By Cyril Tuohy
A federal appeals court has found that the Affordable Care Act (ACA) standards for health insurance agents and consultants who advise people on buying health coverage pre-empt portions of Missouri’s Health Insurance Marketplace Innovation Act (HIMIA).
Under the ACA, consultants — known as navigators or certified application counselors (CACs) — are paid to help people enroll through the federally operated health insurance exchange upon which the state of Missouri relies.
In a 17-page opinion handed down by the 8th U.S. Circuit Court of Appeals, Circuit Judge William J. Riley said the ACA gives the U.S. Department of Health and Human Services “wide discretion” in establishing the standards for navigators and clarifying the duties of CACs.
Missouri’s HIMIA law also regulates compensation to people who provide information or services in connection with enrollment in any health benefit exchange operating in Missouri, but regulates what navigators operating in that state cannot do unless they are also licensed insurance agents.
HIMIA came under attack from a coalition of public health organizations including the St. Louis Effort for AIDS, Planned Parenthood of the St. Louis Region and Southwest Missouri, Consumers Council of Missouri, and Missouri Jobs with Justice.
Siding with the public health organizations were AARP and the Sargent Shriver National Center on Poverty Law.
The health groups sued John M. Huff, director of the Missouri Department of Insurance, Financial Institutions and Professional Registration, on the grounds that federal law pre-empted HIMIA and that HIMIA violated due process.
The Missouri Association of Insurance Agents filed briefs in support of the Missouri Department of Insurance.
A U.S. District Court had issued an injunction preventing HIMIA from going into effect against navigators and CACs after the court found that the plaintiffs were likely to succeed in their HIMIA challenge due to the ACA’s powers of pre-emption.
Huff appealed the District Court’s decision.
In defending HIMIA, which prevents ACA navigators from providing advice about one health plan over another, Huff argued there is no conflict between the state law and the ACA.
The appeals court was unconvinced.
The appeals court found that HIMIA, which forbids CACs from giving information or services about health benefits not offered on the health insurance exchange, prevents counselors from fulfilling their duties under the ACA.
“Contrary to Huff’s claims, the relevant laws and regulations do not limit CACs to discussing only those plans offered on the exchange,” the court ruled.
The appeals court also found that the Missouri law impedes a CAC’s duty to provide fair and impartial information about insurance options.
The appeals court, however, vacated the claim by the health groups that HIMIA violated the Due Process Clause.
InsuranceNewsNet Senior Writer Cyril Tuohy has covered the financial services industry for more than 15 years. Cyril may be reached at [email protected].
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