Texas’ top insurance regulator has found herself in the midst of a battle over rules that govern those who will provide information to consumers about the health insurance exchanges that are a part 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 in the 2013 legislative session that addresses the regulation of “navigators” for the state’s health insurance exchange. The letters are in regard to the Texas Department of Insurance’s approach to developing rules for navigators in the exchange.
Perry has made his disdain for the Affordable Care Act and the health 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 would not a willing participant in the health exchange.
“It is clear there is no such thing as a state exchange. Instead, this is a federally mandated exchange with rules dictated by Washington,” Perry stated.
Enrollment in 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 are more stringent than those required by the federal government.
Watson countered in his own letter to the commissioner, dated Sept. 19, that Perry’s request is out of line and that many of the items the governor outlined in his letter are not 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 does not 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 perform their federally defined duties.”
The navigator rules called for in SB 1795 do not apply licensed insurance agents. The bill specifically states that the navigator rules provided for in the bill do “not apply to a licensed life, accident, and health insurance agent, a licensed life and health insurance counselor, or a licensed life and health insurance company,” according to an analysis of the bill provided by the Legislature.
In his letter, Perry instructed Rathgeber to ensure, 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 course of a minimum of 40 hours coursework in addition to any federal coursework,” and pass a “rigorous” state developed exam.
Watson pointed out, however that SB 1795 does not authorize TDI to place 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 training and pass an exam for certification, Watson said.
The bill does allow the department, however, to authorize “additional training for navigators as 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 on a regular basis the names of those persons they sign up for the federal health care exchange, and locations at which sign-ups take place.”
Watson said SB 1795 does not provide TDI with the authority to create a database that identifies people who were assisted by navigators and where such assistance took place.
Watson also said fees that navigators would pay to the state and surety bond requirements for navigators, both of which were suggested by Perry, were not authorized by the bill.
Stakeholder Input, Meeting
For its part, TDI has issued a call 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 informal stakeholder meeting to discuss SB 1795 and rule development to take place on Sept. 30 in Austin.
TDI said it is especially interested in stakeholder input relating to 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 highest rate in the country of people without health insurance and ranks among 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 in the nation in poverty, with 17.2 percent of the population living in poverty, the AP reported. That’s less than $18,500 a year for a family of three.
An Associated Press report contributed to this story.