Republicans Are Trying to Sabotage Obamacare at State Level

If you can’t beat ’em, undermine ’em.

(Photo: Jonathan Ernst/Reuters)

Sep 26, 2013· 3 MIN READ
Paul Tullis is TakePart's Features Editor, and a Contributing Writer for The New York Times Magazine.

Before some Republicans in Washington were fighting to repeal, defund and now delay the healthcare law known as Obamacare, their allies in state capitols were similarly hard at work obstructing its implementation.

One target has been the Affordable Care Act’s “navigators.” These are people—many of them volunteers—affiliated with community groups, hospitals and other organizations that have won government grants to educate uninsured consumers on Obamacare’s benefit packages and help them enroll in appropriate plans.

But laws passed in several Republican-controlled states are making it harder for navigators to do their work, say healthcare advocates and academics. Health Care for America Now, a liberal group working to promote and defend Obamacare, Medicare and Medicaid, has researched recently passed laws in more than a dozen states. It found patterns suggesting that the regulations imposed on navigators (over and above those in the Affordable Care Act itself) are part of a concerted, politicized effort.

In seven states, the organization’s research found, navigators must complete extra training beyond the 20 hours required by Obamacare. Rick Perry, Republican Governor of Texas, has proposed 40 additional hours of training. (Texans who want to carry a concealed weapon must complete between four and 10 hours of training; school bus drivers must complete 20.)

Nine states require a state exam exceeding the ACA requirement, and nine have restricted navigators from advising enrollees or providing information about benefits under the ACA—which is pretty much the job description.

“Republicans are doing everything in their power to undermine the rollout of the Affordable Care Act,” said U.S. Rep. Jackie Speier (D-Calif.), Ranking Member of the House Subcommittee on Energy Policy, Healthcare and Entitlements.

Georgia Insurance Commissioner Ralph Hudgens, for example, announced his department would be doing “everything in our power to be obstructionist” against ACA. He said in a speech last month that to overcome ACA’s ban on states requiring navigators to be licensed insurance agents, he’ll make them pass the same test.

“Basically, you take the insurance agents’ test, you erase the name, you write ‘navigator test’ on there.”

The navigator program is modeled on a similar program for Medicare beneficiaries, known as SHIP. More than 12,000 SHIP counselors now work in 50 states. When Georgetown University’s Health Policy Institute asked senior citizens what was the most beneficial aspect of Medicare Part D, the prescription-drug program passed as an unfunded mandate by a GOP-controlled Congress and signed by President George W. Bush in 2003, SHIP counselors were cited most commonly.

The House Energy and Commerce committee, which has a Republican majority, wrote last month that “The sheer volume of personal information collected by navigators raises serious privacy concerns.” But a Medicare advocate with more than 20 years’ experience with Medicare counseling told National Journal that she’s not aware of any instances of fraud by SHIPs, who have access to the same information.

The attempt to obstruct Obamacare at the state level brings to mind two other recent efforts by Republicans: Voter-ID laws, and restrictions on abortion and abortion services. The former is an attempt to fix a problem—voter fraud—which experts say doesn’t exist. The latter tries to place restrictions on Americans’ access to legal health services.

In Florida, navigators are barred from conducting outreach at the site of any county health departments. In Ohio, navigators must be fingerprinted. And in Iowa, navigators must provide evidence of financial responsibility. North Carolina received a $74 million grant from Washington to help implement Obamacare, but sent the money back.

“How sinister are the actions of some of these state governments?” Rep. Speier asked.

Adam Linker, a health policy analyst at the North Carolina Justice Center’s Health Access Coalition, said he’s had to, “spend a good portion of our time correcting misinformation people have received about Obamacare before we can start educating people about their benefits.” This is particularly straining on resources given that they’ll only have 30 or 40 navigators, down from the 500 they expected to be able to pay through the rejected federal grant. The campaign “is having real impact” in North Carolina’s large rural areas, Linker said.

The states that have implemented restrictions on navigators are home to 17 million people, or about 40 percent of the nation’s uninsured. The crush of uninsured patients seeking basic healthcare at hospital emergency departments, which are required by law to treat the uninsured, has led to the closure of many hospitals straining under the cost. Lacking insurance has been demonstrated detrimental to consumers’ health, and disincentivizes people from seeking medical care early in an illness, or as prevention. Treatments late in disease progression cost much more than prevention or early treatment. That cost is borne largely by taxpayers, since the patient is uninsured, which has led many to doubt the avowed motivations of self-proclaimed “conservatives” obstructing the Affordable Care Act.

Despite efforts to diminish navigators’ impact, Speier expressed confidence that Obamacare would be popular once people understand the benefits they’re eligible for.

“The ACA is here to stay,” she said. “Once people see the premiums, we’ll see a take-up that’s quite high.”

The average cost of health insurance for Georgians, for example, will be less than originally projected, the federal Dept. of Health and Human Services announced Wednesday. That will be true even for demographic groups that often opt out of health insurance although they can afford it, because they’re confident they’ll remain healthy, Speier believes. “I was surprised at how important this is even to twenty-somethings I’ve spoken to.”