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Missouri Law Restricting Insurance Navigators Is Pre-Empted By ACA, Judge Rules

Mike Sherry
Heartland Health Monitor

A federal judge says that Obamacare navigators may dispense advice to those looking for insurance under the federal health reform law.

U.S. District Judge Ortrie Smith on Wednesday struck down provisions of a Missouri law that bars insurance navigators from giving advice about health plans. He ruled that the law is preempted by the federal Affordable Care Act.

Missouri legislators passed the law, the Health Insurance Marketplace Innovation Act (HIMIA), in 2013 at the behest of insurance agents and brokers. The law prohibits navigators from counseling consumers about the benefits, terms and features of health plans offered on the exchanges, or marketplaces, established by the Affordable Care Act, commonly known as Obamacare. It also bars them from providing information on health plans not offered on the exchanges.

Navigators are individuals or organizations trained to help consumers understand their health coverage options under the ACA. More than a dozen states, including Missouri, passed laws restricting their activities. The laws were widely seen as an attempt to hobble implementation of the ACA, the signature domestic achievement of President Obama.

After HIMIA’s enactment, several organizations, including St. Louis Effort for AIDS and Planned Parenthood of the St. Louis Region and Southwest Missouri, sued to block its implementation. In January 2014, Smith found that the ACA preempted Missouri’s law and issued a preliminary injunction in favor of the plaintiffs.

The Missouri Department of Insurance, which is responsible for enforcing HIMIA, appealed, and in April 2015 a federal appeals court upheld most of Smith’s findings.

On Wednesday, Smith permanently blocked the insurance department from enforcing the “no advice” and “off exchange” provisions of the law. He also blocked it from enforcing another HIMIA provision that requires navigators to refer consumers with existing health insurance coverage to insurance brokers or agents “regarding coverage in the private market.”

Smith noted that if the plaintiffs comply with HIMIA, they risk violating their obligations as navigators. On the other hand, if they perform their duties under the ACA, they risked violating HIMIA.

A spokeswoman for the Missouri Department of Insurance did not immediately respond to a request for comment.

Abigail Coursolle, an attorney for the National Health Law Program, which represented the plaintiffs, said Smith’s decision was significant not just for Missouri but for states with similarly restrictive laws.

“We really are hoping that this decision sends a message to those states that they can't put barriers in the way of letting people know about their options for affordable health care coverage,” she said.

Missouri was one of the first states to enact such a law, and Coursolle said her organization viewed it as a test case.

“Some of the states that passed laws have subsequently watered them down – there were new federal regulations that came out that made it clear that laws of this kind were not allowable,” she said. “But I think this ruling really makes that very, very clear for other states and hopefully we'll see those laws going away.”  

Jay Angoff, a former Missouri insurance director who also represented the plaintiffs, said Missouri has one of the most restrictive navigator laws, which is why it was singled out for legal challenge.

“We think it's a very significant decision beyond Missouri because there are about 15 states that have at least one of the three provisions that Judge Smith struck down in their law,” Angoff said. “This decision obviously is not binding in those states, but we think that it would certainly be influential.”

In a statement, Mary M. Kogut, President and CEO of Planned Parenthood of the St. Louis Region and Southwest Missouri, said her organization was “very pleased” with the decision.

“Unfortunately,” she said, “many of the Missourians our assisters met with this year fell into Missouri’s Medicaid Gap and therefore remain uninsured. We urge the Missouri legislature to close the gap so that all Missourians have access to affordable health insurance.”

Kogut was referring to consumers who make too much to qualify for Medicaid in Missouri but too little to qualify for subsidies in the Affordable Care marketplace. In Missouri, adults qualify for Medicaid if they make less than 18 percent of the federal poverty level, or about $3,600 a year. Marketplace subsidies are available only to those who make between 100 percent and 400 percent of the federal poverty level.

Dan Margolies, editor of the Heartland Health Monitor team, is based at KCUR. You can reach him on Twitter @DanMargolies.

Dan Margolies has been a reporter for the Kansas City Business Journal, The Kansas City Star, and KCUR Public Radio. He retired as a reporter in December 2022 after a 37-year journalism career.
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