Texas Governor, State Senator Square Off on Health Exchange Navigator Rules

Texas’ top insurance regulator has found herself in the midst of a battle over rules that govern folks that will provide information to consumers in regards to the health insurance exchanges that are portion of the U.S. healthcare reform initiative passed by Congress in 2010.

Texas Insurance Commissioner Julia Rathgeber recently received letters from both Gov. Rick Perry and Sen. Kirk Watson, author of the bill passed contained in the 2013 legislative session that addresses the regulation of “navigators” for the state’s medical insurance exchange. The letters are in regard to the Texas Department of Insurance’s option to developing rules for navigators inside the exchange.

Perry has made his disdain for the Affordable Care Act and the medical insurance exchanges well-known. In November 2012 he sent a letter to U.S. Department of Health and Human Services Secretary Kathleen Sebelius reminding her that the Texas wouldn't a willing participant within the health exchange.

“It is obvious there is no such thing as a state exchange. Instead, it is a federally mandated exchange with rules dictated by Washington,” Perry stated.

Enrollment inside the exchanges is set to begin Oct. 1, 2013; the exchanges are to become effective in January 2014.

In his Sept. 17 letter to Rathgeber, Perry instructed her to implement rules for navigators that may be more stringent than those required by the govt.

Watson countered in his own letter to the commissioner, dated Sept. 19, that Perry’s request is out of line and that some of the items the governor outlined in his letter aren't permissible under Watson’s bill, Senate Bill 1795.

In his letter, Perry said SB 1795 “specifically allows TDI to adopt more stringent regulations than federal rules.”

Watson said, however, that the bill does no such thing.

“SB 1795 wouldn't authorize the agency to place onerous restrictions on navigators,” Watson told Rathgeber. The bill, he said, instead “lets TDI step in if the agency finds that federal standards and training prove insufficient in equipping navigators to complete their federally defined duties.”

The navigator rules called for in SB 1795 don't apply licensed insurance agents. The bill specifically states that the navigator rules provided for inside the bill do “not apply to a certified life, accident, and medical insurance agent, a licensed life and medical insurance counselor, or a professional life and medical health insurance company,” according to an analysis of the bill provided by the Legislature.

In his letter, Perry instructed Rathgeber to make certain, among other things, that the navigator rules impose a minimum age limit of 18 years; require proof of U.S. citizenship or legal residency; require navigators to “complete a comprehensive, TDl-approved training process a minimum of 40 hours coursework in addition to any federal coursework,” and pass a “rigorous” state developed exam.

Watson mentioned, however that SB 1795 doesn't authorize TDI to put age restrictions on navigators, require citizenship status to be reported to TDI or require an “arbitrary” amount of additional training. Nor does it authorize any additional exam requirements beyond that required by federal rules, under which navigators must complete a minimum of 30 hours of educating and pass an exam for certification, Watson said.

The bill does allow the dep., however, to authorize “additional training for navigators since the commissioner considers necessary to ensure compliance with changes in state or federal law,” according to the legislative analysis of the bill.

Another requirement that Perry recommended and Watson found contentions is a provision that navigators should “report to TDI regularly the names of those persons they join the federal health care exchange, and locations at which sign-ups occur.”

Watson said SB 1795 doesn't provide TDI with the authority to create a database that identifies folks that were assisted by navigators and where such assistance occurred.

Watson also said fees that navigators would pay to the state and surety bond requirements for navigators, both of that have been suggested by Perry, weren't authorized by the bill.

Stakeholder Input, Meeting

For its part, TDI has issued a decision for input on the scope of rules to implement SB 1795. Comments should be submitted to the agency by 5 p.m. on Sept. 27.

TDI has scheduled an off-the-cuff stakeholder meeting to discuss SB 1795 and rule development to happen on Sept. 30 in Austin.

TDI said it's especially curious about stakeholder input in the case of the registration and training of navigators, background checks for navigators, consumer privacy protection safeguards and continuing education requirements for navigators.

Highest Uninsured Rate

Texas has the suitable rate throughout the country of people without medical health insurance and ranks many of the highest in poverty, the Associated Press reported.

According to U.S. Census data for 2012 that was released on Sept.17, nearly 25 percent of Texans did not have health insurance, compared to the national average of 15.4 percent. The rate was much higher among working-age adults, with 32 percent lacking health coverage.

Texas ranked eighth inside the nation in poverty, with 17.2 percent of the population living in poverty, the AP reported. That’s lower than $18,500 a year for a family of three.

An Associated Press report contributed to this story.