This week the health insurance exchange (HIX) proposal cleared three more committee to continue its quick march to the House and Senate floors. No major new amendments were adopted. The support and opposition to the HIX proposal continues along party lines. However, an amendment was adopted to give the legislature greater oversight over the HIX board, their activities and finances. A legislative oversight committee of 10 legislator will perform this function.
With the role of agents somewhat defined now in the bill, discussion has turned to the responsibilities of "navigators" and "in-person assistors". Navigators are required under the Affordable Care Act to assist people in steering the exchange web site. Under the federal law, states cannot require them to be licensed as insurance producers or carry errors and omissions coverage. However, they can be prohibited from making recommendations on insurance products. Under our HIX proposal, it appears the major role of navigators will be to enroll persons in public programs. Projections suggest that nearly 60 % of the initial enrollees in the exchange will qualify for our extended Medicaid program. Navigators will most likely work for advocacy groups, social service agencies and county government units. Their compensation will be set by the exchange and be paid by the exchange. Suggested fees range from $25-$35 per enrollee. While navigators cannot act as insurance producers, agent could function as navigators.
The definition of in-person assistor is a bit murkier since it is not specified in the Affordable Care Act, but they will basically act as navigators. In-person assistors are individuals that will assist qualified persons of specific populations that might have trouble in using the exchange web site. Their funding will be coming from federal grants and will be available for two years. They would not act as insurance producers. The main difference between navigators and in-person assistors is the navigators cannot be funded from federal grants, but in-person assistors can.
There are still a couple of controversial provisions that have not been addressed to everyone's satisfaction. One relates to the governance and the seven member exchange board that will direct the exchange staff and their activities. Some feel that seven members is too few. Others object to the conflict of interest provision that prohibits board members from being from the insurance industry unless they have not been employed by the industry within the last year.
Another controversial provisions relates to the exchange board's ability to choose insurance companies that can participate in the exchange. This is referred to as the "active purchaser" model. The state's health plans would prefer to allow any plan certified by the department of Commerce to be qualified for the exchange, an "any willing plan" model. They fear that the HIX board may deny a carrier access to the exchange.