In North Texas, ACA Navigators Under Fire

For Martha Blaine, the 10 Affordable Care Act "navigators" who meet clients daily on behalf of the Community Council of Greater Dallas blend in with the rest of her staff.

“They are all employees,” said Blaine, the organization’s executive director. “So they have to undergo all of the same rules, regulations ... and standard operating procedures.”

The Community Council is one of several Texas organizations awarded a combined $11 million from the federal government to hire and train so-called navigators to help the uninsured seek insurance in the new online marketplace, which has been riddled with technical problems. 

But these organizations have come under intense scrutiny, particularly in North Texas, over allegations that navigators are breaking rules in an effort to get more people enrolled in Obamacare.

State leaders have also raised concerns that the navigator program does not offer adequate consumer privacy protections. The Texas Department of Insurance (TDI) is in the process of approving additional regulations on navigators that would require more training, background checks and prohibit conflicts of interest.

Over the last month, Project Veritas, a group led by conservative activist James O’Keefe, has fanned these flames by releasing videos showing navigators at the Urban League of Greater Dallas telling applicants to lie in order to increase subsidies they would receive under the new health law.

“Whatever the status quo is, whatever the oversight is, it’s not working," O'Keefe said. "It’s just not working.”

O’Keefe said his staffers found fraud of varying degrees in every office they visited. 

“If our cameras can cause congressional hearings, more oversight,” O’Keefe said, “I think that speaks volumes to how little is being done.”

One such congressional field hearing occurred Monday in Richardson. Republicans on the panel raised concerns about whether navigators were receiving proper background checks, and suggested that clients enrolling in the health care program should have a chance to verify a navigator’s certification.

U.S. Rep. Darrell Issa, a California Republican and chairman of the House Oversight and Government Reform Committee, called the Dallas area “ground zero” for the fraud and deception that has surfaced in the navigator program. “If it’s happening in Texas," he said, "I’m sure it can happen in other states." 

Supporters of the health law and its navigators say such concerns have been wildly overstated by Republicans seeking to discredit the health law. At least two organizations that received navigator grants in Texas have backed out of the program in response to the state's political pressure.  

Blaine said her organization is in the business of protecting clients. All of the navigator candidates at the Community Council have to undergo background checks, reference checks, education verification and complete a written application. They have to verify their legal status and submit a government-issued ID before being eligible for the online course to become certified to facilitate ACA signups. 

In the more than two months since enrollment opened, Blaine said she hasn't had to discipline a single navigator, who field appointment requests in 18 counties across North Texas. They are overseen by supervisors, attend weekly debriefs and conference in on weekly calls with the Centers for Medicare and Medicaid Services and grant managers, she said.

Blaine said the new rules proposed by TDI are unnecessary. Navigators already must undergo 20 to 30 hours of training, pass a certification test and renew their certification annually, according to the U.S. Department of Health and Human Services. Although federal program rules already require navigators to provide information on health plans in the marketplace that is “fair, accurate and impartial,” and prohibit conflicts of interest, such as financial relationships with health insurers, the rules proposed by TDI would require navigators to undergo criminal background checks, comply with additional privacy training, and provide proof of identity and documentation that they complied with education requirements. The rules also explicitly prohibit navigators from charging consumers, selling or soliciting health insurance coverage, recommending a specific health plan, providing advice on how to compare benefits of specific plans, and engaging in certain political activities, such as campaigning or promoting a political party or candidate.

“My people are not insurance agents,” Blaine said. “We’re not selling anything. We’re not receiving commission. And we already have all of these procedures in place that are appropriate for our profession.”

A public hearing on the proposed rules is set for Friday.