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Will state health exchanges be effective?

When state health insurance exchanges open for enrollment on Oct. 1, state navigators will be there to aid participants in finding and receiving economical healthcare for 2014. Under the Affordable Care Act (ACA), all residents must have access to affordable healthcare or be subject to a penalty. Exchange navigators are trained professionals who are there to help people learn how to apply for economical insurance and guide them through the process, but a recent report suggests navigators may limit people’s access to assistance. In fact, numerous states have instituted laws to ensure the health insurance guides keep information secure, yet the laws may be part of the problem.

Questions arise over navigator legislation

According to Becker’s Hospital Review, a recent report from The Center for Public Integrity found health policy experts do not think navigators will provide as many benefits as previously suggested.

MedCity News, a healthcare resource, reported each state must have at least one community-based group as a professional guide under the ACA, but many groups are able to apply to serve as navigators. Since these navigators are also set to market the exchanges, concerns about the programs have arisen regarding how navigators will spread the word about the insurance plans. Many insurers have suggested the groups may only speak to participants about a few plans rather than them all, creating an unfair advantage for those plans. Previous estimates found only 45 percent of uninsured Americans had heard of the exchanges, bringing into question how well the navigator programs were working before the exchanges even opened.

Because many insurers claimed navigator programs required additional oversight, numerous states introduced navigator legislation to ensure no insurance group is at a disadvantage when the exchange opens. Numerous states, such as Missouri, have also created a state certification program for navigators to ensure each guide is properly trained and can officially offer advice about the insurance plans. According to Florida Today, the training program developed by the federal government is between 20 and 30 hours long. Some states even require navigators to undergo a background check.

Possible issues when the health exchanges open 
According to the report, while these laws may increase the amount of navigator regulations, some experts are arguing it will limit the power of the professional guides and negate their benefits for consumers. This may result in fewer people receiving aid when they enroll in the exchanges, making the marketplaces and the navigator programs less effective. The report suggested the laws may place too many guidelines on navigators, which may result in those who enter the exchanges receiving sub-par service as only a limited number of organizations will be able to become healthcare guides.

Yet navigators are also under scrutiny regarding the confidentiality of private health information. As exchange applicants may share personal information with navigators, many states have expressed concern over privacy standards and the need for strict security. According to Florida Today, the state has also raised the question of data security once the exchanges open. Although the information is not stored in a database, the news source reported there is a risk of navigators distributing consumers’ personal information.

Florida Gov. Rick Scott said there are too many unanswered questions about the exchanges that may impede their effectiveness, most notably the issue of data security, according to Florida Today.

“What we do not know is how this information will be shared among federal agencies or if the federal government will also distribute it to outside groups,” Scott said in a statement.

While there are numerous concerns arising about whether the exchanges will be effective, they are still set to open for enrollment on Oct. 1.

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Erin Woulfe
Erin Woulfe
Erin Woulfe likes to write about things that matter. Keeping her finger on the pulse of what’s happening in the public sector world, she blogs about the latest legislative news and employee benefit trends that affect our school, city and county clients. She’s been with NIS since 2002. “I love connecting to our clients and providing them with the tools they need in order to administrate their plan,” says Erin. “Whether that be materials to educate their employees on certain benefits, how to effectively communicate change within an organization or just providing tips and how-to’s to help them make their job easier.”

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