Navigating the ACA With the Newly Insurable

Lat week, Judge Ortrie Smith( in  St. Louis Effort For AIDS v. John Huff)  granted a preliminary injunction against  the enforcement of Missouri's Health Insurance Marketplace Innovation Act as inconsistent with the Affordable Care Act.  The HIMIA prohibits federally qualified health insurance navigators from discussing the full range of insurance products and programs available to Missourians unless these individuals also become qualified as licensed insurance brokers in the state.  Holding that "the state law obstructs the federal purpose," Judge Smith noted that HIMIA put ACA qualified navigators between a rock and a hard place, unable to comply fully with the HIMIA unless failing in compliance with the ACA and its implementing regulations.

Roughly nineteen states have taken advantage of the ACA's invitation to impose additional requirements on ACA qualified navigators but only a few have gone so far as to require insurance broker licensing, something  specifically called out as unnecessary under the statute and its implementing regulations. It is possible that the state's insurance brokers played some role in shaping of Missouri's statute. The revenge of the disintermediated can be a fearsome thing.

Tennessee has a similar statute that met a similar fate in October of last year (League of Women Voters vs. McPeak). But there are lots of other state specific navigator requirements short of full broker licensure requirements that appear to correlate with lowered insurance counseling and application assistance for the newly insured in some states.  

Sara Robsenbaum and others at GW have just released a study comparing health center outreach and enrollment activities. Categorizing states into full implementation and restrictive states and studying the range of assistance from information provision to application assistance to guidance on how to seek legal help for an appeal, it turns out that the health centers in restrictive states do less for the newly eligible as they navigate the health insurance application process and follow up less on what they do.

Why does this matter? We are, as a group, weak in health insurance literacy and the newer we are to insured status, the weaker our knowledge.  The exchanges offer products of considerable complexity. Those new to health insurance selection (and even some of those who are not) may be, for example, weak in understanding the implications of geographically limited provider networks, one of the hallmarks of exchange products. 

Those who are newly eligible from among historically uninsured populations are most likely to seek the clinical encounter at federally-qualified community health centers, precisely where the variance in degrees of health insurance application assistance and follow up  is so striking.

One of the great ironies of health law is in considering how health as well as health insurance is unevenly distributed in our society.  Now we need to add health insurance counseling to that list.


x-posted at Prawfsblawg:

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