After a convicted felon produced an edited video that appeared to show National Urban League “navigators” agreeing to allow the felon might file inaccurate information to get covered for health insurance under the Affordable Care Act, Republicans in Texas called for greater regulation of the navigators.
Such is the topsy-turvy world of GOP gotcha politics in Texas.
After committees of the U.S. House of Representatives held press conferences* damning the Affordable Care Act, the Texas Department of Insurance (TDI) is holding hearings across Texas to develop regulations to restrict actions of those people who act as navigators to enroll people into federal health insurance programs or private insurance through ACA.
In short, the Texas government is working to screw up federal law and deprive Texans of health care insurance (yes, that’s probably a felony, but who could prosecute it under the current political climate?).
Burnt Orange Report described the situation:
On January 6th the Texas Department of Insurance will hold its last public hearing regarding the state’s regulation of health care navigators. The navigators are responsible for helping individuals get enrolled through the new Healthcare.gov exchange, but in Texas Governor Rick Perry has been working to add unnecessary red tape in order to impede the success of the law. Reputable non-profit organizations in Texas like United Way received $11 million in federal grant money to help enroll individuals in local communities across the state.
In September just days before the health insurance exchange website went live Perry ordered TDI to craft new rules that included additional training and background checks for individuals who serve as navigators. Apparently even Senator Kirk Watson the author of the bill (that authorized navigators in Texas) was unaware that TDI had sent a letter to federal Health and Human Services Secretary Kathleen Sebelius, or the plan to implement rules that, “appear to both conflict with federal law and be inconsistent with SB 1795.”
In other words, TDI’s actions, on orders from Gov. Rick Perry, may violate Texas law as well.
State Sen. Kirk Watson provided this testimony at the TDI hearings today:
Texas State Sen. Kirk Watson, D-Fort Worth, wrote the law that enables Affordable Care Act Navigators to work in Texas, and testified that further state regulation would be expensive, confounding bureaucracy. Star-Telegram photo by Ron Ennis.
Posted on January 6, 2014 at 10:12 am.
State Senator Kirk Watson issued the following statement Monday regarding the Texas Department of Insurance’s hearing on proposed rules for healthcare navigators:
Texans have made themselves heard, and it’s clear what they want: fair rules that truly protect consumers without making it harder for them to find health insurance.
The vast majority of healthcare navigators are honest folks who are working hard, and in good faith, to connect their fellow Texans with health insurance. The Department of Insurance should create regulations that protect the state from bad actors without making it harder for navigators to do their jobs.
Texans support common-sense requirements such as criminal background checks for navigators. The bill I passed in the legislative session allowing for navigator regulations prohibits convicted felons from providing these services. Of course the state should enforce that provision and protect consumers. We shouldn’t have electioneering; my bill prevents that too. And we need to be sure we protect privacy.
But some other proposed rules appear designed only to make it harder for navigators to do their jobs.
The Department of Insurance has proposed requiring 40 hours of navigator training on top of the 20-30 hours that’s already mandated by law. That kind of training requires real time and costs real money. Where did the additional 40 hour requirement come from exactly? Who is it truly meant to help? How will Texans benefit if navigators are spending as much as 200 percent more time in class? So far, TDI has failed to provide any explanation although repeatedly requested to do. If the Commissioner waits until the final rules are out, she robs Texans of a transparent, accountable process and avoids a fair debate on this issue.
It’s also patently unfair to assess fees on navigators who, by law, aren’t allowed to charge Texans for their services. The fiscal note on my original bill said the Department of Insurance could implement these rules using existing resources. Why is it now proposing these costly, burdensome fees?
I thank Commissioner Rathgeber for scheduling this second public hearing in response to my request for it. And I urge her to listen to the Texans she’s heard from in this process.
It’s wrong to impose heavy-handed, politically motivated rules that primarily serve to make life harder for hard-working Texans who are simply trying to help their friends and neighbors find affordable health insurance. Common-sense regulations should strike a balance that actually protect Texans, both by protecting their privacy and by protecting their ability to find good, reliable, affordable health insurance.
Sen. Watson also contributed more detailed suggestions in writing:
Posted on January 6, 2014 at 12:16 pm.
Jan. 6th, 2014
Good morning, Commissioner Rathgeber and Assistant General Counsel, John Carter. Thank you for scheduling this second public hearing in response to my request for it. There remain a number of questions which TDI has yet to answer and the people deserve another opportunity to be heard on this important issue.
First, I want to be very clear about avoiding the political straw men in this this conversation.
Texans support common-sense requirements such as criminal background checks for navigators. The bill I authored in the legislative session allowing for navigator regulations prohibits convicted felons from providing these services. Of course the state should enforce that provision and protect consumers. We shouldn’t have electioneering; my bill prevents that too. And we need to be sure we protect privacy.
We are all in agreement that these requirements are paramount to protecting consumers – that’s why we put them in the bill.
But my bill authorizes TDI to create regulations that protect the state from bad actors without making it harder for navigators to do their jobs. Remember the purpose clause of SB 1795: the purpose of this chapter is to provide a state solution to ensure that Texans are able to find and apply for affordable health coverage under any federally run health benefit exchange, while helping consumers in this state.
Your goal is to help ensure that Texans are able to find and apply for affordable coverage under the federally run exchange. Remember, those in control of the capital have chosen not to have a Texas exchange, creating the need for SB 1795.
The vast majority of healthcare navigators, as you can see and have seen from the testimony you received on September 30, 2013 and most recently on December 20, are honest folks who are working hard, and in good faith, to connect their fellow Texans with health insurance.
TDI has yet to provide justification for why it has gone as far as it has with these rules.
On December 20, I and several other senators submitted a letter to you in which we requested explanations to very specific questions. The people of Texas deserve answers to these questions. They deserve to know why some of these proposed rules are so far-reaching.
What’s very troubling to me is that my office asked when we might expect answers to these questions. We were told that an email you sent on December 23 was a reply. But that so-called reply reads as an acknowledgement of receiving the letter – not as a response to it. In fact, you seem to suggest you will answer these questions in the final rule order. With all due respect, Commissioner, that’s inappropriate. As I stressed in my September 30 testimony to you, because this issue has been so politicized, people have reason—even an obligation to be skeptical. So process matters here.
Your process – your refusal to answer critical questions prior to the final rule order – leaves no opportunity to discuss fallacies or poor decisions before the proposed rules are final. More importantly, it robs Texans of a transparent, accountable process and avoids a fair debate on the issue.
So, what are the questions that haven’t been answered?
- TDI has yet to explain how it arrived at the arbitrary 40 hour training requirement, in addition to the 20-30 federally required training hours.
- Nor has TDI explained how it arrived at the 13-13-14 hours of training in the areas of Texas Medicaid, privacy and ethics, respectively.
- TDI has not explained why navigators will have to pay registration fees as well as significant costs associated with additional training in light of a) the fact that navigators cannot charge a fee for their service, and b) the fiscal note for SB 1795, based on information provided by TDI, assumes any cost associated with implementation of the bill would be absorbed with existing staff and resources.
- TDI has yet to explain how it arrived at the proposed options for proving financial responsibility, which include surety bonds.
- TDI has yet to provide a detailed timeline showing each step that a navigator organization and individual navigators must accomplish to come into compliance with the proposed rule. We also haven’t seen a timeframe for which each step can reasonably be completed — an essential question for honest, hard-working Texans who are working right now to connect folks with health insurance.
- TDI has not explained how extending the registration requirements to almost anyone providing enrollment assistance protects Texas consumers, or how restricting the use of the term navigator outside of the federally operated insurance exchange protects Texas consumers.
Under your proposed rules, navigators must comply with many of the rules’ requirements by March 1, 2014. Assuming this rule becomes effective in early February, navigators and navigator organizations will have only about a month to come into compliance.
Given that the open enrollment period for people seeking coverage in 2014 ends on March 31, I fear that many navigator entities will face significant problems in meeting your proposed rules without compromising their ability to help Texans secure health care. I respectfully request that you postpone the compliance deadline until after the open enrollment period ends.
And although the training requirements for TDI-certified courses are not applicable until May 1, 2014, I question how many companies will be able to set up the training and examination requirements precisely as you’ve laid out in the proposed rules. An open and transparent process shouldn’t result in a product that only a certain business or type of business can provide.
People have a right to question whether the timing, combined with the extremely expanded training requirement that doesn’t seem capable of justification other than because the Governor suggested it, might be to benefit a private provider of training. Perhaps one that already has a contract with the state. This would put public money that should be going to help people get health coverage in a private enterprise’s hands. Again, with no justification.
I respectfully request that you delay the implementation of the state training requirements until the universe of potential providers can be better assessed.
We still have time to do this right. You still have the opportunity to strike the appropriate balance between two equally important responsibilities: protecting consumers, and ensuring Texans have access to the health insurance that’s right for them.
I urge you to provide answers to the questions raised by members of the Senate on December 20 and to do so before you finalize this rule.
In Texas, the Republicans will consort with convicted felons to hoax up stories about people trained to help enroll Texans for health insurance, and make completely unsubstantiated claims that the helpful people are felons, and Texans should worry about it.
If the GOP will take the word of felons to impugn the Affordable Care Act, why are they worried about the honesty of others who are not known to be felons, on the other side?
If it doesn’t make your head hurt, you’re not paying attention.