What Exactly Are Obamacare Navigators?

Published November 11th, 2013 -  - 11.11.131


As we’ve covered, the House of Representatives’ Education and the Workforce Committee has launched an investigation into Obamacare “navigators” to “ensure individuals’ privacy is protected and contact with an ObamaCare navigator doesn’t lead to a phone call from union organizers.” But what exactly are navigators?

Put simply, navigators are individuals or organizations who receive federal funds under the Affordable Care Act “to help consumers, small businesses, and their employees as they look for health coverage options through the Marketplace, including completing eligibility and enrollment forms.” These federally-funded navigators are different from employees and volunteers of nonprofit organizations that do not receive federal money but are also trying to assist individuals in signing up for health insurance under the new law – organizations like Enroll America.

In August, the federal government “awarded $67 million in [navigator] grants . . . to more than 100 organizations around the country.” The recipients include “large private companies, charities, health care providers and universities to local legal-aid providers and faith-based organizations.” Some of the grantees and sub-grantees are groups that are typically associated with liberal causes,  such as Planned Parenthood affiliates, community development agencies, and labor unions, which has led to criticism from some conservative media outlets and politicians.

Yet, the navigators program was modeled after the Senior Health Insurance Assistance Program (SHIP), “which helps seniors navigate the Medicare Part D perscription-drug program.”  According to a former Georgetown University health policy researcher, “you just don’t have these same kind of requirements on SHIPS as we see on navigators.”  Many of the types of community centers who received navigator grants “have a long history of helping seniors or children enroll in government programs like Medicare, Medicaid and the Children’s Health Insurance Program” safely and effectively, without the additional safeguards and restrictions states are enacting specifically for Obamacare.

Several Republicans, including members of the House Education and the Workforce Committee, have pressed for additional regulations and restrictions due to concerns about navigators having access to Social Security numbers, tax information, and other personal data when helping individuals enroll in a health plan. But, under existing federal rules, navigators must “receive 20 hours of training, including instruction in client privacy,” are subject to “fines of up to $25,000 for violations of confidentiality,” and must adhere to federal standards for ensuring the privacy and security of personally identifiable information. Nonetheless, at least “[s]eventeen states have . . . passed laws that place restrictions on navigators above and beyond those in the federal health law.”  These laws typically involve “fees, background checks, tests, extra training, certifications, threats of civil penalties, or delays.” As a result, several navigator grant recipients have turned back navigator funds in light of these burdens and congressional and state investigations – posing yet another challenge for the federal government in the implementation of the Affordable Care Act.

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