Relax, Republicans, Obamacare’s Sherpas Pose No Threat

The latest front in the GOP assault against the president’s health care initiative involves so-called navigators who will help consumers find health insurance. But their concerns about privacy are overblown.

Nepalese Sherpas with luggage make their way through the Khumbu Icefall to Everest base camp, Nepal, Saturday, May 24, 2003. With the season for climbing Mount Everest coming to an end in the month and the unpredictable weather, many teams have aborted plans for attempting to climb the world's highest peak, commemorating the 50th anniversary of Sir Edmund Hillary and Tenzing Norgay's climb to the summit on May 29, 1953. 
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Catherine Hollander
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Catherine Hollander
Sept. 5, 2013, 4:10 p.m.

The latest cri­ti­cism of Obama­care has centered on the “nav­ig­at­or” or­gan­iz­a­tions charged with help­ing Amer­ic­ans find health in­sur­ance cov­er­age un­der the law. The Af­ford­able Care Act tasks nav­ig­at­ors with edu­cat­ing the pub­lic about health re­form, dis­trib­ut­ing “fair and im­par­tial” in­form­a­tion about in­sur­ance plans, and provid­ing en­roll­ment as­sist­ance in some in­stances. In ex­change for per­form­ing these du­ties, nav­ig­at­or or­gan­iz­a­tions re­ceive fed­er­al grants; $67 mil­lion was dis­trib­uted to 105 non­profits and com­munity-based or­gan­iz­a­tions just last month.

Re­pub­lic­an crit­ics have fo­cused re­cently on wheth­er these coun­selors pose a threat to pri­vacy. “Amer­ic­ans will de­tail their very per­son­al health and fin­an­cial in­form­a­tion to these in­di­vidu­als,” ac­cord­ing to an Aug. 15 re­lease from the GOP-led House En­ergy and Com­merce Com­mit­tee. “The sheer volume of per­son­al in­form­a­tion col­lec­ted by nav­ig­at­ors raises ser­i­ous pri­vacy con­cerns.” Thir­teen Re­pub­lic­an state at­tor­neys gen­er­al wrote to Health and Hu­man Ser­vices Sec­ret­ary Kath­leen Se­beli­us ex­press­ing sim­il­ar mis­giv­ings.

But the nav­ig­at­or pro­gram has a pre­ced­ent, one that sug­gests the con­cerns may be over­blown: the State Health In­sur­ance As­sist­ance Pro­gram, which was en­acted through the Om­ni­bus Budget Re­con­cili­ation Act of 1990 to of­fer free coun­sel­ing to Medi­care be­ne­fi­ciar­ies. SHIP coun­selors were the mod­el for Obama­care’s nav­ig­at­ors. “The no­tion that this is some un­heard of “¦ in­cur­sion in­to people’s lives is about as far from real­ity as it could be,” says Sara Rosen­baum, a pro­fess­or at George Wash­ing­ton Uni­versity’s School of Pub­lic Health and Health Ser­vices. “This is ex­actly what Medi­care SHIPs do all the time.”

SHIP staff mem­bers played a key out­reach role after Con­gress passed the Medi­care Pre­scrip­tion Drug, Im­prove­ment, and Mod­ern­iz­a­tion Act of 2003. The le­gis­la­tion in­tro­duced pre­scrip­tion-drug be­ne­fits — Part D, which was a com­plic­ated ad­di­tion to the cov­er­age offered un­der Medi­care avail­able through en­roll­ment in private plans. In the spring of 2005, just half a year be­fore open en­roll­ment began, 66 per­cent of seni­ors polled by the Kais­er Fam­ily Found­a­tion said they didn’t think they had enough in­form­a­tion to un­der­stand how the be­ne­fit would af­fect them. Enter SHIPs.

“With Part D, they were in­cred­ibly im­port­ant,” said Laura Sum­mer, a seni­or re­search schol­ar at Geor­getown Uni­versity’s Health Policy In­sti­tute. In 2008, Sum­mer coau­thored a re­port on how the early Part D rol­lout went, based on the find­ings of a sur­vey of 660 coun­selors, pro­gram man­agers, and oth­ers who worked with be­ne­fi­ciar­ies. “The avail­ab­il­ity of one-on-one coun­sel­ing, in­clud­ing help from the State Health In­sur­ance Pro­gram (SHIP) coun­selors, was cited most com­monly in re­sponse to an open-ended ques­tion re­gard­ing as­pects of the pro­gram that have been par­tic­u­larly help­ful for Part D be­ne­fi­ciar­ies,” she and her col­leagues wrote.

SHIP coun­selors had ac­cess to in­form­a­tion to de­term­ine wheth­er in­di­vidu­als might qual­i­fy for Part D’s low-in­come sub­sidy, as well as cer­tain per­son­al health in­form­a­tion that helped them ad­vise on plan se­lec­tion. Na­tion­al Journ­al in­ter­viewed a num­ber of people who stud­ied the rol­lout of Medi­care Part D, none of whom re­called the kind of con­cern over pri­vacy voiced by today’s op­pon­ents of Obama­care. News­pa­per re­ports and con­gres­sion­al tran­scripts from 2005 to 2007 also sug­gest that per­son­al in­form­a­tion was not a key worry dur­ing the early days of Part D en­roll­ment, al­though there was a broad­er dis­cus­sion tak­ing place in Con­gress over how to re­spect pa­tient pri­vacy while mod­ern­iz­ing health-in­form­a­tion tech­no­logy.

Any new health care pro­gram is ripe for fraud. Part D was, and the Af­ford­able Care Act is likely to be, too. Bon­nie Burns, a policy spe­cial­ist with Cali­for­nia Health Ad­voc­ates, a Medi­care ad­vocacy non­profit, re­calls the scam artists who have cropped up as the Medi­care pro­gram evolved over the years. “Every single time there’s any change in Medi­care, Medi­care be­ne­fi­ciar­ies get flooded with these mail­ings that say, “˜Your health care is chan­ging, Con­gress has done X, Y, Z.’ And those are at­tempts to reach Medi­care be­ne­fi­ciar­ies to sell them something,” Burns says. But she’s not aware of any in­stances of SHIP coun­selors com­mit­ting fraud in Cali­for­nia in the more than two dec­ades she’s been in­volved with Medi­care coun­sel­ing.

HHS has prom­ised that nav­ig­at­ors, who will be re­quired to com­plete 20 hours of train­ing, will be in­struc­ted on pri­vacy and se­cur­ity stand­ards. The GOP state at­tor­neys gen­er­al counter that the gov­ern­ment’s pri­vacy safe­guards are “vague” and “will res­ult in im­prop­erly screened or in­ad­equately trained per­son­nel” who will be “more prone to mis­ap­pro­pri­ate — ac­ci­dent­ally or in­ten­tion­ally — the private data of con­sumers.”

But Larry Ko­cot, who was a seni­or ad­viser to the ad­min­is­trat­or of the Cen­ters for Medi­care and Medi­caid Ser­vices dur­ing the Part D rol­lout and was heav­ily in­volved in its launch, says such as­sist­ance should be viewed as a case of risk versus re­ward. Part D showed how im­port­ant in-per­son coun­sel­ing is when ex­plain­ing a com­plex new health care law. “With ap­pro­pri­ate se­lec­tion, safe­guards, and mon­it­or­ing,” Ko­cot says, “the be­ne­fits clearly out­weigh the risks.”

The Obama ad­min­is­tra­tion faces per­haps an even more daunt­ing chal­lenge than the Bush ad­min­is­tra­tion did dur­ing Part D’s early days. Half of Amer­ic­ans say they don’t have enough in­form­a­tion about the Af­ford­able Care Act to un­der­stand how it will af­fect them and their fam­ily, ac­cord­ing to Kais­er’s Au­gust health track­ing poll. Open en­roll­ment be­gins in three weeks. The pop­u­la­tion the gov­ern­ment is seek­ing to get covered is more di­verse than the Part D con­stitu­ency and may nev­er have had in­sur­ance be­fore — which is why coun­sel­ing will be para­mount. Con­cerns over se­cur­ity should be taken ser­i­ously and mon­itored. But the Part D pre­ced­ent sug­gests that nav­ig­at­ors can play an im­port­ant role.

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