In Rebuttal / Regulate navigators in Pennsylvania

The state should know who is providing us with insurance advice

Share with others:

Print Email Read Later

A Post-Gazette editorial (“Off Course: The Navigator Bill Isn’t About Helping Consumers,” April 7) said sponsors of legislation in Harrisburg to better regulate Affordable Care Act “navigators” are insincere and seek only to undermine the federal health care law by preventing people from getting insurance through exchange markets. This is absolutely incorrect.

Senate Bill 1268 and House Bill 1522 would do nothing more than bring consumer protections governing insurance to the new class of unlicensed persons and groups created by the ACA to “facilitate enrollment” in health insurance exchanges.

Four official Pennsylvania navigator organizations and 316 certified application counselor groups have been given navigator status by the U.S. Department of Health and Human Services. These range from community groups to the Greater Pittsburgh Food Bank to Citizen Power, which until recently was interested only in promoting alternative energy. Certified counselors also include at least 63 free walk-in community health centers. The numbers of unlicensed people working in these organizations to “facilitate enrollment” in the exchanges are unknown.

Keep in mind that the federal government decreed that licensed health insurance agents and brokers cannot be navigators or certified application counselors.

Navigators help determine if people qualify for tax subsidies through the exchanges. They see personal information such as Social Security numbers, tax returns, W-2s and pay stubs. Yet HHS says they are not bound by the federal privacy law that covers other insurance transactions because they are not licensed insurance agents.

Needless to say, consumers would not want convicted felons looking at their Social Security numbers. Yet, while most navigators and certified counselors would never steal someone’s identity, they go through no required criminal background checks.

HHS has started requiring consumers to sign a form allowing navigators to see their personal information and threatens rigorous penalties if someone’s privacy is violated. But these safeguards do not compare with background checks like those required for licensed insurance agents and brokers.

The Federal Violent Crimes Act requires that anyone “in the business of insurance” must not have a criminal record. HHS chose to ignore this prohibition, so Pennsylvania legislators should step in to protect their citizens.

Navigators are in the “business of insurance.” Only licensed agents may sell, solicit or negotiate contracts of insurance. “Negotiate” is legally defined as “to confer directly with or to offer advice directly to a purchaser or prospective purchaser of a particular contract of insurance concerning the substantive benefits, terms or conditions of the contract, providing that the person engaged in that act either sells insurance or obtains insurance from insurers for purchase.”

Navigators do not sell insurance but are a conduit in obtaining insurance. Navigators also “solicit” — “to attempt to sell insurance or ask or urge a person to apply for a particular kind of insurance from a particular insurance entity.”

Again, navigators do not sell insurance, but consumers ask them, “Which qualified health plan is best for me?” They are in the insurance business even though they are not licensed.

Who does this navigating for the various approved organizations? How many unlicensed navigators work for or volunteer for certified application counselors? HHS doesn’t know.

The Pennsylvania Insurance Department keeps meticulous track of the insurance agents and brokers they license. Agents and brokers go through criminal background checks.

Having navigators register with the Insurance Department is a reasonable way to help Pennsylvania regulators make sure that navigators and certified application counselors are not steering consumers toward particular health plans or doing what only licensed agents and brokers can legally do.

The Post-Gazette worries that navigators could be hindered in their efforts to help people get health care coverage.

Nothing could be further from the truth. What’s wrong with a criminal background check? How would that prevent someone from reaching out to an underserved insurance population and explain the exchanges? How would registration impose a barrier to outreach? Insurance agents and brokers have to comply with a great deal more oversight and yet they provide access to insurance to millions of Pennsylvanians.

Consumers should have confidence that navigators and certified application counselors are reputable and comply with Pennsylvania law. S.B. 1268 and H.B. 1522 would provide such commonsense protections.

Vince Phillips runs the lobbying firm Phillips Associates in Mechanicsburg and is media relations chair of the PA Association of Health Underwriters.

Join the conversation:

Commenting policy | How to report abuse
To report inappropriate comments, abuse and/or repeat offenders, please send an email to and include a link to the article and a copy of the comment. Your report will be reviewed in a timely manner. Thank you.
Commenting policy | How to report abuse


Create a free PG account.
Already have an account?