The Affordable Care Act has already been a grand occasion for Obama-bashing from Texas Republicans, but now state leaders are using the law for another time-honored pastime: greasing the private sector with public money. By requiring new health care “navigators” to get hours of costly training beyond what’s required by federal law, Texas would steer hundreds of thousands of dollars to training and testing firms.
Hundreds of navigators are helping Texans apply for health insurance in the federal exchange created under Obamacare, but Texas is one of 17 states setting extra job qualifications they’ll have to meet if they want to keep doing their jobs much longer. Gov. Rick Perry has said the extra measures will keep Texans’ medical information and Social Security numbers from falling into the wrong hands, but Democrats and groups supporting enrollment efforts say they’re obstacles meant to sink the program. State regulators are holding their second and final meeting on the proposed rules Monday, which include background checks, proof of citizenship, and 40 hours of additional training—on top of 20 to 30 hours already required by federal law.
That extra training requirement would be a burden on navigators and the groups they work for, but that’s not all—it could also be a sweet deal for private companies that will provide the training and administer the tests, at a cost the Texas Department of Insurance estimates at $200 to $800 per navigator. If other states—not to mention other programs at the insurance department—are any clue, the new job of testing navigators will fall to one of Texas’ closest friends in the private sector: Pearson.
Training could cost $400,000 to cover the 500 navigators the insurance department estimates are working in Texas. Stacey Pogue, a senior analyst at the Center for Public Policy Priorities, says the number of navigators is probably closer to 300, but complying with all the new requirements would be expensive. She estimates the total cost at $330 to $990 per navigator.
Those fees would likely be paid by the nonprofit groups that took $11 million in federal grants to run the navigator program in Texas, which would, in turn, have to either cut navigators’ hours or let some go. Texas’ new rules would, in essence, take federal money meant to help people get health insurance, and steer it to for-profit companies.
“From the perspective of Pearson and the state, it seems like it’s pretty much free money,” says Bee Moorhead, executive director of Texas Impact and Texas Interfaith Center for Public Policy. “Those navigators are getting grants, they’re federal funds, so it’s not like it’s state dollars. So how is it any skin off anybody’s nose if you just sort of siphon it away and give it to Pearson?”
The London-based publishing giant is best known in Texas for its dominance of the education market, from its textbook sales to its $500 million contract for Texas’ standardized tests. But through its offshoot Pearson VUE, it also handles licensing tests required by agencies like the Texas Department of Insurance. In other states that have already set training requirements for health care navigators, Pearson VUE is there to run the tests. Pearson handles Missouri’s navigator testing at a cost of $41 per test; it charges a $75 fee in Wisconsin, and $90 in Georgia.
Moorhead says it shouldn’t be a surprise if Pearson ends up handling Texas’ navigator tests too. But she says using private companies to train and test navigators is a waste of taxpayer money, when other state agencies already provide similar training. But Moorhead says the insurance department’s proposed rules, vague in some parts but full of detail about how navigators will be tested, read to her like a “vendor bill” written for a specific company.
“The problem is we shouldn’t have to be using a for-profit vendor at all,” Moorhead says, “and the one that would be getting the contract is the one the Legislature just got done beating up on.”
John Greeley, a spokesman for the Texas Department of Insurance, says the department hasn’t made any judgments about which companies will be approved to train and test navigators. “There’s no specific vendor referenced in the rule,” he says. The $200 to $800 price range, he says, was based on “a general survey of the testing and training providers that are currently providing that in Texas.” The department has approved hundreds of firms to train insurance agents for licensing, and one firm—Pearson—to test them. The testing fee is $68. If Pearson VUE charged that much to test 500 navigators, that business would total $34,000. (Pearson spokesman Terry Abbott says TDI hasn’t contacted the company about testing Texas’ navigators.)
Greeley also points out that, under the proposed rules, groups that employ navigators could save on the training fees by getting state approval to run their own training.
Stacey Pogue, a policy analyst at the Center for Public Policy Priorities, has surveyed other states’ navigator training programs, and says Texas’ 40-hour training is by far the longest in the country. Wisconsin requires 16 hours of state training on top of the federal training, for instance, and Georgia has 10. While many states use Pearson for their testing, she says many use a navigator training course from the Kansas-based company A.D. Banker. The company offers other insurance courses in Texas already.
Training for navigators here would cover Texas-specific Medicaid regulations, privacy and “navigator ethics.” Pogue agrees with Moorhead that there’s no reason to hire private firms for the training when other state agencies—like Texas’ Health and Human Services Commission and the Department of Aging and Disability Services—have already developed free, online programs that cover much of what’s in the new navigator training. “It’s just going to waste our taxpayer dollars,” she says.
The cost of all the extra training, and where the money goes, are among a litany of concerns included in a December letter from Sen. Kirk Watson and other Senate Democrats to the Department of Insurance. “Every dollar diverted from enrollment assistance leaves fewer resources to serve Texas’ 6.4 million uninsured,” they say in the letter, which the Quorum Report posted with a story on Friday. The Democrats also say the agency hasn’t justified the 40 hours of training, has rushed its deadlines and has left the definition of “navigator” dangerously broad.
In her remarks to the department last month, Pogue agreed. Under the proposed rules, Pogue said, even “a mother helping her young adult son with an application for insurance” would be considered a “navigator,” and would have to complete the 40-hour training and a background check. (A similar requirement sparked a lawsuit in Missouri.)
And for all the extra hoops for licensed navigators to jump through, Moorhead says there’s little in the proposed rules to discipline fraudulent navigators for abusing the system, or to protect victims.
The insurance department will hold its last meeting on the proposed rules Monday, before the window for public comment closes at the end of the day. The meeting starts at 9 a.m. in the William P. Hobby Jr. Building in downtown Austin, and there’ll be a live webcast here.
Clarification on Tuesday at 3:30 p.m.: This story has been updated to clarify that Pearson’s testing service—for which it charges between $41 and $90 in other states—is separate from the $200-$800 navigator training other firms would provide.