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Court Allows Health Care Plan Information Access to Continue in Missouri

AARP’s brief supported allowing certified application counselors to fully assist people seeking health plan information.

Background

The Affordable Care Act (ACA, also known as “Obamacare”) authorizes grants to organizations to assist individuals with enrollment in health plans. The entities who receive such grants must adhere to federal standards designed to ensure they have the ability to provide effective assistance to enrollees that is free from any conflicts of interest. The individuals hired by these entities to provide impartial assistance with enrollment are called “navigators” or “certified application counselors” (or “CACs”).


Missouri enacted a statute that limited the types of information and assistance that CACs can provide.  Specifically, the law forbids navigators from “provid[ing] advice concerning the benefits, terms, and features of a particular plan” and requires navigators to advise currently-insured individuals to contact a private insurance agent.

Several CAC organizations sued, arguing that the Missouri law conflicted with federal standards and impeded their ability to carry out their duties to assist individuals under the federal law. The district court issued an order preventing the state from enforcing its statute. The state appealed this order.

AARP Foundation Litigation attorneys filed AARP’s friend-of-the-court brief in the litigation, citing studies showing that statutes like Missouri’s have a negative impact on the effectiveness of enrollment assistance and education. This is particularly important to older adults because, as the brief pointed out, studies show that older adults are more likely to seek out and benefit from the type of in-person information and assistance provided by CACs. The brief describes the harms occasioned by the Missouri statute requiring CACs, who are required to provide unbiased information and assistance, to refer presently-insured individuals to an insurance company, who are naturally biased in favor of their own products. The brief also described the positive impact of CAC organizations during the recent “open enrollment” cycle that ended in March 2014.

The appeals court upheld the lower court’s injunction as to the provisions relating to the ACA, finding that the plaintiffs were likely to succeed on the merits. The provisions of the Missouri law that affect the actions of navigators, therefore, cannot take effect while the substantive challenge is pending.  

What’s at Stake

The complexities of selecting a health plan provide a daunting challenge, particularly to individuals who are trying to secure health insurance for the first time. As a result, many people — and older adults in particular — want, need, and benefit from in-person, face-to-face counseling and assistance, as opposed to relying on mass media sources. Moreover, CAC organizations fill a need for impartial assistance and advice that is not acting at the direction or under the influence of a particular insurer. Adults seeking the benefits of the ACA need access to all types of assistance — in the media, in brochures, online, and via certified navigators — and should not be denied available help.

Case Status

St. Louis Effort for AIDS v. Huff was decided by the U. S. Court of Appeals for the Eighth Circuit.