GOP Says Exchanges’ Navigator Program Lacks Proper Safeguards

In a letter sent Thursday to HHS Secretary Kathleen Sebelius, a group of nine Republican senators said the proposed rules for the health insurance exchanges' navigator program does not have adequate safeguards to protect consumers' information and lacks proper standards for navigator selection or training, The Hill's "Healthwatch" reports (Viebeck [1], "Healthwatch," The Hill, 6/20).

Background

Under the Affordable Care Act, exchanges that will be operated solely or in partnership with the federal government are expected to have two certified navigators, one of which must be a not-for-profit. The navigators must provide "fair, impartial and accurate information that assists consumers with submitting the eligibility application, clarifying distinctions among [qualified health plans] and helping qualified individuals make informed decisions during the health plan selection process." They also must provide additional assistance to consumers with disabilities, limited proficiency in English or who are unfamiliar with health insurance.

Congressional Republican leaders in recent months have stepped up their scrutiny of the navigators program and a separate "in-person assisters" program in states that will operate their own exchanges. HHS has allocated $54 million in funding grants to train and pay navigators in the 37 states with federally run exchanges. The ACA prohibits such grants for the assisters program because it does not have to meet the same criteria as the navigators program (California Healthline, 6/14).

Details of Letter

In the letter, the senators wrote, "The unreasonably low standard for becoming a navigator not only undermines the state's ability to ensure consumers are protected but raises questions about the appropriate use of federal resources and the protection of highly sensitive consumer information" (Viebeck [1], "Healthwatch," The Hill, 6/20).

The senators asked Sebelius to provide by Aug. 1 a list of information and materials regarding the program, including:

• The minimum requirements for selecting navigators and providing training, including training documents and potential contract forms if navigators are hired as contractors;
• Demonstration of HHS' authority to create the navigator and assisters programs;
• How HHS plans to enforce or penalize violation of its "conflict of interest" requirement, which requires that navigators cannot be individuals who receive compensation from insurance companies;
• The training and enforcement of privacy requirements; 
• The liability for navigators who harm consumers, including whether they will be advised on liability for disclosing taxpayer information without authorization; and
• HHS' plans to prevent potential fraud by people posing as navigators or other outreach workers.

The senators also observed that HHS' proposed standards for navigators and other outreach workers are lower than what states require of licensed insurance providers (Ethridge, CQ Roll Call, 6/20). They pointed out that the program could potentially enroll convicted felons as navigators, giving them access to confidential consumer information.

The letter was signed by Sens. John Barrasso (R-Wyo.), Richard Burr (R-N.C.), Tom Coburn (R-Okla.), Mike Enzi (R-Wyo.), Orrin Hatch (R-Utah),  Johnny Isakson (R-Ga.), Pat Roberts (R-Kan.), John Thune (R-S.D.) and John Cornyn (R-Texas) (Viebeck [1], "Healthwatch," The Hill, 6/20).

GOP HELP Committee Members Criticize FDA for ACA Promotion Efforts

The letter to Sebelius comes one day after 10 Republicans on the Senate Health, Education, Labor and Pensions Committee -- in a letter to FDA Commissioner Margaret Hamburg -- sought details on how the agency is using its resources for ACA implementation efforts and how those efforts are being financed, "Healthwatch" reports.

The senators criticized the agency on the financial implications of its ACA support, noting, "While our nation suffers from numerous drug shortages and patients are waiting for drugs and medical device approvals, the FDA should not be using resources designated for these purposes to fund an effort unrelated to your agency’s mission" (Viebeck [2], "Healthwatch," The Hill, 6/20).