Navigators and the Power Struggle Over Access To At-Risk Communities

BY BECKY GREENFIELD — The Affordable Care Act (“ACA”) establishes federally funded “Navigator Programs” to inform even the most at-risk communities about Health Exchanges, Qualified Health Plan enrollment, and premium tax credit eligibility. However, Florida Governor Rick Scott informed Congress that Navigators will be banned from all Florida state-run facilities. What does this mean for Florida’s indigent and minority populations that primarily receive care from state-run clinics, hospitals, and public benefit offices? Like most questions pertaining to the ACA’s implications and future outcomes, the answer is highly unknown.

Governor Scott presented to Congress his concern that Navigators, in collecting individuals’ personal information for qualified health plan enrollment, will invade people’s privacy. If this is his real concern, would Governor Scott also fear citizens sharing personal information with healthcare providers, accountants and IRS officials, or even academic admissions offices with fear that personal information would be used inappropriately?

More likely, Governor Scott is employing the Navigator Program ban as an obstruction of Federal power onto the state. Thus, the question of whether Federalism is being implicated must be addressed. The ACA provides that the federal government will not impose on state law so long as it does not inhibit the federal government’s implementation of the federal provisions. See 42 U.S.C.A § 18031(a)(2)(d). This is exactly what the state ban does: It directly bars a federal program, mandated by federal law, to meet the overarching goals and directives set out by the ACA.

While the context is different, Governor Scott’s ban is strikingly similar to Alabama Governor George Wallace’s fight against desegregation of the state’s university, physically blocking African Americans from entering the university’s enrollment office. Just like Governor Wallace’s stand against the federal government, Governor Scott, in banning Navigators from entering state-run facilities, effectively cuts off minority and indigent populations from learning about, and therefore enrolling in, qualified health plans.

The ban has therefore arguably violated protection under Equal Protection Act by creating significant barriers to access of information and enrollment services for those who rely heavily on state-run health facilities and services. Why is this so important? Individuals who do not sign up for health care and who are not already covered by a qualified health plan, are subject to penalty. Further, this population, due to low income and high need, are eligible for federal subsidies, making health care far more affordable, or even free. Without access to Navigators information and assistance, many at-risk individuals will be either penalized or will not receive the federal financial assistance they are eligible for.

Some Florida counties have acknowledged the importance of Navigators in the community and have rejected the ban on grounds that county-run, state health departments are owned by the county.

“It is criminal that anyone would put their foot out to trip up that process for sharing [Affordable Care Act information],” reported Broward Mayor Jacobs. “You can’t tell us what to do in our own facility.”

In Florida, where the governor has so publicly criticized and rejected the Act and who has refused to use state funds to release wide-spread information, these Navigators are integral for informing the public. Low income groups are especially harmed due to limited access to computers, education, and legal, tax, and health services. While it is still too early know the impact of the ACA, it is clear that tensions between state and federal governments will continue and will greatly influence at-risk communities.