With enrollment for subsidized insurance set to begin in several weeks, Triangle organizations are responding to a voluminous data request from congressional Republicans who want to know how the groups will spend federal grant money to train health care assistants called “navigators.”
Republican members of the House Energy and Commerce Committee, including Rep. Renee Ellmers of Harnett County, last month wrote dozens of groups around the country that received grants to train navigators who will enroll the public under the Affordable Care Act.
The congressional letters advise navigator grant recipients they have until Friday to respond in writing to the data request and to schedule briefings with congressional staff. If the organization’s responses raise further questions and concerns, Republicans could hold public hearings, Ellmers said.
One of the letter recipients, Randolph Hospital in Asheboro, is in Ellmers’ congressional district. Ellmers said hospital officials have assured her staff that they will train navigators on medical privacy laws and other patient safeguards.
“This is obviously very sensitive information they will be privy to,” Ellmers said in a phone interview. “To me, it’s more of an effort at making sure that those who will be navigators will be well-prepared for this.”
Navigators – the term for insurance advisers who will guide the public through new coverage options – will be at the forefront of promoting subsidized health insurance in the coming weeks. Navigators will be especially important in North Carolina and other states that have not set up their own health insurance exchanges and are leaving public outreach work to the federal government, contractors and volunteers.
Critics have denounced the GOP data sweep as political intimidation and part of a campaign to sabotage public enrollment for subsidized insurance, set to begin Oct. 1. The data request comes at a time when organizations that received a total of $67 million in navigator grants are scrambling to train workers and volunteers so they can begin assisting the public next month.
“The implied threat is that if they don’t fulfill this request, we’ll send you a subpoena,” said Timothy Jost, a health law professor at Washington and Lee University. “I don’t think they’re after information. I think they’re after gumming up the works.”
North Carolina has more than 1.3 million uninsured and about 435,000 who pay out-of-pocket for individual insurance. More than 1 million of them are expected to qualify for subsidized insurance under the Patient Protection and Affordable Care Act.
Four North Carolina groups received $3 million in grants last month and could train and deploy more than 50 navigators. The money will also pay for office space, phone, Internet and other expenses.
N.C. Community Care Networks in Raleigh received $2 million; Alcohol Drug Council in Durham received nearly $325,000; Randolph Hospital in Asheboro, $352,230; and Mountain Projects in Sylva, $359,750.
Coordinating to respond
The two Triangle groups said they are coordinating with the federal Centers for Medicaid & Medicare Services on how to respond to the committee Republicans’ letter. Both said that much of the information being requested is spelled out in their grant applications as well as in the rules of conduct for grant recipients.
“We’re excited that there is a high degree of interest in the project and expect the committee’s request will channel more consumers toward our navigators,” said Nyi Myint, the navigator program director at the Alcohol Drug Council. “This is a pretty routine request when you work with government grants.”
Katherine Restrepo, health and human services policy analyst at the conservative John Locke Foundation in Raleigh, said extra scrutiny should be expected when receiving public funds.
“If anything, it’s just a way for these organizations to prepare how they are going to use the money,” Restrepo said.
Ellmers, who has voted more than 40 times to repeal the Affordable Care Act, said the health law is a “complete and total disaster” and has been plagued by delays and cost overruns. She said she would be pleased if the congressional navigator inquiry stymies the nonprofits planning navigator work.
“If this ended up resulting in a delay, I wouldn’t be unhappy about it,” Ellmers said.
Jost predicted the congressional inquiry could not only delay but also dissuade small nonprofits from promoting the controversial health care law.
“They’re asking for every email, every letter, every document you’ve ever touched,” Jost said. “I wouldn’t be surprised if some of these groups say, ‘Forget this, I didn’t sign up for this kind of harassment.’ ”
The creation of navigators under the Affordable Care Act has raised concerns from some public officials that the new insurance advisers will lack the training and experience of licensed insurance brokers. More than a dozen states have enacted professional standards for navigators that exceed federal requirements with regard to protecting individuals’ private information and other aspects of the navigators’ work. North Carolina is not among them.
What the letters demand
The congressional letter of Aug. 29 was sent to about 50 navigator grant recipients, including universities, hospitals, health centers, food banks, agencies for the elderly, mental health groups, United Ways, Urban Leagues, a Legal Aid Society and a board of county commissioners in Florida. The letter asks for descriptions of what work will be performed, as well as job descriptions and pay scales for those who will do the work. It asks for details on worker and volunteer training, monitoring and supervision.
The letter also asks how grant recipients will use personal information obtained in the course of their work, and what safeguards are in place to protect the public. The letter asks whether members of the public who are advised by navigators will be contacted for the purposes for fundraising, voter registration, campaign activities or for any other reason.
The letter requests documentation of communications related to the navigator grants. These include applications and follow-ups with federal agencies as well as contacts with Enroll America, the nonprofit created to promote the federal law.
Navigator grant recipients are required to submit some of the requested information as a condition of their grant. The terms include three pages detailing how recipients are to file quarterly and annual reports to the federal Center for Consumer Information & Insurance Oversight. All security breaches must be reported immediately to the U.S. Department of Health and Human Services.
Navigators will be required to provide voter registration opportunities to people they advise about insurance options, according Project Vote, a national advocacy group. The requirement is part of the National Voter Registration Act of 1993 and applies to all those who assist individuals with public assistance programs.
‘Abuse’ of authority
In a Democratic response to the congressional inquiry, California Rep. Henry Waxman denounced the Republican inquiry as an abuse of power and political bullying.
“It is an abuse of your oversight authority to launch groundless investigations into civic organizations that are trying to make health reform a success,” Waxman wrote.
“Indeed, it appears that these requests may have been sent solely to divert the resources of small, local community groups, just as they are needed to help with the hew health care law.”