Critics pan new health adviser plan

Lack of funding seen shutting Ohioans out


COLUMBUS — Uninsured Ohioans must find coverage by the beginning of the year under the federal health-care law, but critics argue a new state law could make it tougher for consumers to find someone to advise them in navigating their options when shopping for policies.

States are required to have online marketplaces, or exchanges, where individuals and small businesses that must acquire or provide health insurance can compare and buy policies.

Ohio will let the federal government develop and run its exchange.

But the state will regulate the insurers who operate within it as well as the “navigators” who will be charged with providing consumers with information that can help them find the coverage best suited for them and their wallets.

Despite calls that he veto it, Gov. John Kasich recently signed House Bill 3, sponsored by Rep. Barbara Sears (R., Monclova Township), into law.

It imposes certification, background checks, continuing education, and other requirements on a newly created position of navigator.

Critics argue that a provision that states that only federal funds will be used to pay for the navigators could mean there will be too few navigators for the estimated 1.4 million uninsured Ohioans.

Navigators would provide information to people and businesses who face a Jan. 1 deadline to find coverage under President Obama’s signature Affordable Care Act.

“Those kinds of activities have been happening in hospitals for years — What about COBRA? Medicare? Medicaid? V.A. benefits?” said Ms. Sears, the No. 3 Republican in the House.

“They’ve been doing this function in a nonspecific way. We’re now titling it.”

But unlike insurance brokers, they cannot recommend or sell a specific policy.

“All we’re going to do is regulate and protect Ohioans from harm, which is very consistent,” Ms. Sears said. “We’re going to certify the navigators, who will be funded by the federal government.”

Opponents are concerned about a last-minute amendment limiting the navigator function to only what the federal government will fund.

“It’s not only community-based organizations that are up in arms, but also hospitals and health centers,” said Cathy Levine, co-chairman of Ohio Consumers for Health Coverage.

“We’re estimating that, with the amount of federal funding, we’re talking about 60 or 70 navigators for the whole state,” she said.

According to the U.S. Department of Health and Human Services, the state would receive $2.2 million in federal grants in the first year under the federal health-care law.

“Many people who will be going to the new marketplace or exchange will be comfortable using insurance brokers, but many people, because they’ve been shut out of the insurance market, don’t know how to find an insurance broker they’re comfortable with,” Ms. Levine said. “Insurance brokers are not one-size-fits-all.”

She said she believes the federal government will ultimately determine that Ohio’s navigator law is inconsistent with the Affordable Care Act

“[Ms. Sears'] navigator legislation is aimed at, I believe, making sure that people get reliable information from well-trained people and drawing a line between activities of insurance brokers and the activities of others doing outreach and enrollment," Ms. Levine said. "We disagree about where you draw the line."

The critics of House Bill 3 are many of the same people who have otherwise praised Ms. Sears for standing with Mr. Kasich in bucking their party to support the expansion of Medicaid.

The expansion of eligibility to those earning 38 percent above the federal poverty level would be expected to draw an estimated $13 billion in federal funds over seven years.

House Republicans removed the expansion from the $62 billion, two-year budget now in the General Assembly, but they’ve left the door ajar for further discussions.

Ms. Sears, despite opposing Obamacare, said she remains optimistic some form of expansion will happen. “I still have great hopes that we can come up with something that enough legislators can wrap their arms around.”

Contact Jim Provance, or 614-221-0496.