Criticism of Additional Rules for Health Care Navigators Dominates at TDI Hearing

Supporters of the Affordable Care Act and its so-called navigators, who are charged with helping uninsured Texans sign up for health insurance coverage, on Friday criticized proposals for additional regulations of navigators during a Texas Department of Insurance hearing.

Political pressure from state leaders, costly additional training and the broad definition of navigators by the state were among the top concerns raised by lawmakers, representatives of health service providers and community organizations that represent navigators working in Texas. TDI proposed the new rules earlier this month. Aimed at addressing concerns from state leaders, the rules would require navigators to undergo criminal background checks, comply with additional privacy and Texas Medicaid training, and would prohibit conflicts of interest.

“These rules, for the most part, do not appear they are aimed at protecting consumers,” said state Rep. Chris Turner, D-Grand Prairie. “Rather, they seem clearly intended to make a political statement.”

Turner said that navigators had become an “easy target in an all-out assault” on the federal health reform law.

The federal government awarded almost $11 million to local organizations in Texas charged with hiring and training navigators to help individuals sign up for health insurance, as required by the Affordable Care Act, through a federal health insurance marketplace. The U.S. Department of Health and Human Services already requires navigators to complete 20 to 30 hours of training and to pass a certification test, among other requirements.

Gov. Rick Perry, who staunchly opposes the federal health reform law, first requested the additional rules in September, citing consumer privacy concerns. Other Republican state political leaders, including Lt. Gov. David Dewhurst and Attorney General Greg Abbott, who are both currently campaigning for office, also called for additional regulation of navigators and have called for the repeal of the Affordable Care Act.

State Sen. Kirk Watson, D-Austin, who authored the bill that required TDI to make a “good-faith effort” to comply with HHS rules before implementing additional state rules, said many of TDI’s proposed rules are already included in his bill, adding that implementing the new rules would present “challenges and reduction of access” for the uninsured.

“You need to demonstrate that the obstacle you’ve created is truly and meaningfully about consumer protection,” Watson told Insurance Commissioner Julia Rathgeber. “These rules must not be seen as the products of raw political pressure to impose needless, expensive, burdensome, bureaucratic regulations that would deny reliable health care to Texans who need it.”

The additional rules also explicitly prohibit navigators from charging individuals for their services, selling or soliciting health insurance, recommending specific health plans, providing guidance on comparing the benefits of specific plans, and engaging in certain political activities, such as campaigning or promoting a political party or candidate.

At the hearing, representatives of organizations that hire and train navigators said that privacy concerns raised by political leaders were unwarranted because of the experience and training navigators already have.

Tim McKinney, CEO of United Way of Tarrant County, asked TDI to provide evidence of incidents that would demonstrate the need for “such stringent standards.”

United Way of Tarrant County is the lead organization of the Consumer Health Insurance Marketplace Enrollment Services Consortium, which was awarded a $5.9 million grant to hire and train navigators in Texas. The consortium is made up of 16 organizations that currently employ a combined 158 navigators.

McKinney said that the costly additional 20 to 40 hours of training TDI would impose under the new rules are excessive and that using existing, free web-based training is sufficient for navigators to help consumers understand their options.

The estimated cost of additional training — about $800 per navigator — would be detrimental to the uninsured, McKinney said.

“The people who will be hurt by the proposed cost increased are the people we are supposed to be serving — those who are uninsured,” McKinney said.

At least two organizations that received navigator grants in Texas have backed out of the program in response to the state’s political pressure. 

Representatives for the Texas Hospital Association and the Teaching Hospitals of Texas organization said they were concerned that the proposed TDI rules contain a definition of a navigator that is too broad and could affect hospital staff who help patients register for health insurance.

Allison Brim, organizing director for the Texas Organizing Project, said many of its staffers would be unable to provide members across Texas with guidance about signing up for insurance if the current language of the proposed rules was kept.

Members of the Texas Organizaing Project made up a large portion of the modest audience at the hearing, which more than 100 people attended.

TDI’s Friday hearing comes on the heels of a congressional field hearing Monday in Richardson during which members of the U.S. House Oversight and Government Reform Committee intended to address allegations that some navigators have broken program rules and encouraged tax fraud.

Navigators have recently come under scrutiny after Project Veritas, a group led by conservative activist James O’Keefe, released videos that show navigators in Dallas suggesting to applicants that they should lie to increase the subsidies they could receive under the federal health reform.

Republican lawmakers, including state Rep. Kenneth Sheets of Dallas and state Sen. Donna Campbell of San Marcos, cited the videos in their testimony.

The videos revealed the “intrinsic flaws” of the “ill-defined” navigator program, Campbell said.

A second hearing is scheduled for Jan. 6, and Rathgeber is expected to issue a decision on the rules afterward.