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Will New Laws in States with Federally Run Health Insurance Marketplaces Hinder Outreach?
This fall, under the Affordable Care Act, there will be new marketplaces in each state where insurance companies will sell private health plans. People without job-based affordable health benefits can go to these new marketplaces either in person, by phone, or on the Internet and choose a health plan.
This means that consumer outreach and enrollment assistance in the marketplaces, also known as exchanges, will be vital to achieving one of the law's core purposes: substantially reducing the number of people without health insurance in the United States. To help with outreach and enrollment, the law requires that every state marketplace establish a "navigator" program to support consumers.
The Department of Health and Human Services recently released proposed rules that provide additional guidance on standards for the navigator programs, particularly for the 33 states that have decided to allow the federal government to operate their exchange.
What is a navigator? Under the Affordable Care Act, navigators must perform the following key functions:
* conduct public education activities;
*distribute fair and impartial information on health plan enrollment, premium tax credits, and free or low-cost *coverage through Medicaid;
* facilitate enrollment in qualified health plans;
* provide referrals to other consumer assistance organizations or state agencies that address health insurance issues; and
* provide information in a culturally and linguistically appropriate manner.
Navigators may be self-employed individuals or organizations as diverse as trade, industry, and professional associations, chambers of commerce, and ranching and farming organizations. Each state must include at least one community and consumer-focused nonprofit group as a navigator.
Some requirements may prevent the application of the federal navigator program. A state law that prohibits navigators from offering advice about the benefits, terms, and features of a particular health benefit plan could prevent a navigator from facilitating enrollment and helping individuals make informed decisions, as required under federal law.
For example, would state restrictions prohibit a navigator from "advising" a consumer with HIV about which plans cover certain antiretroviral drugs or "recommending" that a consumer consider plans that includes her providers in its network?
Stringent standards could be a barrier for respected community-based organizations—such as agricultural extension centers, churches, and safety-net health care providers—that want to serve as navigators for underserved communities, including those whose primary language is not English, those who live in remote areas, and the uninsured.
Many of these laws require the state's insurance department to further define navigator requirements in regulations. Because many states have not yet issued regulations, potential navigators may be unable to comply with state requirements ahead of open enrollment in October 2013, potentially leaving a state without a navigator program.
As October 1 approaches, stakeholders are focused on the need to inform and educate millions of consumers who will be eligible for expanded coverage options. While all would agree that navigators must be held to high standards to ensure that consumers are protected, uncertainty remains regarding how state and federal regulators will interpret critical terms such as "advise" and "recommend." This uncertainty could result in confusion and, potentially, litigation to determine whether state navigator requirements are preempted by federal law. To avoid confusion and delays or limits to implementation of effective navigator programs in each state, additional federal guidance on the scope of state-specific navigator requirements could be helpful as stakeholders prepare to help people get needed and affordable coverage.
BTW what is wrong with actually dying and not prolonging the inevitable? Why is everyone so necrophobic?
BTW what is wrong with actually dying and not prolonging the inevitable? Why is everyone so necrophobic?
Viesczy
If that was the case, the plan is really to thin the herd, why not simply END health care and let Nature burn off the dead wood that needs meds X, Y, & Z?
BTW what is wrong with actually dying and not prolonging the inevitable? Why is everyone so necrophobic?