Washington • The individuals and groups tasked with helping people enroll for health insurance coverage under the Affordable Care Act (ACA) face a stiff head wind of restrictive laws, regulations and outright obstruction in some Republican-led states.
In Florida, health officials won't allow these so-called "navigators" onto county health department properties to help uninsured people sign up for coverage in new state insurance marketplaces.
In Georgia, state Insurance Commissioner Ralph Hudgens recently told a gathering of Republican supporters the state would do "everything in our power to be an obstructionist" of the ACA.
Navigators also have drawn the ire of congressional Republicans, who have asked 51 navigator groups nationwide for detailed information about their activities, funding and staffing just as the groups are training and preparing for the launch Oct. 1 of the marketplace open-enrollment period.
In a recent hearing on the health law, Rep. Frank Pallone, D-N.J., called the Republican requests "despicable."
"This is an egregious abuse of the committee process and an attempt to intimidate community organizations and overwhelm them with information requests at a crucial period so that they don't implement the program," Pallone said.
Rep. Michael Burgess, R-Texas, was unapologetic.
"Why wouldn't we have questions about the vast sums of money that have been pushed out the door relatively hastily to these navigator groups?" Burgess asked. "Why wouldn't we have questions as to â¦ their ability to provide what they've been required to provide?"
The Obama administration responded to the Republicans on behalf of navigator groups, but the political scrutiny and heightened legislative oversight have taken a toll. Several navigator organizations have returned their ACA funding and dropped out of the program because of complications involving state laws.
Trained to be impartial consumer-outreach workers who are prohibited from recommending one health plan over another, navigators are crucial to meeting the Obama administration's goal of enrolling 7 million Americans in health coverage through the marketplaces next year.
But that undertaking has been complicated by the navigators' late start, their limited funding and widespread public confusion about Obamacare. Tough state laws regulating the navigators have added to the challenge.
In Missouri, Georgia and Ohio, navigators can't give advice about the benefits, terms and conditions of marketplace health plans. Consumer advocates say those laws conflict with federal guidelines that call for navigators to help people compare and understand different health plans.
For that reason, the Center for Health Law Studies at Saint Louis University has asked Missouri not to enforce its provision.
Navigators in Louisiana, Missouri and New Mexico can't assist people whose coverage was purchased from an insurance agent or broker, which greatly limits the universe of people they can help.
State law requires Nebraska navigators to inform people who already have insurance that they can seek similar assistance from insurance agents and brokers.
In Georgia, navigators can't contact anyone who has insurance. A similar law is pending in Pennsylvania.
"They're basically telling them who they can and can't talk to," said Mark Dorley, a health policy researcher at George Washington University who studies navigator laws.
At least 16 states have passed laws requiring licensing or certification of navigators beyond federal requirements, and five have similar laws pending, Dorley said.
Republican officials say state certification laws protect people from navigators who could be poorly trained, have criminal backgrounds and possibly misuse or reveal consumers' personal health information.