New Orleans The news on enrollment under the Affordable Care Act puts the numbers through December 28, 2013 at more than 2.1 million people with 24% under 34, 37% between 34 and 55, and 33% between 55 and 65. Officials for the Kaiser Foundation which has been following all of this carefully, said these figures are highly acceptable including the young enrollments, arguing that even if they stay the same through March 31st, when more younger, healthy registrants are sought, it would only lead to a 2 or 3% price increase for 2105.
All of which is a battle cry for the right to double down, and they did so with a vengeance in Texas, which is the biggest prize for enrollment in Obamacare, by trying to deliver a body blow on all of the federally funded navigators assisting enrollment. New rules being promulgated by the Insurance Commission are expected to go into effect on March 1st in the critical last full month for enrollment for this year ending on March 31st.
The Houston Chronicle couldn’t have been clearer in laying out the facts, which make it impossible not to see this as a full frontal, political assault to try to discourage and thwart enrollment before the deadline, as Governor Rick Perry has advocated loudly.
The proposed rules being developed by Texas Department of Insurance Commissioner Julia Rathgeber would require health care navigators receive an additional 40 hours of training on top of the 20 to 30 hours required by federal law. The rules would require navigators hired by local organizations through a federal grant to take an additional 40 hours of training on Medicaid rules, ethics and privacy. ACA navigators also would pay training fees of up to $800, an additional $120 for six hours of continued education, plus a $50 registration fee. They also would have to undergo a criminal background check and a fingerprinting process that could cost up to $62, prove their U.S. citizenship, and provide documentation of their educational credentials.
By comparison, Texas Department of Insurance-certified counselors under the Health Insurance Advocacy and Counseling Program -which provides enrollment assistance on Medicare benefits – are required to complete 25 hours of training. Navigators who help citizens enroll in Medicaid, the Children’s Health Insurance Program, the Supplemental Nutrition Assistance Program and Temporary Assistance for Needy Families are required to take only four hours of training. Those navigators operate under the Texas Health and Human Services Commission’s Community Partner program. Counselors working in those programs do not have to pay fees for training or continuing education. They also do not have to submit to fingerprinting or criminal background checks.
With organizational fees of $1800 and per navigator costs of $1000 a head, the first hope in Texas is to price navigators out of business. The second hope is to stall them past the deadline. One source argued that changing the budget for navigators would take weeks for them to get the money to pay these fees, which for big programs add up to tens of thousands of dollars, and then going through the actually training and waiting for the criminal checks could add more weeks or even months. In Arkansas, the backlog of criminal checks delayed certification there for 10 weeks for many navigators. The tests and training is not ready. God only knows what so-called “educational requirements” are now involved for navigators or where this mess will end?
The first question on the lips of many navigators involved in the critical enrollment process in Texas and elsewhere was whether the Justice Department would move to enjoin these obviously discriminatory barriers. The second question was whether it was time for navigators to just do their jobs, since it was “life or death” for many people to acquire the insurance, and let the chips fall where they may.