I suppose I should no longer be surprised at the level of official obstruction the state of Texas – led by Gov. Rick Perry – will devote to preventing several million Texans from acquiring health insurance. In the state with the highest percentage of residents without such coverage, Perry has resolutely refused to expand Medicaid; setting aside the humanitarian and public health consequences, emergency hospital care has driven up hospital and health insurance prices – and property taxes – across the state. His implacable and blatantly political opposition to the federal Affordable Care Act has been among the most obstinate, even among Republican governors, and continues despite the fact that nationwide, millions of people have now acquired health insurance under the law, in addition to those of us who have benefited from broader coverage the law mandates.
The latest battleground is "health care navigators" – people working, mostly for nonprofit agencies, to help those without insurance to work through the federal process, the application standards, and the website Healthcare.gov, to finally acquire insurance. Each state is allowed under the federal law to establish its own standards (beyond those already built into the law) for the training and supervision of navigators, and enabling legislation was carried by Austin state Sen. Kirk Watson last year. At Perry's explicit insistence, the Texas Dept. of Insurance is doing its best to draft unnecessary and onerous regulations that will make it as difficult and expensive as possible for the navigators to do their jobs.
This week TDI held the second of two hearings on the proposed regs Downtown at the Hobby building, and heard a line of health care advocates testify that the agency's proposed regs – in particular, defining as a "navigator" virtually anyone who discusses the law with potential clients, and requiring 40 hours of training over and above the 20 to 30 hours already in practice – will obstruct enrollment and substantially raise costs for navigators and their organizations. Insurance Commissioner Julia Rathgeber was unfailingly polite, but didn't appear appreciably receptive to the witnesses' testimony.
Watson was among those testifying against overburdensome regulations, as was Houston state Sen. Sylvia Garcia and Austin Rep. Donna Howard. Garcia noted that the "navigator" definition is so broad – a complaint offered by many of the health professionals who spoke – that it could include any member of her staff speaking to a constituent. Most who testified described the exorbitant costs that would be imposed on the nonprofit organizations that are providing most of the navigators. In a particularly nasty detail, although navigators are forbidden to charge for their services, the regs would require registration fees for the privilege of having the state micro-manage them.
Watson has been somewhat caught in the middle in this process – it's his bill, designed to compensate for the state's failure to create its own insurance exchange, which is now being used as justification for undermining the federal law. In his testimony and afterward to reporters, he complained specifically that TDI and Rathgeber have offered no justification at all for requiring 40 additional hours of training, and summarized, "It's wrong to impose heavy-handed, politically motivated rules that primarily serve to make life harder for hard-working Texans who are simply trying to help their friends and neighbors find affordable health insurance."
The sole witness in favor of the new regs was Austin GOP Rep. Paul Workman, who cited the repeatedly discredited conservative prank filmmaker James O'Keefe and Fox News as good sources on the dangers of Obamacare and navigators. Although Rathgeber was noncommittal in her responses, judging by the run-up to the hearing and the rhetoric reverberating from the governor's office, it's fairly certain that Workman's perspective will carry more weight than those of the other side.
As if to confirm that impression, the Dallas Morning News' Bob Garrett reported that following the hearing Rathgeber commented that while she doesn't want to "burden" other health care workers, she would "require registration, background checks and 40 hours of training for people who help consumers 'use the [Healthcare.gov] website.'" In his comments, Watson has been very carefully diplomatic about Rathgeber's role, apparently in the hope that she will listen to reason before formalizing the rules – which could be imposed March 1, with the heaviest month of insurance enrollment period just ahead. Based on her comments – not to mention the prevailing Texas political winds – there is little reason for optimism.
A stronger indication was provided by Rep. Lon Burnam, D-Fort Worth, who said he's acquired TDI documents that reflect a political agenda to sabotage Obamacare – specifically by requiring the otherwise unjustified 40 hours of training – but he is prevented from releasing them by TDI, which says it won't allow publication without a subpoena. "The Texas Department of Insurance has internal documents showing that it was political influence and not any rational process that decided Navigators should be required to undergo 40 hours of training on top of the 20-30 hours of federal training," Burnam said in a press release. "This training will cost up to $800 per Navigator and is tougher than any other state in the nation. I have seen these documents and I call upon TDI to stop keeping them confidential and release them to the public."
My guess is we'll eventually see those documents, but it will take long enough to have little or no effect on TDI's regulations. It hardly takes a conspiracy theorist to confirm what the Republicans have made no secret: They intend to do whatever is necessary to sabotage the Affordable Care Act, and if millions of Texans continue to go without health insurance as a consequence ... that's just too bad.
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