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A Project of The Annenberg Public Policy Center

GOP Attack on Health Care Navigators

Republicans wrongly claimed in a blog post that the Obama administration went back on its word not to send federal health care “navigators” door to door to enroll Americans in the insurance exchanges. The false claim is based on a Fox News report that mistakenly described representatives of the United Way of Florida and Enroll America as “health care navigators” as they went door to door in Florida. But neither group received federal funding as part of the administration’s outreach program.

The Affordable Care Act provided funding to create a network of navigators — individuals and organizations — that would educate uninsured citizens about health coverage options in the new insurance marketplace and assist them with enrollment. Navigators can provide information in person at health care facilities or over the phone. In August, Health and Human Services Secretary Kathleen Sebelius announced $67 million in navigator grants to 105 organizations that applied to provide navigator services.

But navigators have become a target of the health care law’s opponents. Congressional Republicans have raised questions about the training that navigators receive and the potential for fraud and abuse under the system.

For example, some Republicans, including Sen. John Barrasso, have repeated the claim that individuals working as navigators don’t have to go through criminal background checks. It’s true — as we’ll explain later — that there is no federal requirement for navigators to undergo criminal background checks. But a handful of states have made them a requirement. And there are other safeguards in federal statutes aimed at safeguarding against identity theft.

Door to Door Prohibition

On Oct. 1, Fox News correspondent Phil Keating reported that the United Way and Enroll America, in Coral Gables, Fla., had “navigators going door to door, knocking on the homes of the uninsured … helping them navigate through the different plans that are available.” That led the House Energy and Commerce Committee — chaired by Republican Rep. Fred Upton of Michigan — to post an item on its website claiming “Navigators Go Door-to-Door Less Than Two Weeks After Obamacare Czar Assured Committee They Would Not.”

Gary Cohen, director of the Center for Consumer Information and Insurance Oversight, appeared at a House hearing on Sept. 19, to address Republican concerns that navigators would be taking their outreach efforts directly to the homes of the uninsured. He said workers would be told not to go door to door to enroll anyone in the exchanges.

Rep. Tim Murphy: Will navigators be going door-to-door?

Cohen: We will be issuing instructions to navigators that they should not be going door-to-door.

Murphy: And so that will be the ruling you’ll have. With two weeks left, they would not be doing it.

Cohen: That’s right.

Murphy: They’ll remain in other public places?

Cohen: They can’t be enrolling anyone now because no one can be enrolling now. So in terms of going door-to-door to solicit people to enroll in coverage, they will be instructed not to do that, and it’s timely because no one can be going door-to-door enrolling anyone because no one can enroll today.

The Centers for Medicare and Medicaid services later issued the “CMS Navigator Grantee Guide.” According to the document, “outreach activities should not include door-to-door activities to help consumers fill out applications or enroll in health coverage.”

The Energy and Commerce Committee’s blog post says the Fox News report “makes clear, such activity began on day one,” and it includes a video clip labeled “Fox News Shows Obamacare Navigators Going Door-to-Door.” But that’s not accurate. Enroll America and the United Way of Florida were not among the eight organizations in Florida that received federal navigator grants.

Justin Nisly, national press secretary for Enroll America, described Enroll America as a national, nonprofit organization focused on educating consumers about their health insurance options under the federal law. The group’s own “Get Covered America” campaign does involve sending staff and volunteers door to door to let uninsured Americans know about the new health insurance marketplace. But it isn’t being funded as part of the government’s navigator grant program.

Nisly told us in an interview that the group is “definitely not a navigator” and “anyone who describes us as such is mistaken.” Nick Duran, Florida state director of Enroll America, made a similar statement in an interview with the Huffington Post. Ted Granger, president of the United Way of Florida, also told us in an email that his group isn’t a navigator for the government.

Brian Cook, spokesman for the Centers for Medicare and Medicaid Services, confirmed that for us. It is also confirmed by the agency’s list of navigator grant recipients, which does not include either group.

“We can confirm that the organizations in the video are NOT Navigators,” Cook wrote in an email to FactCheck.org. “Neither Enroll America nor United Way are navigators in Florida.”

And Granger of the United Way of Florida said his group’s involvement with Enroll America’s awareness campaign was limited to providing “in-kind space” for its kickoff events.

Fraught with Fraud?

Some Republicans are warning about fraud and identity theft issues with navigators. Sen. John Barrasso, for example, warned on Fox Business News that navigators don’t have to go through criminal background checks. He’s right that there is nothing in the federal statutes that requires background checks, but a handful of states have made that requirement. And there are other safeguards in federal statutes aimed at safeguarding against identity theft.

Here’s what Barrasso said on Fox Business News on Oct. 1:

Barrasso, Oct. 1: And through the navigators — people who are after your own identity. I mean, these so-called navigators hired to help you sign up are individuals that don’t have to go through criminal background checks. They don’t even need the same criteria that Census takers have to meet in terms of security so real opportunity for identity theft because you’re going to have to give people bank account numbers, credit card numbers, Social Security numbers — all of these sorts of things to try to sign up.

Those concerns and others were raised by Republicans on the House Committee on Oversight and Government Reform in a staff report on Sept. 18 titled, “Risks of Fraud and Misinformation with ObamaCare Outreach Campaign: How Navigator and Assister Program Mismanagement Endangers Consumers.

According to that report, “Some of the training received by Navigators and Assisters will be related to consumer protection and privacy standards, but substantial risks remain. In part, substantial risks remain because the Administration decided not to require background checks and fingerprinting of individuals hired by Navigator and Assister organizations.”

The same day, the Democratic staff of the House Committee on Energy and Commerce” released a memo that said “there is no basis for the Republican concerns about the Navigator program.” Specifically, the memo states that navigators “have extensive experience assisting individuals with federal and state benefits” and there are “effective privacy protections in place.”

Nonetheless, Barrasso is correct that there is no federal requirement for navigators to undergo criminal background checks.

An official with the Department of Health and Human Services told FactCheck.org in an email that there is “no statutory requirement for Navigators to complete background checks, although some organizations already conduct background checks and some states have laws that require it of Navigators.”

Among the states that have laws that will require navigators to undergo criminal background checks: Arkansas, Florida, Georgia, Indiana and Ohio.

An HHS official told us that “Navigators will not be able to access information once it has been submitted to the marketplace. The only way that a navigator would have access to a consumer’s information would be if the consumer chose for the navigator to complete the enrollment process for them, which typically would be done in-person, with the consumer sitting with the navigator.”

— D’Angelo Gore and Robert Farley