information about enrollment in qualified health plans. The requirement to “facilitate enrollment” is left undefined. Leaving open the question of whether navigators will or should stop short of assisting with enrollment of a particular product selling insurance coverage and provide related services, such as advising consumers on specific plan options and actually helping them enroll in the option of their choice.
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Training requirements.
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Quality assurance.
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What funding source may exchanges use for navigator programs?
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If brokers serve as navigators, how will commissions be paid?
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Compensation.
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What funding source may exchanges use for navigator programs?
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If brokers serve as navigators, how will commissions be paid?
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Federal versus state powers.
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Will the regulations promulgated by the HHS Secretary establish a ceiling of standards or will states have flexibility with regard to the overnight and role of producers and navigators in their exchange?
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Will the criteria established by the HHS Secretary for participating navigators be minimum criteria upon which states may add, or will the criteria be absolute and immutable?
Role of the Broker Today & Tomorrow
Brokers fulfill a critical role in the sale of health insurance, the White Paper states:
In looking at the historical background of producers in the health insurance marketplace and issues surrounding the establishment of a navigator program under the PPACA, it is clear that determining the future role of producers is a vital part of the implementation process for the exchanges. States must consider not only what role producers will play in the start-up and day to day operations of an exchange but how producers will interact with the navigators. There are many issues in this regard, but experience has shown that all issues must be considered with the firm belief that producers are crucial players in the success or failure of an exchange.
Oklahoma Commissioner of Insurance John Doak circulated a letter at the time the White Paper was released that further amplified some of the questions raised in the NAIC’s White Paper. Doak vigorously defends the role of the broker in the health insurance marketplace. His opening statement alludes that the role of the navigator should be deleted from PPACA, or short of that, the navigator should be licensed under the same terms as a broker.
Doak also calls into question the use of the term “facilitate enrollment” that PPACA uses to describe the role of the navigator. He states that brokers have been successfully assisting the public in navigating the process of purchasing health insurance for generations.
BenefitMall commends the NAIC for bringing to light the many questions that remain about the confusing and conflicting role of the navigator. We also commend Commissioner Doak for defending the role of the broker in assisting the public in the health insurance marketplace.
If the states and the federal government allow untrained or semi-trained navigators to attempt to fill the role that trained, licensed and well-regulated brokers have successfully filled for decades; chaos may result for many trying to purchase health insurance. Now is not the time to gamble with people’s health insurance by using untrained or semi-trained navigators. There is simply too much at stake.