Saturday, September 30, 2023
Courthouse News Service
Saturday, September 30, 2023 | Back issues
Courthouse News Service Courthouse News Service

MO Law Steps on Toes of Obamacare, Court Rules

(CN) - The 8th Circuit chided Missouri for eviscerating the provisions of the federal health care reform law that let organizations advise consumers on plan selection.

One section of the Patient Protection and Affordable Care Act creates "navigators" and certified application counselors (CACs) to assist consumers in purchasing health insurance from state and federal health exchanges.

With federal navigators and CACs facilitating the federal exchange that the U.S. government established in Missouri under the health care reform law, Missouri enacted the Health Insurance Marketplace Innovation Act (HIMIA) to regulate "person[s] that, for compensation, provide[] information or services in connection with eligibility, enrollment, or program specifications of any health benefit exchange."

The act prohibits a navigator or CAC from providing "advice concerning the benefits, terms, and features of a particular health plan or offer advice about which exchange health plan is better or worse for a particular individual or employer."

It also forbids the discussion of off-exchange health benefit plans.

In addition, the legislation requires CACs to advise consumers to consult with insurance providers regarding private coverage. It permits the state to levy a fine on navigators of up to $1,000 for misconduct "or for other good cause."

St. Louis Effort for AIDS, joined by Planned Parenthood of the St. Louis Region and Southwest Missouri, challenged the law as unconstitutional.

A federal judge enjoined Missouri's law, however, after finding that the Affordable Care Act pre-empts the state's legislation aimed at regulating navigators and CACs.

On the government's appeal, the 8th Circuit ruled last week that the lower court correctly enjoined the state law as applied to CACs, but ruled that its decision regarding federal navigators must be vacated because the plaintiffs do not meet the job description.

To qualify as a navigator, plaintiffs would have to receive federal grant money.

"It is likely the appellees will succeed in showing the HIMIA requirement that state CACs refrain from providing information about health insurance plans not offered through the exchange may prevent CACs from informing consumers about the full range of health care available to them and 'clarifying the distinctions among health coverage options,'" Chief Judge William Riley said, writing for the three-judge panel in St. Louis.

The requirement in Missouri's law that CAC's "refer" clients to a private insurance provider furthermore likely "contravenes a CAC's duty to provide 'fair, impartial, and accurate information' about insurance options," according to the ruling.

Riley did, however, reject the plaintiffs' argument that Missouri's law impermissibly allows the state to fine them "for other good cause," because it allegedly "does not provide fair notice of what is prohibited."

The law allows the direct to limit a CAC's license for misconduct such a fraud, misrepresentation or misappropriation of funds.

"The appellees' fear that § 376.2010.1 empowers the director to punish them merely for engaging in the speech required of a CAC is unfounded," the 17-page opinion concludes.

Plaintiffs in a Tennessee case won a restraining order against similar rules aimed at blocking organizations from assisting people choose a new healthcare plan through the federal marketplace.

Categories / Uncategorized

Read the Top 8

Sign up for the Top 8, a roundup of the day's top stories delivered directly to your inbox Monday through Friday.