John Doak, the Oklahoma insurance commissioner, today gave members of a Senate panel advice that would please many health insurance agents and brokers: He called for the Senate Committee on Health, Education, Labor and Pensions to investigate the Affordable Care Act Navigator program.
"I would ask for the full Senate committee to do an audit of the Navigator program," Doak told Sen. Tammy Baldwin, R-Wis., a Senate HELP Committee member. "Are they doing the job they're supposed to be doing? Where's the checks and balance there?"
Doak was one of five state insurance commissioners who appeared as witnesses at a Senate HELP hearing in Washington on stabilizing the individual major medical insurance market. The hearing is one of four the committee has scheduled on the topic for this week and the next. The other witnesses at today's hearing were Mike Kreidler of Washington state; Julie Mix McPeak of Tennessee; Lori Wing-Heier of Alaska; and Teresa Miller, who recently left her post as Pennsylvania's insurance commissioner to take over as head of the state's Health and Human Services Department.
The ACA drafters hoped the Navigator program would create independent, nonprofit ombudsmen who would help consumers use the new ACA public health insurance exchange system. The idea was that the ombudsmen would show consumers the difference between a premium and a deductible, and how to use exchange websites, without trying to sell the consumers insurance.
Agents and brokers have complained for years that the Navigator ombudsmen have competed with them for business, and given consumers advice about complicated, sensitive matters without having the proper training or liability insurance.
As of Tuesday, none of the 20 witnesses scheduled to appear at the Senate HELP individual health hearings was appearing as an agent or broker.
Doak, however, has worked in the past as an insurance broker for Aon. One of the other commissioner witnesses, Wing-Heier, has worked as an independent broker and as a corporate risk manager.
Doak brought up the topic of agents and brokers at the hearing. Oklahoma has agents and brokers in each of its 77 counties, he said.
"They're trained insurance professionals that should be the ones helping folk," Doak said.
The Senate HELP Committee streamed the hearing live on the web. A recording of the video, and written versions of the witnesses' testimony, are available here.
Here's a look at seven other idea that came up at the hearing.
1. Make using an existing ACA rule waiver program earlier.
The ACA itself includes a provision, Section 1332, that lets states apply for waivers from some ACA rules in an effort to increase access to coverage, improve the quality or reduce the cost.
The Centers for Medicare and Medicaid Services, the U.S. Department of Health and Human Services arm in charge of the Section 1332 waiver program, has been helpful, Wing-Heier said.
But one problem is that, even though CMS is helpful, it has not created a form that a state can use to apply for a waiver and know whether its waiver proposal meets CMS guidelines, Wing-Heier said.
Officials at CMS then take six months to make a decision on the waiver program application, she said.
She said one thing officials could do to stabilize the individual major medical market is to create a clear process a state can use to apply for an individual market stabilization-related waiver.
2. Keep existing ACA subsidy programs in place until and unless new market rules replace the current ACA rules.
Doak, a Republican, is strongly opposed to the ACA, but he said the individual major medical market, as it is now structured, needs the ACA reinsurance program, which helps shield insurers against some of the cost of covering individual policyholders with catastrophic claims, and the ACA cost-sharing reduction subsidy program, which helps low-income exchange plan users pay their co-payments, coinsurance amounts and deductibles.
The other commissioners at the hearing, including both ACA opponents and ACA supporters, said they also agree on the need to keep the current stabilization programs in place at least until 2019.
