After extensive negotiation on a bill that would lay out the role of Nebraska's health insurance exchange navigators, the Legislature moved the bill Friday to final reading.
The bill (LB568), introduced by Omaha Sen. Burke Harr, originally would have licensed navigators to help people sign up for health insurance -- many for the first time -- through exchanges that will be part of the Affordable Care Act. Exchanges bring together private health insurance companies along with a government health insurance option to compete for business among individuals and small businesses.
The original bill also provided sanctions and fines if a navigator gave more than fair and impartial general information concerning enrollment.
That original bill had an uphill battle for passage.
So, many changes were made, Harr said. With the amended version, navigators would be registered, rather than licensed, by the Department of Insurance, and the sanctions for violations would be probation, suspension, revocation or refusal to issue, renew or reinstate registration.
Navigators would be located at federally qualified health centers and nonprofits.
The bill creates no greater burdens than those already found in the Affordable Care Act, Harr said.
Between Oct. 1 and Jan. 1, the state has to sign up more than 217,000 people who will be eligible for subsidies under the Affordable Care Act, he said.
Sen. Mike Gloor, chairman of the Banking, Commerce and Insurance Committee, said people fear the Affordable Care Act and its ramifications because they don't understand it yet.
"And that's the reason we need this bill," he said. "It's a good bill."
Lincoln Sen. Danielle Conrad said the negotiation on the bill was one of the most difficult of her seven years in the Legislature. There is nothing new or scary about navigators, she said. They are community educators.
They will empower consumers with information about how to make a decision that's best for them, their families and health care needs, she said.
"There is an extensive set of federal laws, regulations and guidance on this topic, and these navigators are held to a very high standard in terms of their expertise and knowledge before they start interfacing with consumers in need," Conrad said.
Still, Sen. Jim Scheer of Norfolk, an insurance agency owner, had concerns about the amended bill. Navigators who are not licensed agents will be trying to explain coverages, he said. And if and when they make a mistake that impacts the health care of the insured person, there is no recourse.
"Like it or not, they will be giving advice, I know that ... and so we have the most vulnerable getting perhaps no advice, which is in my opinion terrible, or bad advice which is even worse," he said. "Or incorrect advice which will impact how they receive their health care."
Navigators will get 30 hours of training, continuing education, registration and certification with the exchange, Conrad said. They must pass an exam. There will be conflict of interest standards and a written plan to remain free of conflicts of interest as a navigator.
They must inform consumers of the full range of qualified health plans.
"These are not insurance producers, friends, these are consumer educators. Let's not miss that critical distinction moving forward," Conrad said.