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Big ‘I’ Responds to ACA-Related Regulatory Proposal

Earlier this month, the Department of Health and Human Services released a wide-ranging proposal that would revise many regulations related to the administration of the Affordable Care Act.
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Earlier this month, the Department of Health and Human Services (HHS) released a wide-ranging proposal that would revise many regulations related to the administration of the Affordable Care Act (ACA).

In response to the proposed regulation, the Big “I” submitted a lengthy comment letter to the HHS outlining concerns regarding potential changes to the oversight of agents and brokers that operate within a federally facilitated exchange (FFE), among other issues.

The HHS proposal would grant the agency broad new authority to immediately suspend an agent or broker’s agreement and registration with an FFE in certain instances of suspected fraud or other abusive conduct. A health insurance agent or broker who loses the ability to sell exchange-based plans to customers could suffer profound impacts. Having access to the exchanges and the ability to enroll clients in qualified health plans is essential to the business of many health insurance professionals.

The Big “I” agrees that bad actors who engage in criminal or fraudulent conduct should be removed from the insurance industry and punished, but this must occur with the appropriate measure of due process protections the U.S. Constitution requires and with deference to state insurance regulators.

The Big “I” also offered comments on a proposed expansion of the duties of navigators. The ACA specifically directs navigators to distribute fair and impartial information and facilitate enrollment in exchange-offered plans. The law does not empower the HHS to expand the scope of navigator responsibilities.

Federal policymakers never contemplated that navigators would provide assistance with eligibility appeals, advise consumers about tax issues or counsel individuals about the detailed nuances of health coverage. Navigators lack the expertise and qualifications to take on these responsibilities, and it is inappropriate to empower these insufficiently regulated actors to perform an ever-growing series of activities on behalf of exchanges.

Navigators should not be held to a less onerous standard of conduct than other market actors. The duties of navigators must remain within the scope intended by Congress.

Jennifer Webb is Big “I” federal government affairs counsel.