[House Hearing, 113 Congress]
[From the U.S. Government Publishing Office]
OBAMACARE IMPLEMENTATION: WHO ARE THE NAVIGATORS?
=======================================================================
HEARING
before the
COMMITTEE ON OVERSIGHT
AND GOVERNMENT REFORM
HOUSE OF REPRESENTATIVES
ONE HUNDRED THIRTEENTH CONGRESS
FIRST SESSION
__________
DECEMBER 16, 2013
__________
Serial No. 113-82
__________
Printed for the use of the Committee on Oversight and Government Reform
Available via the World Wide Web: http://www.fdsys.gov
http://www.house.gov/reform
----------
U.S. GOVERNMENT PRINTING OFFICE
87-014 PDF WASHINGTON : 2014
-----------------------------------------------------------------------
For sale by the Superintendent of Documents, U.S. Government Printing
Office Internet: bookstore.gpo.gov Phone: toll free (866) 512-1800;
DC area (202) 512-1800 Fax: (202) 512-2104 Mail: Stop IDCC,
Washington, DC 20402-0001
COMMITTEE ON OVERSIGHT AND GOVERNMENT REFORM
DARRELL E. ISSA, California, Chairman
JOHN L. MICA, Florida ELIJAH E. CUMMINGS, Maryland,
MICHAEL R. TURNER, Ohio Ranking Minority Member
JOHN J. DUNCAN, JR., Tennessee CAROLYN B. MALONEY, New York
PATRICK T. McHENRY, North Carolina ELEANOR HOLMES NORTON, District of
JIM JORDAN, Ohio Columbia
JASON CHAFFETZ, Utah JOHN F. TIERNEY, Massachusetts
TIM WALBERG, Michigan WM. LACY CLAY, Missouri
JAMES LANKFORD, Oklahoma STEPHEN F. LYNCH, Massachusetts
JUSTIN AMASH, Michigan JIM COOPER, Tennessee
PAUL A. GOSAR, Arizona GERALD E. CONNOLLY, Virginia
PATRICK MEEHAN, Pennsylvania JACKIE SPEIER, California
SCOTT DesJARLAIS, Tennessee MATTHEW A. CARTWRIGHT,
TREY GOWDY, South Carolina Pennsylvania
BLAKE FARENTHOLD, Texas TAMMY DUCKWORTH, Illinois
DOC HASTINGS, Washington ROBIN L. KELLY, Illinois
CYNTHIA M. LUMMIS, Wyoming DANNY K. DAVIS, Illinois
ROB WOODALL, Georgia PETER WELCH, Vermont
THOMAS MASSIE, Kentucky TONY CARDENAS, California
DOUG COLLINS, Georgia STEVEN A. HORSFORD, Nevada
MARK MEADOWS, North Carolina MICHELLE LUJAN GRISHAM, New Mexico
KERRY L. BENTIVOLIO, Michigan Vacancy
RON DeSANTIS, Florida
Lawrence J. Brady, Staff Director
John D. Cuaderes, Deputy Staff Director
Stephen Castor, General Counsel
Linda A. Good, Chief Clerk
David Rapallo, Minority Staff Director
C O N T E N T S
----------
Page
Hearing held on December 16, 2013................................ 1
WITNESSES
Ms. Carolyn Goodwin, President-Elect, Dallas Chapter, Texas
Association of Health Underwriters
Oral Statement............................................... 9
Written Statement............................................ 11
Mr. Randy Farris, M.D., Regional Administrator, Centers for
Medicare and Medicaid Services
Oral Statement............................................... 19
Written Statement............................................ 21
Mr. Kevin Brady, Deputy Chief of Staff, Texas Department of
Insurance
Oral Statement............................................... 28
Written Statement............................................ 30
APPENDIX
Obamacare Navigator and Assister Staff Report No. 2, submitted by
Mr. Issa....................................................... 88
Letters from Texas Elected Officials Regarding Navigators,
submitted by Mr. Veasey........................................ 95
Letters from Community Healthcare Centers and other groups,
submitted by Mr. Veasey........................................ 105
Letter to Ms. Julin Rathgeber signed by 54 Legislators, submitted
by Mr. Veasey.................................................. 108
OBAMACARE IMPLEMENTATION: WHO ARE THE NAVIGATORS?
----------
Monday, December 16, 2013
House of Representatives
Committee on Oversight and Government Reform
Washington, D.C.
The committee met, pursuant to call, at 1:30 p.m., in the
Eisemann Center/Hill Performance Hall, 2351 Performance Drive,
Richardson, Texas, Hon. Darrell E. Issa [chairman of the
committee] presiding.
Present: Representatives Issa and Farenthold.
Also Present: Representatives Sessions, Burgess,
Neugebauer, and Veasey.
Staff Present: Brian Blase, Senior Professional Staff
Member; Will L. Boyington, Press Assistant; Adam P. Fromm,
Director of Member Services and Committee Operations; Emily
Martin, Counsel; Sarah Vance, Assistant Clerk.
Chairman Issa. Good afternoon. Before I begin, I want
everyone to understand this is a hearing of the U.S. Congress.
It is not a town hall meeting. And I say that because we are
bound by rules of the House of Representatives, and we will
adhere to those rules. The only exception that we do during
field hearings is anyone who has any letters or other
information that they want the committee to consider on this or
other issues, our staff will take them back. Additionally, we
will give you a card in order to contact us if you want to send
additional information. But please understand that we are bound
by the rules of the House for this hearing, and we will
strictly adhere to them.
With that, the hearing will come to order.
The Oversight Committee's mission statement simply is we
exist to secure two fundamental principles. First, Americans
have a right to know that the money Washington takes from them
is well spent. And second, Americans deserve an efficient,
effective government that works for them.
Our duty on the Oversight and Government Reform Committee
is to protect these rights. Our solemn responsibility is to
hold government accountable to taxpayers, because taxpayers
have a right to know what they get from their government. It is
our job to work tirelessly in partnership with citizen
watchdogs to deliver the facts to the American people and bring
genuine reform to the Federal bureaucracy.
I now ask unanimous consent that the following
individuals--the gentleman from Texas, Mr. Sessions; the
gentleman from Texas, Mr. Burgess; the gentleman from Texas,
Mr. Neugebauer; and the gentleman from Texas, Mr. Veasey--be
allowed to participate in today's hearing even though they are
not members of the committee but are members in good standing
of the U.S. House of Representatives.
Without objection, so ordered.
I will now recognize myself for a short opening statement.
We come to Dallas today, or more specifically to
Richardson, Texas, to hold a field hearing on the Affordable
Care Act, Obamacare Implementation: Who are the Navigators?
Over the past several months, as we have begun to and now
rolled out the President's signature legislation, the law has
faced one after another problem. First and most notably
publicly, over $600 million was spent on a website that simply
didn't work. But that is but the tip of the iceberg. We now
know there are fundamental unanswered questions, complications
and, quite frankly, flaws in the Affordable Care Act that need
to be addressed.
The question of administering the website and patching the
security holes that existed on launch date and may still
threaten the American people's private information is, of
course, paramount. But long after the website is fixed, we will
still have the question of millions of people who have lost
their health insurance even though the President promised if
you like your healthcare, you can keep it; if you like your
doctor, you can keep him, period.
We know that that, in fact, is not going to happen. Many
times more people have lost their healthcare than have gained
an opportunity under the Affordable Care Act. That is not to
mean that it isn't the law of the land. It means we must fix
it.
A number of other areas have been explored by this
committee, and today we are going to explore a major portion of
the Affordable Care Act rollout. Today's hearing focuses
specifically on the administration's Navigator program. The
purpose of Navigators is to explain Obamacare to people and
facilitate enrollment into coverage. This was approved in the
law and is anticipated in every sense. However, what has not
been anticipated is such failures as defined that somebody who
has a history of identity fraud, healthcare fraud, or some
other felony conviction might very well receive the job of
being a Navigator.
This and other areas we will hear about today represent
areas in which government must do better. The expectation of
the American people is that people who represent the power of a
mandated law and a service that the taxpayers pay for will, in
fact, receive a trained individual with an acceptably clean
record and an expectation of their privacy.
The HHS training program for Navigators will only provide 5
to 20 hours of training, and in some cases online-only
training. The Navigators' exams are conducted online and
individuals may attempt to take these exams an unlimited amount
of times. As we all know, an online exam also can be taken by
somebody else pretending to be the Navigator.
Despite these expected lack of experiences and lack of
training, HHS officials testified that it would be logical for
Navigators and Assisters to conduct outreach activities prior
to completing their training. I repeat, even with the short
amount of training, even with the training being online, even
with the possibility that the person taking the test one, two,
10 or 100 times, finally getting someone else to take the test
for them, even though that low standard is there, HHS has said
that it may be necessary or reasonable for them to go out in
the field prior to this testing and training.
One CMS whistleblower warned that because it is not
possible to track every computer and hard drive used by
Navigators to gather applicants' personal identifiable
information, the fact is sensitive information may be
vulnerable to, among other things, viruses on their individual
computers.
Top HHS officials acknowledge concerns that con artists and
identity thieves will pose as Navigators, and testified that
the problems will only increase as the Affordable Care Act is
fully implemented.
We are now 2-and-a-half months into the rollout. We
certainly want to hear about things that were wrong at the
launch. We, more importantly, want to know have they been fixed
or are they to be fixed.
In Dallas, Navigators have been caught on camera advising
individuals to commit tax fraud by under-reporting income in
order to gain higher subsidies. Our committee more than two
years ago dealt with a similar situation with fraud in the
housing market that helped contribute to people having homes
they could not afford. We cannot have a repeat of the Acorn-
like activities that led to too many people believing that
there was something for nothing and ultimately ending up with
nothing when they started with something.
Finally, this hearing is titled ``Who are the Navigators?''
We invited Dr. Beverly Mitchell-Brooks, the CEO of the Dallas
Urban League, to testify today. The Dallas Urban League
received $376,800 in Federal taxpayer dollars to fund its
Navigator program. Unfortunately, despite repeated requests,
Dr. Brooks would not make herself available to testify today.
We are anticipating a Democratic member of the U.S. House
being here, and I would like to publicly express that that is a
good thing. We need to have a diversity of opinions. We need to
have people who are working and believe that this program has
sufficient merit to go forward with, and hopefully would
contribute positively to the dialogue of those items which can
be fixed on a cooperative basis. Notwithstanding that, we will
go forward with the hearing and allow additional information,
including Dr. Brooks' testimony be placed in the record if she
so wishes to submit one.
I now with great pleasure recognize my colleague and fellow
member of the committee, Subcommittee Chairman Farenthold. And
I will give you the mic.
Mr. Farenthold. Thank you, Chairman Issa. It is an honor
and a privilege to be here in Richardson, Texas to be a part of
this very important hearing. My wife grew up in Richardson, so
it is great to be back.
Unfortunately, this area is also ground zero of some of the
problems that are beginning to appear with the Navigators. We
have the tape that the chairman referred to, and what we are
doing here today as government watchdogs and in partnership
with various outside organizations, we are looking to find ways
to make the system better. We are looking for ways to protect
taxpayers.
Unfortunately, under the Affordable Care Act and the way it
is being implemented, it really appears that folks' private
information is going to be in jeopardy, be it through problems
with the website or be it through Navigators. Even the most
conscientious Navigator may not have the tools necessary to
keep the data private.
So we have a real problem here that we need to look for a
solution for and look for a way to protect folks' information.
Unfortunately, we are losing trust in the government. We have
had such a plethora of scandals in recent months that the
American people are losing confidence in their government, and
that is a bad thing. I mean, we can look to Fast and Furious.
We can look to Benghazi. We can look to the IRS scandal. We can
look to the broken promises of if you like your health
insurance, you can keep it, period. And Americans are losing
faith with their government.
We have to make efforts to regain that faith, the faith of
the American people, and we have to work towards good
government and transparency. That is part of what this
committee does, and it is my honor and privilege to be a part
of it.
And I will yield back the remainder of my time.
Chairman Issa. The gentleman yields back. Thank you.
And we now go to the chairman of the Rules Committee of the
U.S. House, and the reason that we are here today was an
invitation to hold this hearing in the Dallas/Fort Worth area,
Mr. Sessions.
Mr. Sessions. Mr. Chairman, thank you very much, and good
afternoon. And I do want to begin by thanking you, Chairman
Darrell Issa, the chairman of the Government Reform and
Oversight Committee.
This is one of a series of field hearings held across the
country that Chairman Issa and other members of Congress have
participated in which lead the investigative shortcomings of
what is known as the Affordable Care Act or Obamacare. And I
appreciate your leadership on this and so many issues that are
important to the American people.
I would also like to thank today the City of Richardson,
Mayor Laura Maczka, the City Council members, as well as the
people here at the Eisemann Center in Richardson who have made
this not only a great place to be but their hard work that was
included also.
Additionally, I would like to thank my fellow members of
Congress who are in attendance today: as you have heard,
Congressman Blake Farenthold from Corpus Christi, who is a
member of this Government Reform Committee, here to lend his
expertise and ideas to this hearing; Congressman Michael
Burgess, a member of the Energy and Commerce Committee and the
Rules Committee. I also want to thank the gentleman Randy
Neugebauer from Lubbock, Texas who is here, who has graciously
agreed to be here as part of this panel. We also recognize that
Congressman Marc Veasey, a brand new member of Congress who
responded that he would be here today, and I fully expect that
he will in a few minutes.
I would also like to thank our witnesses who are in
attendance today. We have the gentleman, Mr. Kevin Brady,
Deputy Chief of Staff of the Department of Insurance for the
State of Texas; Dr. Randy Farris, my friend from Centers for
Medicare and Medicaid Services; and Carolyn Goodwin, President-
Elect of the Texas Association of Health Underwriters.
Signing up for healthcare is one of the most important and
daunting tasks that Americans do today. Unfortunately, over the
last few months, what is known as Obamacare has made an already
difficult process even more confusing and daunting for
America's families.
Initially, President Obama promised that if you liked your
healthcare plan, you could keep it. Since then, millions of
Americans have received cancellation letters informing them
that they can no longer keep their preferred health insurance
plan.
President Obama also promised the American people that if
they liked their own doctor, they could keep their own doctor.
In reality, many people all across America are losing access to
their existing and preferred doctor under Obamacare.
But the confusion does not end with the administration's
broken promises. As Americans are forced to choose new
healthcare plans, they are facing higher premiums, as I do as a
member of Congress for my healthcare. Exactly as I had it
before is doubling in price, and I have a new $2,000
deductible, higher out-of-pocket costs, and changing networks.
The American people are frustrated with these changes, and it
is simply adding to the confusion surrounding their healthcare.
And then we heard this, and I would have you look at the
screen.
[Video shown.]
Mr. Sessions. Mr. Chairman, after learning that Navigators
here in North Texas were actively encouraging applicants to lie
on their applications, I asked you to hold a field hearing of
the Government Reform and Oversight Committee to help us to
better understand who are these Navigators and what is their
role.
I look forward to the testimony that we hear today to help
us not only to better understand this program but to hold
accountable the people who are hired with Federal money and who
really represent the American people.
Mr. Chairman, I yield back my time.
Chairman Issa. I thank the gentleman.
We now go to the gentleman from Texas, Mr. Burgess.
Mr. Burgess. I want to thank the chairman of the Oversight
and Government Reform Committee, the chairman of the Rules
Committee for calling this important hearing and allowing the
committee to hear how the Affordable Care Act is specifically
affecting Texas.
I have heard from a lot of constituents about how the
Affordable Care Act is having employers drop health coverage
for their employees, raising premiums and preventing
individuals from keeping their doctor and their health plan.
The President promised if you like your plan, you can keep
it; if you like your doctor, you can keep your doctor; and that
the law would cut annual health insurance costs for a family by
$2,500. We now all know that that was not true.
In the midst of these broken promises, even more concerning
is the issue that Federal officials have assigned much of the
responsibility for education and outreach to Federally funded
Navigators. Sixty-seven million dollars, $13 million more than
originally budgeted, has been given out to Navigators across
the nation, all at taxpayers' expense. So it begs the question:
Who are the Navigators?
And as your representative for the people in Denton County,
I am responsible to ensure that my constituents are protected
and that their money is well spent. I am concerned that the
Navigators are not properly vetted or trained. The Federal
requirements to become a Navigator are inconsistent, opening
individuals up to possible abuse of personal information.
In an effort to address this issue further, several members
of the Texas delegation--in fact, I think most of the
Republican members of the Texas delegation--wrote a letter to
Governor Perry, encouraging that the governor use his authority
to ensure that the Navigators that operate in Texas are
properly vetted, trained and certified.
So I certainly welcome our witnesses today.
Dr. Farris, it is always good to be with you. We have had
an opportunity to visit several times over the past 11 years,
and I always enjoy the time that we get to spend together.
But I welcome our witnesses to Richardson, and I will yield
back my time.
Chairman Issa. Thank you.
We now go to Mr. Neugebauer.
By the way, my chief of staff is Neugebauer, and I
apologize. I have been doing that to you for a decade. Thanks,
Randy.
Mr. Neugebauer. Thank you, Chairman Issa.
It is good to be here in Richardson, Texas, and also in the
home district of my good friend, Pete Sessions. I appreciate
the Chairman taking these hearings out to the American people.
There is probably no greater responsibility that members of
Congress have, and that is to do oversight, making sure that
the government is doing what it is supposed to be doing, and
doing it in a way that is effective, and doing it in a way that
is in the benefit of our country.
You know, we have had a lot of hearings, a lot of
discussions in a number of our committees about the Affordable
Care Act, or Obamacare, as it is referred to. I just recently
am on the Science Committee as well, and we had a hearing about
the website. As you know, the website has had a number of
problems, obviously people still having a difficult time
getting into the website.
But I think one of the more troubling things to me was to
learn that this website may be vulnerable to attacks, cyber
attacks. And why is that important to you and the American
people and families all across the country? Because some very
sensitive information is being put into this system. So
basically, if people can hack into these systems, then they can
get access to personal information on families and basically
possibly have their identities stolen.
The other thing that is going on and that won't be a part
of this hearing today is the discussion that we are hearing
from hundreds of letters that I know I am getting in my office
and I think other members are, too, and that is that we are
learning that all of the promises that were made about
Obamacare aren't coming true.
We are hearing stories about families losing access to the
health insurance policy, for example, that has been taking care
of their little girl that has cancer.
We are learning that the premiums that were affordable to
some families in the past now are not going to be affordable in
the future.
We are also hearing, unfortunately, about families that are
going to lose access to maybe a family physician that has been
serving that family for 20 or 30 years and now that physician
will no longer be a part of their plan.
These are very unfortunate things, and affecting a very
sensitive and a very important part of American families, and
that is their healthcare. So I think this is an appropriate
hearing today.
One of the things that concerns me about the Navigators--
and we want to learn more about this program today--is that
basically we have people that aren't being really vetted that
are going to be accessing very sensitive information about
families, about their Social Security number, about their
income. So what happens when they have access to this
information? If they wanted to use it in an inappropriate way,
they could basically steal someone's identity, basically
impacting their credit and their future.
So I think it is important that we know what is going on,
what is being done. I want to applaud the governor and the
state legislature for the things and the steps that they have
taken to make sure that people that are doing this basically
have some standard.
What we are also, I think, going to hear today is that, you
know, the people as a profession that advise people on
healthcare have to have a tremendous--a lot more training than
these Navigators are. And why is that important? Because this
is a very important decision, and one of the things we want to
make sure is that families have the information necessary to
make the very best decision on their behalf.
I thought it was interesting when some of the people in my
district began to learn that their identity could be stolen,
and one of my constituents wrote me a letter and said, ``You
mean this is going to be another promise, if you like your
identity, you can keep it?'' Well, let's hope that the
President, this is a promise that he can keep, because that is
a very important part.
So, Chairman Issa, I want to commend you for the oversight
that you and your committee have done, as well as some of the
other committees, because the American people deserve this kind
of oversight. This is in their best interest.
And with that, I yield back.
Chairman Issa. I thank you for your kind comments.
The gentleman yields back.
We now go to the gentleman from Texas, Mr. Veasey.
Mr. Veasey. Thank you, Mr. Chairman, members and witnesses.
I also want to extend a warm welcome to the members of the
committee, particularly from out of town, for coming all the
way to Texas for this very important field hearing.
I am glad to be here today because I would like to tell you
a little bit about how the Affordable Care Act is helping
constituents in the district that I represent, the 33rd
Congressional District of Texas.
I represent the congressional district that has the highest
number of uninsured in the entire country, or the highest rate
of uninsured in the entire country. Some of the insurance
companies have discriminated against them because they had
preexisting conditions. They have been allowed to charge women
more than men in many cases, and they have been allowed to sell
junk policies that collect premiums up-front but then don't pay
for individuals' hospital bills when they get sick.
But now that the Affordable Care Act is the law of the
land, it has already begun helping them in many ways, and it
will help them even more in the weeks and months and years to
come. Here in Texas and all across the country, millions of
adults now have health insurance on their parents' plans. They
can stay on it until they are 26. Millions of children with
preexisting conditions will no longer be denied coverage. Tens
of millions of seniors have already received free preventive
services, including new annual wellness visits, and consumers
have received rebates from their insurance companies which are
now required to spend at least 80 percent of premiums on
healthcare.
I understand that today's topic is specifically about the
Navigator program, and I know that the purpose of this program
is simple. It is to educate and enroll citizens in health
insurance. Reducing healthcare costs requires that everyone be
covered and that everyone be in the insurance pools. So
Navigators help people get healthcare coverage, some of them
for the very first time in their lives, and that helps them to
lower healthcare costs for everyone in the country. The model
for this enrollment effort is well established.
A very similar model was used here more than two decades
ago to implement the state's Children's Health Insurance
Program. The Texas Navigators are trusted. They are community
organizations and non-profits such as the United Way and the
Council on the Aging. They are also the churches in our
neighborhoods and the Chambers of Commerce.
Last month, when CMS was made aware that some employees of
the Urban League of Greater Dallas encouraged applicants to
provide false information on applications, they immediately
decertified the two individuals from participating in the
Navigator program. Of course, everyone here agrees that no one
should ever tell applicants to lie on their forms, and that is
why I was encouraged that the Urban League and CMS took swift
action in firing those who engaged in that activity. They give
this program a bad name. But make no mistake, they are the
exception. They are not the rule.
So while I am happy that the committee came to Texas today
to talk about these individuals, now that you are here, I hope
that we can talk about a much more significant problem, and
that is why our governor, Rick Perry, is refusing to expand the
state's Medicaid program.
[Applause.]
Mr. Veasey. We desperately need Medicaid expansion in this
state. The governor is refusing to accept billions of dollars
in Federal assistance that we so desperately need, and why he
is doing that, I can only imagine that it is for purely
political reasons. Governor Perry has denied those constituents
that I talked about earlier, where I have the highest rate in
the entire country. He has denied them coverage. Under the
Affordable Care Act, the Federal Government would pay states
100 percent of the cost of this expansion the first three years
and 90 percent after that, and yet the governor would rather
leave $9 billion on the table for our healthcare that our state
desperately needs.
So, Mr. Chairman, thank you for coming all the way to
Richardson, Texas to hold this hearing about a handful of
people that we agree absolutely have no place in this program,
but it is high time we started talking about the millions of
people right here in this state who absolutely have no
insurance at all and they are being denied coverage under the
Affordable Care Act.
Thank you.
[Applause.]
Chairman Issa. Thank you.
I would caution the audience that neither positive nor
negative is encouraged during an official hearing.
Members may have seven days to submit additional opening
statements and extraneous material for the record.
We now recognize our first panel of witnesses.
Mr. Kevin Brady is the Deputy Chief of Staff at the Texas
Department of Insurance. Welcome.
Dr. Randy Farris is the Regional Administrator for the
Centers for Medicare and Medicaid Services. Thank you again for
being here.
And Ms. Carolyn Goodwin is the President-Elect of the Texas
Association of Health Underwriters. Thank you also.
And if you would all, pursuant to the rules, please rise to
take the oath and raise your right hands.
Do you solemnly swear or affirm that the testimony you are
about to give will be the truth, the whole truth, and nothing
but the truth?
Please be seated.
Let the record reflect that all witnesses answered in the
affirmative.
In order to allow time, we have given you the universal
red, yellow and green that we all drive by. Green, of course,
means go. Yellow means go even faster. And red means you didn't
make it through the light. So if you would try to stay within
that 5 minutes, we would appreciate it. It would leave more
time for answers. I won't cut anyone off mid-sentence, but bear
in mind that your entire opening statements will be placed in
the record whether you stick to those or not.
So, with that, I will recognize ladies first, Ms. Carolyn
Goodwin.
WITNESS STATEMENTS
STATEMENT OF CAROLYN GOODWIN
Ms. Goodwin. Thank you very much, Mr. Chairman. I
appreciate the honor of being ladies first. And I need to
correct your record. I am not the President-Elect of the Texas
Association. I have already been there, done that. I am the
President-Elect of the ----
Chairman Issa. Of the national ----
Ms. Goodwin.--Dallas chapter.
Chairman Issa. The record is hereby corrected.
Ms. Goodwin. You have my written testimony, and I don't
want to take the time to read it, but I do want to add some
additional comments to that testimony for those in the
audience.
I have been in the insurance business for slightly over 20
years, and my job is to help small groups and individuals
uncover the maladies and the benefits of health insurance, and
help them meet their objectives.
There are a couple of things that I would like to talk
about with regard to what is the difference between a Navigator
and an agent and broker, which is what I am. A Navigator is
hired by one of the agencies. They are an employee who has a
job. They work with people either on the phone or help guide
them through the website.
Agents and brokers do the very same thing. We do it in the
private marketplace, except that there are 70,000 agents who
are now certified to work on the marketplace itself.
Now, the difference between me and a Navigator, I have to
have 40 hours of education. That is to get my license. And then
I have to take 30 hours of continuing education every two
years, including professional ethics, to keep my license, and I
must promise the carriers that I will be forever honest and
true. I also have to carry a professional liability policy that
is probably $1 million in face value, and if I do something
dishonestly, I don't lose my job, I lose my livelihood. I lose
my license. I can't do what I do today.
If I disclose PHI--that is the protected health
information--and I do it for profit, I can go to jail. If one
of my client employers does the same thing, they too could go
to jail. So there is a significant amount of risk to us to act
the way we do.
Now, do we just sell insurance? No. Much happens after the
sale of the policy, and I am going to give you an example of
what happened to me last week. I have a very dear friend who
has an individual policy, and for some reason the systems in
that policy said she had no prescription coverage. She was on
hold with the carrier for over two hours without result. She
came to me. I called the company. I got it corrected, and she
had her prescriptions within 30 minutes. That is what agents do
on a daily basis.
I don't think Navigators have that ability. They can't talk
to the carrier. They can't solve the problem that the insured
has.
If I could make one political statement, the Affordable
Care Act is not the promised healthcare reform. It is health
insurance reform. The cost of care and the increasing mandates,
both at state and Federal levels, continue to drive the cost of
insurance, and until those items are addressed, we are going to
have those escalated premiums over and over and over again.
Nothing has been done to control the cost of care.
Everything has been done to tell insurance companies how to run
their business.
I think I am done.
[Prepared statement of Ms. Goodwin follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Chairman Issa. I thank you.
We now go to Dr. Farris.
STATEMENT OF RANDY FARRIS, M.D.
Dr. Farris. Thank you, Mr. Chairman, and good afternoon,
Mr. Chairman and members of the Texas delegation. Thank you for
the opportunity to discuss CMS Affordable Care Act outreach
efforts, including the Navigator program. The Dallas Regional
Office plays an important role in working with community and
consumer groups, providers and other stakeholders throughout
the region to ensure that people understand the Affordable Care
Act and their new coverage options.
Over my 15 years at CMS, I have very much appreciated the
opportunities to work closely with many of you, as well as your
staff, on critical public health issues like emergency
preparedness, nursing home safety, quality improvement and Part
D enrollment and outreach efforts. During the Medicare Part D
rollout, we worked extensively with bipartisan congressional
offices to help seniors understand their new options and sign
up for prescription drug coverage. These efforts included
participating in congressional town halls, meeting with medical
societies and editorial boards, and helping with constituent
casework issues.
The Affordable Care Act requires similar types of outreach.
CMS is pursuing a variety of ways to provide outreach,
education, and enrollment assistance to the uninsured and
others seeking coverage through the marketplace. The Navigator
program enables qualified and well-trained individuals and
organizations to help consumers find and enroll in healthcare
coverage while adhering to standards and requirements designed
to ensure that taxpayer money is used appropriately on these
programs.
Navigators are helping consumers prepare electronic and
paper applications to establish eligibility, to find out if
they are eligible for affordability programs like premium tax
credits, cost-sharing reductions and Medicaid, and enroll in
coverage through the marketplace. Navigators also provide
outreach and education to consumers to raise awareness about
the marketplace.
As Texas has one of the highest numbers of eligible
uninsured residents in the country, eight grantees received
nearly $10.9 million in Federal Navigator grants for work in
the state. These grantees are groups and organizations with a
proven ability to reach out to likely marketplace consumers in
their local communities, many of which are located in the
Dallas-Fort Worth area.
For example, the United Way of Metropolitan Tarrant County
has served the people in the Fort Worth and Arlington areas of
Texas for over 90 years and is working across the state to
promote enrollment in the marketplace. The Navigator grant
program, its application process, its terms and conditions and
program oversight are informed by the Department of Health and
Human Services experience with grants management.
Navigators are trained on providing consumers with fair,
accurate, and impartial information, along with training on
standards to keep consumers' personal information private and
secure. Marketplace Navigators have regular refresher
opportunities where they can share updates, receive
information, and address issues as they are in the process of
helping people in their communities.
CMS takes allegations of suspicious activity and fraud
seriously and actively monitors complaints about potential
wrongdoing. Last month, CMS was made aware of incidents in
which employees of one Navigator grantee, the Urban League of
Greater Dallas, instructed consumers to falsify information on
their marketplace applications. CMS took immediate action to
officially decertify the Navigators identified in the videos
and to inform the National Urban League and its sub-grantee in
Dallas that they were non-compliant with Navigator regulations.
CMS issued a detailed corrective action plan outlining the
remedial actions that the National Urban League must take to
continue as a Federal Navigator grantee.
The National Urban League responded by suspending the
employees involved and has fully complied with the new
requirements. CMS also quickly issued a corrective action plan
to Houston-based Navigator Change Happens when a second
incident of improper conduct by an individual Navigator was
brought to our attention. CMS has alerted all Navigators
operating in the Federally-facilitated marketplace to emphasize
that encouraging consumers to provide inaccurate information is
against the rules of their agreements and could potentially
subject the Navigator and consumer to prosecution.
CMS will continue to vigorously monitor Navigator grantees
and the Federally-facilitated marketplace to ensure that
funding goes to the applicants who are most qualified to serve
their communities in this capacity and to ensure that they are
well-trained in meeting objectives and using grant funding
appropriately.
Thank you for the opportunity to speak today on this
important topic, and I will be happy to answer any questions
that you have.
[Prepared statement of Dr. Farris follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Chairman Issa. Thank you, Dr. Farris.
We now to go to Mr. Kevin Brady.
STATEMENT OF KEVIN BRADY
Mr. Brady. Chairman Issa, members of the Committee and
members of the Texas Delegation, my name is Kevin Brady and I
am here today on behalf of the Texas Department of Insurance.
Commissioner Julia Rathgeber wanted to be here today but
unfortunately she had a prior engagement. She sends her
apologies and included a letter to each of you, which is
included in the packet of information that we provided.
I would like to thank you for this opportunity to be here
today to talk about some proposed rules that my agency has
published for public comment on Navigators.
I would like to take just a moment to talk about TDI by way
of background. The Texas Department of Insurance is known as
the acronym TDI. We are charged with being the primary
regulator of the Texas insurance market. We are charged with
insuring fair competition, and we are charged by law with
protecting consumers.
In 2012, Texas consumers and businesses bought over $121
billion in insurance premiums. We believe that makes Texas the
12th largest insurance market in the world. To help put that
into context, it is about the same size as the entire Canadian
market.
We have over 1,900 insurance companies licensed in Texas.
That number increases to over 2,200 when all insurers with any
type of eligibility are included. The market also includes over
400,000 agents and other licensed entities.
During the 83rd Texas legislative session, lawmakers passed
and Governor Perry signed Senate Bill 1795, which requires the
Commissioner of Insurance to set standards ensuring that
Navigators can perform their required duties if the Federal
standards are deemed to be insufficient.
TDI has worked diligently to ensure a deliberate and
transparent process throughout the implementation of this bill.
We held an initial stakeholders meeting in September. We
followed that with numerous teleconferences with Navigator
groups, consumer groups, healthcare providers, and also the
Department of Health and Human Services. We also posted a
proposed outline of potential solutions on our website for
potential insufficiencies that were identified by agency staff.
The resulting rule proposal was published in the Texas Register
on December 6th.
The proposed TDI rules are necessary to provide a state
solution to help and protect Texas consumers by ensuring the
security of their private information and ensuring that they
are able to find health coverage from the Federally-facilitated
exchanges with the assistance of qualified Navigators. Under
the proposed rules, entities and individuals providing
enrollment services in the exchange would be required to
register with TDI.
The requirement for registration would include proof of
U.S. citizenship or other legal status to gain employment in
the U.S.; documentation of compliance with educational
requirements, including privacy and ethics training;
fingerprinting and background checks; and evidence of financial
responsibility to protect individuals from wrongful acts.
Navigators would be prohibited from certain functions,
including charging consumers for providing information about
health coverage; selling, soliciting, or negotiating health
insurance coverage; or recommending a specific health benefit
plan.
While in the course of performing Navigator duties, they
would be prohibited from electioneering activities or otherwise
supporting the candidacy of an individual for government
office.
Additionally, Texas insurance code provisions related to
privacy and the protection of personal information would apply
to Navigators.
TDI is going to hold two public hearings to receive public
comment. The first public hearing will be Friday of this week,
December 20th at 9:00 a.m. in Austin. A second public hearing
will be on January 6th. That coincides with the closing of the
public comment period. We would invite all parties to submit
comment either at the hearing or in writing to TDI, and the
proposals can change as a result of the comment received.
Mr. Chairman, I am going to close with that but would note
that we have additional information in the packages of
information that we have provided, including instructions for
providing public comment and the actual substantive
requirements of our proposed rules.
Mr. Chairman, thank you again for this opportunity to
testify on our efforts of both the state and the Texas
Department of Insurance that we are taking to protect
consumers. I would be happy to answer any questions.
[Prepared statement of Mr. Brady follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Chairman Issa. Thank you.
On September 18th, this committee issued a preliminary
staff report entitled ``Risk of Fraud and Misinformation with
Obamacare Outreach Campaign: How Navigators and Assisters
Program Mismanagement Endangers Consumers.'' I now ask
unanimous consent that the update of the staff report released
today be included in the record and used for comment during
this hearing.
Without objection, so ordered.
Chairman Issa. Mr. Brady, I am a Californian and an Ohioan
by birth, so if I miss one of these in the insurance questions,
feel free to shame me as much as you want. But you oversee car
insurance in this state?
Mr. Brady. Yes, sir.
Chairman Issa. The Federal Government tell you that you
have to have unlimited coverage on car insurance?
Mr. Brady. No, sir.
Chairman Issa. Do they provide people to sign up car
insurance at Federal expense?
Mr. Brady. No, sir.
Chairman Issa. Do you have worker's comp insurance in this
state?
Mr. Brady. Yes, sir.
Chairman Issa. Does it provide healthcare benefits for
people injured at work, in addition to lost wages?
Mr. Brady. Yes, sir.
Chairman Issa. Do they have Federal Navigators to make sure
that people know about this and get all the benefits?
Mr. Brady. No, sir.
Chairman Issa. Do you have title insurance, renters
insurance, home insurance? As a matter of fact, do you have D&O
insurance for public companies doing business in the State of
Texas?
Mr. Brady. Yes to all those questions.
Chairman Issa. Are there Navigators for any of these? Is
there Federal funding for any of these, or are there mandates
as to what these all have to be under Federal law?
Mr. Brady. Not to my knowledge.
Chairman Issa. So Obamacare is the only time, to your
knowledge, that the Federal Government has come in and mandated
with incredible detail what you must have and how you must have
it for insurance in this state. Is that correct?
Mr. Brady. Certainly on that scale. Yes, sir.
Chairman Issa. But you still get to be responsible for any
failures of your insurance companies. They are still state
insurance company licenses, right?
Mr. Brady. Yes, sir. If a company fails, we are charged
with basically taking it over.
Chairman Issa. This does kind of get me sometimes.
Dr. Farris, we wrote to Secretary Sebelius asking her why
there were no background checks for individuals who are
Navigators and assisters and suggesting strongly that there
needed to be. Do you know why to this day there is still no
background checks here in Texas and around the country for
Navigators?
Dr. Farris. Well, as we mentioned, there are a number of
different agencies with which we work, agencies like the
Community Council of Greater Dallas ----
Chairman Issa. No, I understand who you work with. What I
want to know is when people are taking individual information,
information that could be directly used to do identity theft,
why is there no background check for these individuals as part
of it?
Dr. Farris. These individuals that work for these umbrella
organizations like the Urban League or like the Community
Council of Greater Dallas, these are institutions that
traditionally provide help to people in the community who need
it. It would not be in their best interest to hire people who
would be felons or people who would participate in the sorts of
activities you describe.
Chairman Issa. Well, Dr. Farris, let me follow up on that
quickly. You say it wouldn't be in their interest, but in that
one video, it is in the individual's best interest to pay less,
and if they simply lie and say they don't smoke when they do,
that is in their best interest. If you have individuals who
only care about getting the highest subsidy for people and the
lowest cost, and you don't check them for whether or not they
are con men, how is it that the interest of protecting the
interest of the taxpayer is going to align with their best
interest?
And with all due respect to charity organizations, non-
profits, if they bring people in, brand new people to do this--
this is a new job--and they don't do background checks and you
don't require background checks, how do we know that the
taxpayer dollars are being well spent?
Dr. Farris. Well, we acknowledge that what happened with
regard to the Navigators in the film that you played was
absolutely wrong. There is absolutely no reason for people to
be encouraged to lie. That is not in anyone's best interest.
Chairman Issa. It is in the best interest of the person who
pays less because he lies about smoking.
Dr. Farris. But it is not in their best interest to lie
about a program like this. It is totally wrong, and we
acknowledge that.
Chairman Issa. You said in your opening statement that, in
fact, you had gone into detail and had all these things. What
is it that you have insisted on these organizations doing that
will prevent this in the future?
Dr. Farris. We work very closely with all of the Navigators
to make certain that they receive training on the protection of
personally identifiable information. We make certain that ----
Chairman Issa. You work closely. You just said that you
shop this out to other individuals and they get to do it
online.
Dr. Farris. CMS provides training that is ----
Chairman Issa. In-person training?
Dr. Farris. Weekly training that we do online and that we
do with webinars to train the Navigators on what their
responsibilities are with regard to protecting information with
regard to what they need to impart to people who would like to
sign up. These take place weekly.
Chairman Issa. Doctor, I said in my opening statement that
anybody could sit at the computer screen and take the test for
somebody else. Anybody could be at the webinar or, quite
frankly, be in the kitchen making breakfast. How is it you know
that you are working closely when, in fact, they are not in the
room is actually occurring?
Dr. Farris. We know because of the organizations that serve
as the umbrella organizations for the Navigators, which are
institutions which have great reputations and work with the
community and have traditionally provided good help and good
care. As I said, it would not be in their best interest to hire
people who would not represent them well.
Chairman Issa. Well, you know, I am in the ``trust but
verify'' business, and so far the trust has not been verified.
[Applause.]
Chairman Issa. Ms. Goodwin, I am just going to close with a
quick question to you. You mentioned it, but I think it is
worth asking one more time.
Ms. Goodwin. Yes, sir.
Chairman Issa. Anyone in your state, in the State of Texas,
who sells insurance or, in fact, even participates in that
process ----
Ms. Goodwin. Correct.
Chairman Issa. The assistant that takes phone calls and
provides follow-up information, if you will, your assistants,
aren't they all in this state covered by the requirement that
you know who they are and that they have tangible training and,
in fact, they be bonded?
Ms. Goodwin. Yes, sir. They are, and in our state, to
perform any duties described as the business of insurance, you
must have a license through TDI, go through the training and go
through the continuing education. If you are going to conduct
the business of insurance, you must be licensed.
Chairman Issa. Well, that would have served us well, I am
sure, here in Texas.
Mr. Farenthold?
Oh. Oh, I am sorry. I apologize.
Mr. Veasey, it is tradition to go to the members of the
committee and then the non-members of the committee. So I don't
want it to be a slight, but we will go to you right after Mr.
Farenthold.
Mr. Veasey. Absolutely.
Chairman Issa. Mr. Farenthold?
Mr. Farenthold. Thank you, Chairman Issa.
I will start with a question for Mr. Brady.
You listed out a number of requirements that Texas is
trying to put on Navigators, and they all seem like commonsense
requirements that would make a lot of sense, including some
background checks and such.
But do you think knowledge of all the information and rules
within the Texas law is something that can be imparted in a 20-
hour-or-less training session for a Navigator, along with all
the information necessary to be a Navigator?
Mr. Brady. I guess the best benchmark that I have is the
requirements that we have for insurance agents. They vary
somewhat. We have a lot of different types of agent licenses,
and the requirements are a little different from license to
license. But one thing that is required is a pre-licensing
examination, and the applicant has to pass the exam with a test
----
Mr. Farenthold. Do you have to appear in person to do that?
Mr. Brady. Yes, sir. It is a proctored examination.
Mr. Farenthold. So unlike a Navigator who can sit
anonymously behind a computer and do it, you show up and prove
who you are to take the test.
Mr. Brady. Yes, sir.
Mr. Farenthold. All right. Let me ask you another question.
If I were to go to a private insurance agent in Texas, is there
a way for me to verify that that person is properly licensed
with the State of Texas and has passed these exams?
Mr. Brady. The Department licenses agents. They issue
licenses that agents can show the license.
Mr. Farenthold. All right. Great. Now, let me ask Mr.
Farris, is there a way for somebody to tell whether someone is
a certified Navigator or is just posing as a Navigator? I read
some reports of some scam artists offering to get people
Obamacare cards and things like that. What mechanism is in
place that I can ensure that someone I am talking to or one of
my constituents is talking to for help with Obamacare has
actually gone through this extensive 20-hour training course?
Dr. Farris. Yes. The Navigators who complete the training,
pass the test, do receive certification that they are certified
Navigators. If you would like to know if the Navigator that you
would like to deal with has achieved that certification, they
do have the certification with them.
However, you can look on the ``Finding Local Help'' on the
website and they can tell you where the umbrella organizations
are in your community that are responsible for the Navigators,
and then working through that way, you can find out a
particular Navigator and be assured that that Navigator has
received a certification.
Mr. Farenthold. Okay. Does that part of the website work?
Dr. Farris. That part of the website works.
Mr. Farenthold. All right. Let me go now to Ms. Goodwin.
We have this extensive Navigator system that we have
created. Was this even necessary, or is this something that
could have fallen within the purview of normal insurance
agents? Could you guys have taken this on, and would it have
been economical for you all to take it on, or were we forced to
go to this more community organization type of system?
Ms. Goodwin. In my personal opinion, I think agents could
have taken care of it much better than it has been taken care
of so far.
[Applause.]
Mr. Farenthold. All right. Well, those were the bulk of my
questions. I don't know if we are going to have a second round
of questions or not. I know we are tight on time, so I want to
go ahead and let the other members get their questions in. As a
member of the Oversight Committee, we have had, and I am sure
will continue to have, numerous hearings on this topic, and I
will have plenty of opportunity to do questions, while some of
the members that we have brought in under unanimous consent
don't necessarily have the privilege of participating in this
committee's hearings. So I will yield back.
Chairman Issa. I thank the gentleman.
We now go over to the gentleman from Texas, Mr. Veasey.
Mr. Veasey. Thank you, Mr. Chairman.
Before I begin, I wanted to ask if I could request
unanimous consent to enter the letters from the following
elected officials on Navigators and the critical need for the
Affordable Care Act.
Chairman Issa. Without objection, so ordered.
Mr. Veasey. And also, Mr. Chairman, I request unanimous
consent to submit the following statements, letters from seven
community healthcare centers, clinic Navigators and other
groups, into the record.
Chairman Issa. Without objection, so ordered.
[The information follows:]
Mr. Veasey. Thank you, Mr. Chairman.
I wanted to talk specifically and ask questions about
expanding Medicaid. As most of us know, one of the most
critical features of the Affordable Care Act is its expansion
of Medicaid eligibility to millions of low-income adults. Prior
to the ACA, Medicaid eligibility was restricted primarily to
low-income children, their parents, people with disabilities,
and seniors. In most states, adults without dependent children
are not eligible.
Under the ACA, Medicaid eligibility can be expanded to
cover all non-elderly adults with incomes below 138 percent of
the Federal poverty level. The Federal Government would pay
states 100 percent of the cost for the first three years, and
then phase that down to about 90 percent in 2020, like I stated
earlier in my opening comments. Are those numbers correct, Dr.
Farris?
Dr. Farris. Those numbers are correct, to my knowledge.
Mr. Veasey. Okay. Dr. Farris, by not participating, the
governor is leaving significant resources on the table that
could be used for citizens here in the Dallas-Fort Worth
metroplex and across the state. Is that correct?
Dr. Farris. I can only state that every state has the
ability to either accept or reject the Medicaid expansion. In
the case of the State of Texas, the decision was made not to.
Mr. Veasey. And we talk a lot about this, obviously, the
expansion of Medicaid, but can you tell us why the expansion of
Medicaid specifically is a very important component of the
Affordable Care Act?
Dr. Farris. Well, part of the reasoning behind the
Affordable Care Act is to make certain that people who have
traditionally been uninsured are able to have insurance
coverage such that they can receive things like preventive
care, such that they can get care from physicians rather than
going to an emergency room when they are in extremis.
When you have some sort of insurance, regardless of the
type of insurance, you do have the ability to seek ongoing care
as opposed to care that is rendered once a person becomes ill,
which will make the cost of care, as we have heard earlier
today, much lower if people have the ability to stay healthy,
as opposed to try to get diseases treated. That was part of the
premise of the whole Affordable Care Act, and also the premise
of ensuring that people get health insurance.
Mr. Veasey. One of the things that we have talked a lot
about is the Medicaid expansion and individuals that are being
covered or are not being covered. But I think one of the myths,
or maybe even illusions out there, is that people are not being
covered, and I wanted to ask Mr. Brady a question.
As you know, Mr. Brady, under the Emergency Medical
Treatment and Labor Act, people cannot be denied treatment when
they arrive at emergency rooms. Is that correct?
Mr. Brady. Sir, I am not familiar with the Act. I have a
general impression that people that go to hospital districts
with taxing authority generally will have their emergency needs
met. But it is a very rough impression.
Mr. Veasey. Dr. Farris, when people go to the medical
emergency room and they are treated, these uncompensated costs,
are they passed along to taxpayers? Where do these
uncompensated costs go?
Dr. Farris. They are passed along. And with regard to
EMTALA, that is part of my responsibility at CMS, and my role
as Consortium Administrator for Quality Improvement and Survey
and Certification Operations, we ensure that people who do show
up in emergency rooms receive a screening exam and
stabilization through EMTALA, as you have said, and that is
something that we are concerned about, to make certain that
people have those screening exams.
But part of what we hope to do is to make certain that
people don't have to wind up in emergency rooms as a result of
things like pneumonia or diabetes or situations that could be
prevented by proper ongoing care.
Mr. Veasey. Mr. Brady, I don't know if you saw this study.
I know that you obviously see a lot of different studies come
across your desk, but one that our staff found was that the
Texas Health and Human Services Commission said that
uncompensated claims for the State of Texas in 2006 were more
than $11 billion.
Doesn't it make fiscal sense to expand Medicaid in our
state, which would not only provide needed care for millions
who don't have it, but likely keep the same population from
seeking emergency visits where they cannot pay their bills?
Mr. Brady. Sir, I work for the Texas Department of
Insurance in the State of Texas. The administration of that
program is done by a completely different state agency. I am
not familiar with the policy of that agency.
Chairman Issa. I thank the gentleman.
We now go to the gentleman from Texas, Mr. Burgess.
Mr. Burgess. Thank you, Chairman.
Dr. Farris, let me just ask you for a moment about the
issue of preexisting conditions. Texas has had a risk pool for
some time, has it not?
Dr. Farris. It has.
Mr. Burgess. How does that work?
Dr. Farris. Well, the risk pool provides monies for the
treatment of people who have some preexisting condition to be
able to be seen. It is not as comprehensive as what we have
tried to achieve with doing away with the preexisting
conditions clauses.
Mr. Burgess. Let me ask you a question. I don't mean to
interrupt, but my time is limited.
Dr. Farris. Yes.
Mr. Burgess. Is that risk pool coming to an end?
Dr. Farris. I am not certain.
Mr. Burgess. Well, I talked to Ms. Rathgeber at the Texas
Department of Insurance a little earlier this fall and I
suggested that, I think from a statutory standpoint, yes, the
risk pool was sunsetted on December 31st, the concept being
that the Affordable Care Act will now pick up that slack,
except that there is now a growing concern the Affordable Care
Act is not ready. So Commissioner Rathgeber, I think quite
wisely, found a way to extend that for a period of time for
those people who are in the Texas risk pool. Is that correct,
Mr. Brady?
Mr. Brady. Was that question directed at me?
Mr. Burgess. Yes. The extension of the Texas risk pool?
Mr. Brady. Yes, sir. There were emergency rules that were
adopted to extend the Texas risk pool, I believe for three
months, to the end of March.
Mr. Burgess. So I would just submit here, we labor under
this illusion that the Affordable Care Act is going to save us
from the conundrum of preexisting conditions. But look what has
happened to the Federal preexisting program. Since February of
2013, no new patient has been able to enroll in the preexisting
program.
Now, for whatever reason, the press has chosen to ignore
that, but we heard testimony in our committee in Washington
last April from a woman with lymphoma who had been trying to
wait out the waiting period to get into the Federal preexisting
program, had waited her required six months. When she showed up
on February 1st she was told sorry, sister, this window is
closed, you can't get into this program, we are full up. And
this is the notion there that we sell stuff, but we never
intend to do the follow-through. I am truly bothered by that.
Every time I hear someone bring up the issue that, oh, the
Affordable Care Act is great, we are covering people with
preexisting conditions--no, we are not. No, we are not. And we
are not going to. I don't know when that coverage will kick in.
Now, look, I will just tell you, I have had my own
experience with healthcare.gov. I chose, for whatever reason,
not to go through the congressional insurance. I am just going
to the website. It is tough.
Have you done it, Dr. Farris? Have you gone to
healthcare.gov and tried to buy insurance for yourself, for
your family?
Dr. Farris. I have.
Mr. Burgess. And what has been your result?
Dr. Farris. Well, I have been able to get through.
Mr. Burgess. Did you pay the money?
Dr. Farris. I haven't yet because my son is graduating from
law school. I am hoping he will get a job and I won't have to
do that for him.
Mr. Burgess. Here is the problem. The fundamental unit of a
business transaction is when a man pulls out his billfold and
pays the money.
Dr. Farris. Right.
Mr. Burgess. I have not been able to pay my money. Now here
we are, a week away from December 23rd, and I am wondering if I
am going to get in under the wire.
Oh, by the way, we just extended that wire to January 31st.
If the insurance companies happen to agree, and even if I don't
get signed up by January 31st, maybe we can coerce the
insurance companies to cover me retroactively. I am sorry, that
doesn't give me a feeling of confidence in the way this program
is going to work.
Dr. Farris, you and I are both physicians. You and I know
how difficult it is to run a practice, how your accounts
payable every month is something you sweat because you don't
know whether you are going to get the cash in to keep your
business open. What is going to happen to doctors' offices,
hospitals, nurse practitioners after the first of the year if
there cannot be assurance that this enrollment has, in fact,
occurred because someone has paid the man the money and the
coverage is in effect? Who covers that? Is HHS going to cover
that?
Now, you remember when Part D came online. The pharmacists
kind of got--they were worried. They were filling prescriptions
they didn't know if they were going to get paid or not.
Secretary Levitt, to his credit, Dr. Martin Cullen, to his
credit, said we will make good on all of those prescriptions
that are filled.
Is the Secretary going to make good on all the care that is
delivered after January 1st for which someone, it turns out, in
fact, was not covered when they thought they were covered?
Dr. Farris. Well, Congressman, I can't answer that. I am
not involved in those policy decisions at my regional level.
Mr. Burgess. Well, let me just address one other issue. You
talk about people winding up in the emergency room, expansion
of Medicaid. I would stress that expansion of Medicaid was not
statutory the way Medicaid is now structured. That was a court
opinion, not statutory. The statutory was the states had to do
it. The court said you can't coerce the states, so now it is
voluntary.
So a state like Texas, there is no time limit on it, like
there was with the exchanges. The exchanges said you have to
tell us by whatever it was, January 7th of this year, that you
are going to be in the exchange. But with Medicaid, there is no
time limit because it was a court opinion.
So another session of the state legislature, it is quite
possible they could look around the country and say, you know
what, we like what they did in Arkansas, we like what they did
in Iowa, we would like to modify that for Texas. So that is
still a possibility, is it not?
Dr. Farris. It is.
Mr. Burgess. Now, let me just stress there is also the
possibility, we have another debt limit coming up. I don't know
whether it is May or August or October, but there will be a
point where another debt limit breach is threatened in the
United States Congress, and if Congress doesn't raise the
statutory debt limit, there could be big trouble. Sometimes
there are things that are bargained away, as you saw with the
White House and with Congress during the sequester in August of
2011.
What if there is a sequester that affects entitlement
spending? Who protects those states that have expanded their
Medicaid? What protection do they have that those Federal
dollars, in fact, don't flow? Because you and I both know they
don't exist.
Dr. Farris. Again, that is not a policy question that I can
answer. That is something that is done in Washington and
Baltimore, not at my level.
Mr. Burgess. And let me just stress, Dr. Farris, because
you and I have known each other for a while, and we have worked
together in both Republican and Democratic administrations, and
you are a dedicated career civil servant, and I appreciate what
you have done to further the issues that you are tasked with
furthering. I will just tell you, there are so many open
questions about this, so many things, so many questions are
unanswered, and it really wasn't necessary. The Department,
HHS, has had three-and-a-half years, longer than three-and-a-
half years now, billions of dollars, and to be no further along
than we are today on December 16th is truly discouraging to me.
I yield back, Chairman.
Chairman Issa. I thank you.
Mr. Neugebauer?
Mr. Neugebauer. Thank you, Mr. Chairman.
Ms. Goodwin, I think in your testimony you mentioned that
you are required to carry liability insurance?
Ms. Goodwin. Errors and omissions. Yes, sir.
Mr. Neugebauer. And why is that?
Ms. Goodwin. To protect my clients if I should do something
that causes them financial harm.
Mr. Neugebauer. Would you classify advising someone on
their health insurance is a fairly complex transaction?
Ms. Goodwin. Absolutely, it is.
Mr. Neugebauer. Is it an important one?
Ms. Goodwin. It is a very important one.
Mr. Neugebauer. So what protections do the people that are
using Navigators to basically navigate through this process, if
they cause that person to make a decision that is not in their
best interest?
Ms. Goodwin. I am not certain of the existing regulations
with regard to that coverage. I do know that the Texas rules
call for a minimum of, I think, $100,000 in liability. Maybe it
is $50,000. I can't remember, but a much lower amount than
agents are generally required to cover.
Mr. Neugebauer. But the real damage is if someone makes a
healthcare decision that causes them to have some kind of a
catastrophic loss because they didn't have the coverage that
they thought they had. That is the bigger issue, is it not?
Ms. Goodwin. That is.
Mr. Neugebauer. Mr. Brady, I think you mentioned that Texas
requires 40 hours of education, background checks,
fingerprints. You listed a litany there. Why does Texas require
that?
Mr. Brady. Sir, if I could ask for a clarification. Are you
asking about our proposed rules, or are you asking about the
requirements that apply to licensed insurance agents?
Mr. Neugebauer. Just licensed and brokers, yes.
Mr. Brady. Two primary thoughts come to mind. One is there
is a desire to make sure that the applicant for the license has
the minimal educational requirement necessary to know about the
business of insurance. But also there are requirements to know
about the Texas regulatory environment. So that is one broad
category.
The other important pre-licensing function that we perform
is the background check, and we obtain fingerprints, we do the
criminal background checks, tapping into databases with the
Texas Department of Public Safety, and also the Federal FBI to
see if there are bad apples out there.
Mr. Neugebauer. When someone takes an insurance
application, I guess they give their name, their address, their
date of birth. They give a lot of very personal information,
and that is very sensitive information, is it not?
Mr. Brady. Yes, sir. I will note that there are a number of
laws in the Texas insurance code regarding the privacy of
personal information, all designed to protect that information.
Mr. Neugebauer. Thank you.
Dr. Farris, one of the things that I think I mentioned in
my opening testimony that you may have heard is that we had a
hearing in the Science Committee, and one of the things that we
learned is that the website has got a lot of vulnerabilities to
potential people hacking into that system. So the system itself
is somewhat suspect as to whether people's personal information
is, in fact, safe with the website.
But even with the Navigator, is the preference still for
people to sign up for Obamacare through the website?
Dr. Farris. Well, there are actually four ways that a
person can sign up. One would be through the website. One would
be through a 1-800 number that we have that operates 24 hours a
day, seven days a week, and operates in over 150 different
languages. Then people can also sign up using Navigators or
other application assisters, as you have heard.
We have trained about 70,000 agents and brokers to help
people to sign up for care, for insurance. And then the fourth
way would be through a paper application. There are some people
who are comfortable with paper. There are some people who are
comfortable with computers. There are some people who would
rather deal with a live person such as a Navigator or an
insurance agent or broker, or some certified application
counselor. We have trained about 19,000 of those.
Mr. Neugebauer. I want to go back to something you said
earlier. I want a clarification. You said that you give
Navigators a certificate once they have completed the course.
So do you send them an identification card that says I am a
Navigator?
Dr. Farris. Well, the certification that they receive
states that they have completed the Navigator training and have
successfully passed the examination.
Mr. Neugebauer. So if I wanted to go online and see, for
example, Dr. Burgess, if he is a certified Navigator, could I
ascertain that?
Dr. Farris. Could you do what?
Mr. Neugebauer. In other words, is there a website where
somebody identifies themselves as a Navigator and I wanted to
verify that, is there a place where I could go say ----
Dr. Farris. In order for a person to actually sign up with
a Navigator, they have to do it in-person. They don't actually
do that over the phone. When you deal with a Navigator, you sit
and you deal with them face to face. So that way, the person
can show you their certification that says that they have
actually--and you can set up an appointment to go in and see
them so you can be certain that you are dealing with who you
think you are.
Mr. Neugebauer. But I couldn't verify that. In other words,
unfortunately, there are people in this country who know how to
counterfeit things. So there is not a way for me to go and
ascertain whether someone is actually who they say they are?
Dr. Farris. I will have to check on that. I can get back
with you on it just to make certain that there is a way to
verify.
Mr. Neugebauer. So is there a way for me to go to someplace
on a Texas website and determine whether someone is a licensed
broker or agent in the State of Texas?
Mr. Brady. As I commented earlier, one of our jobs is to
protect consumers, and one of the services that we provide is
an opportunity for members of the public to access our website
to see if insurance companies are licensed, if insurance agents
are licensed. We try to put that out as a check to make sure
that the public knows that they are dealing with trustworthy
individuals.
Mr. Neugebauer. And so what we are learning is that that
same protection is not afforded to people that are dealing with
Navigators, I guess, because there is really not a way to
verify those folks.
Thank you, Mr. Chairman. Appreciate that.
Chairman Issa. Thank you.
Dr. Farris, do you have pictures of all the Navigators?
Dr. Farris. I do not.
Chairman Issa. Do you have fingerprints of all the
Navigators?
Dr. Farris. Not that ----
Chairman Issa. Do you have Xeroxed copies of their driver's
licenses?
Dr. Farris. I would have to check on that. I don't know.
Chairman Issa. So my understanding is if somebody is just a
plain fraud and they walk in and say, ``I am Joe Smith,'' but,
in fact, they are Sam Jones, and Sam Jones is a felon, and they
just come in with a false name, they can go through this
process, and they can take the test and get certified. Now they
have a certificate.
Is that certificate something that I can go online and see
what it looks like to verify that the one they are showing me
is the same, or do they just print it out when they graduate?
Dr. Farris. I would need to check on that, as well.
Chairman Issa. I am pretty sure they just print it out when
they graduate.
Let me go through a couple of questions. You are a long-
time career Federal employee. Are you CSRS or FIRS?
Dr. Farris. FIRS.
Chairman Issa. So you are FIRS. So you are covered by
FEHBP?
Dr. Farris. Yes.
Chairman Issa. So why would you go on the website when you
are covered by the Federal Employee Healthcare Benefit Plan,
and how would you buy under Obamacare when the only healthcare
plan you have is the FEHBP?
Dr. Farris. I wouldn't buy it for me. I was looking at it
for my son, who is ----
Chairman Issa. Okay. So you went on the website pretending
you were your son.
Dr. Farris. No. I did not go on the website ----
Chairman Issa. You went on the website, and you had to put
a name in. You didn't put your name in, did you?
Dr. Farris. I did. We have the same name.
Chairman Issa. Okay. So you are a person covered by the
Federal Employee Healthcare Benefit, and you went on the site
and said I am checking this out. What did you put in for your
salary?
Dr. Farris. My son has no salary. He is a law student.
Chairman Issa. Okay. So you put in your name but no salary.
Dr. Farris. Right.
Chairman Issa. Okay, and I appreciate your candor. These
are some of the things we have been looking at. Apparently you
had no trouble getting into something. I notably tweeted out
the error I got trying to go on. But you can go on, you can say
you have no salary, you can say you are somebody, and had you
gone through and completed it, you would have had healthcare.
At least you would have had the coverage.
Dr. Farris. No. But I didn't.
Chairman Issa. Okay. Well, thank you for your honesty of
not doing it.
Sometimes you just can't make these things up.
[Laughter.]
[Applause.]
Chairman Issa. Now, we do a Census every year, every 10
years, but we don't use subcontractors to ask people about
where they live and so on. We actually hire you through the
Census system. Isn't that right?
Dr. Farris. Yes.
Chairman Issa. And because my committee oversees that, we
are well aware that we do take that identifiable information,
we do have specific records, and we do attempt to run
background on people who work for the Census, even though all
they are really doing is going to a door and asking Census
information.
Does it concern you that today anybody can, in fact, become
a Navigator, and they could be somebody with a felony, somebody
who is in the business of identity theft, and you don't have a
picture of them, you don't have their fingerprints? So if later
on, sort of like that video they showed us, if later on you
discover that, in fact, they are crooks, and then they simply
disappear, you are not going to be able to go fire them or ask
that they be suspended. Is that right?
Dr. Farris. Well, I go back to what we originally said in
terms of the organizations that we work with who hire these
people, that they would do the necessary checks to make certain
that they are not hiring felons, which they usually don't.
Chairman Issa. Okay. Right. And I have one last question,
doctor. You used the word ``suspend'' for these individuals. I
am kind of a funny guy. The people that screwed up Benghazi,
they got suspended, except they didn't lose a day's pay and
they are back on the job today because their suspension ended.
When you say ``suspend,'' do you mean they were fired, or
do you mean that they were suspended, that nebulous state in
which they are not currently out there advising people to do
crooked things?
Dr. Farris. I am aware that one of the persons in training
was fired, and I know that they were all decertified so that
they can never be Navigators or any type of in-person
assisters. But I think the term ``suspend'' was correct, except
for the one that I know was fired.
Chairman Issa. Okay. So one was fired. The other may still
be being paid to do something, including they could be
administering this information, and I will be brief.
There are four ways to get to your insurance, but they all
go to the website, right? Ultimately, if you call up, the
person you talk to is on the website. If you work with a
Navigator, they turn the paper in to the website. Ultimately,
everything goes through the website. So if there is a security
vulnerability or corrupt information in any way, shape or form,
it is all the website, right? I just want people to understand
that.
Dr. Farris. Except that the website does not store any
information. It certainly does not store any personally
identifiable information. The data services hub is used to test
information that a person puts in, but it does not store it. So
it doesn't leave it vulnerable.
Chairman Issa. You are aware that people have received
other people's information. One person signs up in one state,
and somebody else gets a confirmation in another state.
Dr. Farris. No, I was not aware of that.
Chairman Issa. You need to watch a little more Fox, I am
afraid.
[Laughter.]
Chairman Issa. With that, we now go to Mr. Sessions.
Mr. Sessions. Mr. Chairman, thank you very much.
Ms. Goodwin, you and other of your Texas certified agents,
as they perform their duties, are they asked specific
information before there is an offer or a sell, things like
whether a policy has specific coverage, a specific doctor, or a
specific hospital for coverage?
Ms. Goodwin. Part of our process as an agent or broker is
to evaluate all of the carriers that we represent to our
clients, to gather the information about the contract coverage,
how it is covered, how prescription drugs are covered and what
those levels are, and a particular doctor or series of
physicians, are those physicians and hospitals in the network
for that carrier. That is part of our job.
Mr. Sessions. Are you aware of something that might be
known as a deceptive trade or sales practice?
Ms. Goodwin. Uh-huh.
Mr. Sessions. Thank you very much.
Dr. Farris, thank you for being here today. I have worked
with you in my years of service as a member of Congress and I
found every time that you have not only been available to me
but you have promptly tried to assist me or explain to me any
impediment that was placed in its way, and I want to thank you
very much for being here today.
Dr. Farris, how long have you worked for the Federal
Government?
Dr. Farris. Seventeen years.
Mr. Sessions. Some 17 years. And during that time, you have
been a valuable asset, I know, to your organization. Did they
in any way approach you as they were putting together the
Navigator program and ask your feedback, or were you pre-
trained in any way?
Dr. Farris. No.
Mr. Sessions. No. Did anyone from Washington, D.C. ever
tell you this is part of the plan about how we are going to go
and roll this plan out?
Dr. Farris. No.
Mr. Sessions. Have you taken part in the training or seen
the specific training that the Navigators were given?
Dr. Farris. I have, yes. I have not taken it myself, but I
have seen it.
Mr. Sessions. You are aware of that training?
Dr. Farris. Yes.
Mr. Sessions. And do you consider it leading-edge and, in
your professional opinion, on par with the ability for people
to offer insurance plans and to be able to discuss this that
was part of what is known as Obamacare? Do you believe that
they were well trained?
Dr. Farris. Well, what we want people to be able to do
through the Navigator program, number one, is explain health
care insurance to people who may have never been insured and
who may not understand what health insurance is all about; to
explain what could be available to them in terms of various
affordability options, the various tax credits, as well as just
general information about insurance, health insurance in
general, and to get them signed up.
So there are a number of different facets that are involved
in the Navigator training that involve not just enrollment but
also education and outreach to people such that they are aware
of the existence, of the ability to have some health insurance.
Mr. Sessions. Yes, sir. You used the word ``general,'' and
I used the word ``specific'' when addressing the questions to
Mrs. Goodwin. Can you tell me that the Navigators, then, as
opposed to the term ``general,'' were they specific in their
ability to provide information about doctors, about coverage,
about hospitals, about how things would happen?
Dr. Farris. No. The answer to that would be no.
Mr. Sessions. No. So, in other words, we have Navigators
who are out and, in essence, selling, offering a product or
service in the State of Texas, and they cannot offer a specific
but rather a general idea about what this insurance might
include. Is that your testimony?
Dr. Farris. It is designed to be an impartial program where
they are not directing anyone to a specific product, but to
help them to make choices and to understand that there are
choices that are available to them, and to understand the whole
insurance market, not to put them into a specific plan. The
Navigators cannot make that choice for them.
Mr. Sessions. As a professional for 17 years, are you aware
of and would you consider yourself as the Federal
representative on behalf of CMS that you have a specific
understanding of how coverage would work here in Texas
specifically?
Dr. Farris. I don't think I--well, clarify the question a
little bit better for me.
Mr. Sessions. Well, the word ``specific'' is the word that
I used for Mrs. Goodwin, and it is specific coverage, specific
doctors, specific hospitals, not that you would know them off
your head but that you could accurately go and look these items
up and issues up as the professional on behalf of CMS in the
State of Texas.
Dr. Farris. No, I don't believe I could.
Mr. Sessions. So, in other words, your testimony is here
today, as the professional on behalf of CMS, you could not
provide that information, yet Mrs. Goodwin would be required by
the law to offer very specific information.
Dr. Farris. I think that would be true.
Mr. Sessions. That would be a fair statement. Do you
believe that we provided you ample opportunity as we announced
this hearing today, that we properly and professionally
approached you?
Dr. Farris. Yes.
Mr. Sessions. Okay.
I would like to ask, if I can, Mr. Brady a question.
Chairman Issa. Without objection.
Mr. Sessions. And that is, Mr. Brady, as you find people
who are selling products and services that are within your area
that might be health and other insurance matters, does it
disturb you that here we are, even at the backside of this
process, that professionals in the State of Texas that
represent the Federal Government are incapable in testimony
today of providing specific information about products and
services that would be offered in the State of Texas that is
within your purview?
Mr. Brady. Sir, I think it would be best to answer that by
saying that if someone wants to act like an insurance agent,
there is a rigorous pre-licensing examination process and pre-
educational process that they have to go through. The
Navigators are actually, pursuant to our proposed rules,
prohibited from acting like an insurance agent unless they
obtain a license. And then if they obtain a license, then these
proposed Navigator rules would not apply.
The reason I note that is that I think it hits to the heart
of the issue that I believe you are raising, the differences
between specific knowledge and more general knowledge. If we
want someone to be giving specific advice, we under the
proposed rules would say they are going to be held to a higher
standard and are going to be licensed as an agent.
Mr. Sessions. Mr. Brady, are you aware of a letter that was
sent by some 13 attorneys general to Secretary Sebelius on or
about August the 4th that related to questions about
Navigators?
Mr. Brady. Yes, sir. I was provided a copy of the letter.
Mr. Sessions. Would you be surprised if I told you that
three months later these attorneys general have not been
replied to by the Secretary?
Mr. Brady. It is difficult to respond to, sir.
Mr. Sessions. Mr. Brady, if you were asked by an attorney
general to provide information back by 13 attorneys general,
would you believe you would have a diligence placed upon you to
respond back to legal authorities in their own states?
Mr. Brady. Yes, sir.
Mr. Sessions. Mr. Brady, I have one last question, and that
is for you and Dr. Farris, and perhaps it relates to me and
perhaps it does not. But there are many, many families who have
disabled children who count on specialty hospitals, children's
hospitals that have special tools, special doctors, special
beds, special equipment.
Would it surprise you if I told you that many of these
children's hospitals are not covered, nor will they be included
in the proposals for the Affordable Care Act, that they were
intentionally excluded? Would that surprise you?
Mr. Brady. Sir, was that directed to me?
Mr. Sessions. Mr. Brady, would that surprise you?
Mr. Brady. I think the best way for me to answer that is we
are hopeful that the public can get their healthcare needs met
and would be concerned if there are gaps in network coverage.
Mr. Sessions. Mr. Brady, would that surprise you--yes or
no?--if a children's hospital to a large measure was not
included?
Mr. Brady. It would tend to surprise me, sir.
Mr. Sessions. Thank you, sir.
Dr. Farris, would it also surprise you?
Dr. Farris. It would surprise me, yes.
Mr. Sessions. It would surprise you. Thank you very much.
Mr. Chairman, thank you very much.
Chairman Issa. I thank the gentleman.
I would note that we had a previous hearing in which
doctors, including a major facility in Florida and another one
in New York, testified to exactly that, that they were
excluded, specialties were excluded by the exchange insurance
quotes in order to drive down the price, and we will send you a
copy for the record.
Mr. Veasey, do you have additional questions?
Mr. Veasey. Yes, yes. Thank you, Mr. Chairman. I did want
to ask some Navigator questions.
Dr. Farris, I know that it has been suggested that the
Navigator program is somehow unprecedented and that a parade of
horribles could result from community organizations and non-
profits from providing consumers with information on how they
can get enrolled. But, Dr. Farris, I wanted to ask you
specifically what types of Texas organizations applied for
Navigator grants under the funding announcement that CMS has
released.
Dr. Farris. Well, a number of organizations like the United
Way of Tarrant County, the Community Council of Greater Dallas,
the United Way of Central Texas, the Brazos Valley Council of
Governments, the City of Houston Department of Health and Human
Services. I can tell you that in Arkansas, the University of
Arkansas.
Mr. Veasey. All large, national, reputable organizations --
--
Dr. Farris. Yes.
Mr. Veasey.--that have a very broad experience in helping
individuals ----
Dr. Farris. Yes.
Mr. Veasey.--in a bipartisan, non-profit type manner that
has a very good reputation, particularly the United Way in the
metroplex here. Did these organizations have to submit
information regarding their experience and history?
Dr. Farris. They did, and they were all vetted by a panel
of experts. Their applications were screened. The proposals
that they submitted were evaluated to make certain that they
could provide these services in a cost-effective manner, and
their track records in terms of being able to deal with the
community and all facets of the community were looked at to
make certain that they had that ability as well.
Mr. Veasey. I know that one of the things, again, that has
been suggested is that this is unprecedented for the Federal
Government to use Navigators and what-have-you to help people
sign up for insurance, but let me ask you a question. Didn't
the Federal Government use assisters in the enrollment of the
Children's Health Insurance Program, or CHIP, back in the late
1990s in the state?
Dr. Farris. It is my understanding that they did.
Mr. Veasey. Okay. I think that we all can agree that the
Affordable Care Act is a heavy lift as far as getting people
enrolled and what-have-you, because you are talking about
enrolling millions of people at once, many of whom have never
had insurance in their lives. We should obviously encourage
data security, Navigator training, but we should also not
attempt to impede implementation.
Dr. Farris, are the recent actions of the state
unprecedented in seeking to limit public access to the Federal
program?
Dr. Farris. Well, all states have the ability to look at
the program and to make a determination as to whether or not
they think that the procedures and the parameters should be
more stringent than the ones that have been proposed, and I
know the State of Texas has taken a look. They have reached out
to CMS, as well as to CQISCO, for some discussions, and it is
actually probable that as we are speaking today, the State of
Texas is sitting down with people at CQISCO looking at ways
that they can work together with regard to the Texas proposals.
Mr. Veasey. I know that many state elected officials have
expressed concern about the recent actions of Texas Insurance
Commissioner Julia Rathgeber, and I would like to submit into
the hearing record a letter signed by 54 members of the Texas
House of Representatives requesting an extension of a December
the 20th deadline for public comment on Navigators.
Chairman Issa. Without objection, so ordered.
Mr. Veasey. Mr. Brady, have you seen that letter signed by
the 54 Texas legislators?
Mr. Brady. Very briefly, sir.
Mr. Veasey. Okay.
That is all I have, Mr. Chairman. Thank you.
Chairman Issa. I thank you.
We now go to the gentleman, Mr. Farenthold.
Mr. Farenthold. I just have a couple of quick follow-ups.
Mr. Farris, you have testified that you can become a
Navigator by taking an online webinar with no fingerprints, you
all don't even keep a copy of the driver's license, there is no
photo. Is there even a description of the person on the
Navigator certificates?
Dr. Farris. I am not aware. I will be happy to check to
find out exactly what we do keep.
Mr. Farenthold. Okay. And it is my understanding that a
member of our staff with the Oversight and Government Reform
Committee, in under three hours, was able to complete the
Navigator course, and his certificate was simply printed out on
a laser printer. Now, I am no expert forger, but I know how to
use Photoshop. This one sounds like you might be able to do it
with a pair of scissors, scotch tape, and a photo copier. Don't
you think we need to know who the Navigator is that we are
trusting with our personal information and discussions about
our healthcare needs?
Dr. Farris. I am really intrigued by the fact that you say
they were able to do that in three hours and print it out
themselves. I would like to get some more information on that,
if I could, and share that with our folks in CQISCO.
Mr. Farenthold. I will have the committee get in touch with
your office and share that information with you.
Dr. Farris. Yes. Thank you.
Mr. Farenthold. Now, are you familiar with the Office of
Personnel Management within the government?
Dr. Farris. I am.
Mr. Farenthold. You know, they have a nice little side
business where they run background checks. Now, we have had
some issues with how well they do it, but there is a pretty
sophisticated procedure that runs background checks very
frequently. Is there any reason HHS didn't decide to avail
themselves of that for checking out folks? Again, it would be
required to have access to your personally identifiable
information.
Dr. Farris. Those sorts of policy decisions are made at
CQISCO and they don't ----
Mr. Farenthold. I understand. Not all good decisions--okay,
most decisions that come out of Washington may not be--anyway,
we won't go into that.
Let me ask one other quick question, and I will ask this
one to Mr. Brady. What are the remedies now that you are aware
of that a consumer has against a Navigator who either gives him
bad advice or appropriates information? I notice Ms. Goodwin
has to carry insurance. I think she says she has tens of
thousands of dollars, or more, worth of insurance. What are our
remedies against Navigators, and what is the guarantee that
they have the resources to pay those damages should someone
prevail in pursuing them?
Mr. Brady. Sir, earlier I mentioned that Senate bill 1795
from the last Texas legislative session charged us with looking
at the Federal requirements.
Mr. Farenthold. But that hasn't been enacted yet. So if you
go to a Navigator now, you don't have that protection.
Mr. Brady. Yes, sir. What I am leading to is that one of
the insufficiencies that we identified was what I am going to
call a lack of recourse. Because of that, the proposed rules
that I briefed earlier would require financial responsibility.
It could be in the form of a $100,000 errors and omissions
policy--I am sorry, a professional liability policy that
includes errors and omissions coverage. There are a couple of
other options. But it was because of this gap, if you would,
that we have decided that we would propose a rule that would
put some financial safety net programs in place.
Mr. Farenthold. Unfortunately, under the law, I have to go
into the D.C. exchange or I think I would probably be availing
myself of a professional agent instead. But, of course, I am
complying with the law.
And I will yield back.
Chairman Issa. I thank the gentleman.
Mr. Sessions, you had one more, quickly?
Mr. Sessions. I did, Mr. Chairman, and they are really more
comments related to some feedback that I have heard today.
Chairman Issa. Could I ----
Mr. Sessions. Yes.
Chairman Issa. I will finish with the questions and I will
let you close, because this is really something you helped put
together.
Dr. Burgess?
Mr. Burgess. Thank you, Mr. Chairman.
Mr. Farenthold brought up the concept that, through the
Office of Personnel Management, that background checks are done
and could be done. Gary Cohen, who is the head of the Center
for Consumer Information and Insurance Oversight, earlier this
year testified that he didn't think that they had the authority
to require Navigator organizations to conduct background checks
of individuals, and they didn't know whether they had the funds
to do this.
Now, this is interesting because on July 4th of this year,
Robert Pear, writing in the New York Times, talked about a
British company called Serco. Serco we had into our committee,
the Committee on Energy and Commerce, that was talking to the
contractors who were involved in the rollout of the Affordable
Care Act, and Serco, their only job is to take paper
applications and put them in for people.
It turns out that is a pretty expensive process because we
are paying Serco a lot of money to do that. On a per-
application basis, it is in the thousands of dollars. But
nevertheless, every Serco employee has to have a background
check. They have to be fingerprinted, and they have to have a
background check.
So I would just submit that although Mr. Cohen didn't think
it was reasonable or feasible to do that with Navigators,
certainly the Department of Health and Human Services required
that of Serco.
Ms. Goodwin, let me just ask you a question, because Dr.
Farris mentioned dealing with people who have not had a lot of
experience with insurance policies, so I guess we might use the
term ``insurance literacy.'' Part of the job of the Navigator
is to explain what the policy contains and what it covers. This
is what a broker does as well, the concept of being able to
explain, oh, say, what a 60 percent actuarial value policy
really means to the person who is buying it. Would that be your
experience?
Dr. Farris. To whom are you addressing that?
Mr. Burgess. I was addressing it to Ms. Goodwin, but anyone
is free to answer it.
If you have a policy that is 60 percent actuarial value,
and that is what you are buying because it is the cheapest one
on the block, somebody needs to tell that purchaser what that
60 percent actuarial value means, correct?
Ms. Goodwin. Yes.
Mr. Burgess. And what it means is that that person may have
a significant deductible, I mean more than significant, I mean
astonishingly high as far as a deductible, $6,800 on an
individual policy, and they also may be required to spend a
significant amount of money on co-insurance in addition to
their deductible. Is that not correct? The answer to the
question is yes.
Ms. Goodwin. That is correct.
Mr. Burgess. Now, the President, because he loves us, said
he was going to put a cap on out-of-pocket expenses, except
that the President suspended the cap on out-of-pocket expenses
for the first year. So those people buying a 60 percent
actuarial value policy in the Bronze metal level may be in for
a significant amount of sticker shock when they actually go to
the doctor. They have been making their premiums or they get
their subsidy for their premiums, and then they get a kidney
stone at 2 o'clock in the morning, they shop up in the ER, and
they get a bill for $3,500 or $4,500 that they have to pay.
They may have difficulty understanding that concept, may they
not? Are the Navigators going to explain to them that this is a
possibility? Would a broker explain that, Ms. Goodwin?
Ms. Goodwin. Absolutely.
Mr. Burgess. Dr. Farris, would a Navigator explain that?
Dr. Farris. I am not certain that a Navigator would.
Mr. Burgess. So what is likely to happen to that $4,500
bill from the doctor or the hospital that comes to that patient
if they don't know that it is coming?
I will tell you what. They are going to walk the check. It
happens all the time. So the uncompensated care that was talked
about earlier in this discussion, there is nothing in the
Affordable Care Act that is going to make that go away. In many
ways, it may get worse if we are not doing an adequate job of
explaining. The brokers and agents I feel comfortable will. I
am not sure that the Navigators themselves understand that or
are given enough instruction to be able to impart that to their
customers.
Thank you, Mr. Chairman, for the additional time. I will
yield back.
Chairman Issa. Thank you.
Mr. Neugebauer?
Mr. Neugebauer. Thank you, Mr. Chairman.
Dr. Farris, when did you first hear about the news where
people at this Dallas Navigators were telling people to lie on
their applications? How did you come to have that knowledge?
Dr. Farris. I actually saw it on the news.
Mr. Neugebauer. You saw it on the news.
Dr. Farris. Yes.
Mr. Neugebauer. So I think you issued a letter asking them
to take corrective actions. Have you followed up to see if they
have taken those actions?
Dr. Farris. Yes. They have taken those actions. Again, they
have decertified the people who were involved. There are weekly
reports that they have to submit to us to let us know about the
specific training that they are providing now on an ongoing
basis to make certain that they understand what their
responsibilities are with regard to personally identifiable
information. We also have pretty much weekly check-ins with
them, and we reserve the right to do site visits.
Mr. Neugebauer. That was my next question. Are you doing
audits to follow up and make sure that these actions are
actually being taken?
Dr. Farris. Yes.
Mr. Neugebauer. Just with this agency, or with all of the
----
Dr. Farris. With all of the Navigators. In fact, there was
a program on Friday that was a webinar where we talked about,
with all of the Navigators in the country, what had happened at
the National Urban League to make certain that this is never
repeated again. So they understand that ----
Mr. Neugebauer. So are those site visits of people from CMS
traveling around the country doing that, or how does that work?
Dr. Farris. That will actually be managed out of CQISCO,
and they will determine who goes and when. But the site visits
will need to be unannounced visits in order for them to have
any validity at all.
Mr. Neugebauer. So when you find those actions, then what
is the step? I mean, is there a process to revoke if you find
an agency is not properly following those? Can they revoke
those?
Dr. Farris. There are a number of different remedies that
are in place, starting with the corrective action plan. But if
we find really egregious problems, we can certainly revoke the
licenses that they have in order to provide these services.
Mr. Neugebauer. Off the top of your head, can you tell me
approximately how many site visits have been done?
Dr. Farris. I can't. I would have to get that information
from CQISCO. I don't know.
Mr. Neugebauer. Could you get that for me?
Dr. Farris. We will be happy to get back with you on that.
Mr. Neugebauer. I thank you.
Thank you, Mr. Chairman.
Chairman Issa. Thank you.
Mr. Sessions?
Mr. Sessions. Mr. Chairman, thank you very much.
I want to thank all three of you for being here today. I
would like to say that there have been a couple of things said
here that I would take issue with, and one of them is
statements that were made that critics--perhaps they were in
reference to members of Congress--are attempting to make it
more difficult for the American people to sign up for
Obamacare.
And I would like to plainly state that as a result of the
testimony, Mr. Chairman, that we have had here today, I find
that the Navigators, which is why we are here today, are
incapable of properly and professionally selling a product that
people can count on, that they can understand, and I find it is
non-specific. It cannot provide a person information about a
physician, about coverage, or about a hospital.
And I am deeply disappointed and want to make sure that no
one would draw the conclusion that it is someone else other
than the Federal Government and the President and the Secretary
themselves who are making things far more difficult and who I
believe are impeding progress. They are selling a product, and
in the State of Texas I believe it would be deceptive for them
to do this. A deceptive trade practice would be against the
law, and that is what is happening.
Secondly, a viewpoint that these Navigators are non-
partisan and simply representative of just regular, everyday
groups in America that are non-partisan and non-political. But,
in fact, Planned Parenthood is receiving millions of dollars
across the country, and for us to try and sell the idea that
all this is just a good neighbor type of reaching out and
talking with people I find is not only deceptive, it is not
true.
I yield back my time.
Chairman Issa. I thank the gentleman.
I would like to thank our witnesses today. You have been
asked tough questions. We have stretched your roles in many of
those questions, and I appreciate your attempting to answer.
There are many problems with the Affordable Care Act. We
knew it would be hard. I don't think any of us knew it would be
this hard.
We are less informed than we would like to be on a lot of
areas, but we are more informed because of your testimony here
today.
As we continue to look at the Navigators, as the State of
Texas and other responsible insurance commissioners and agents
begin to look at what the proper role is for a Navigator, I
don't envy you your job. To the extent that they are simply
taking information and having it forwarded to a computer to see
if you can get cheap or free insurance subsidized, or Medicaid,
I think it is not insurance.
To the extent that they have any level of competency in
advising people on whether to go with the Bronze plan or Gold
plan, whether or not something would be covered, whether or not
a particular hospital or specialty would be covered, whether it
is right for you and your family, I do share with the State of
Texas and the insurance commission that this is a serious
question that falls under the state's responsibility and
historic knowledge, and I would hope that Texas would find a
way to make sure that what they can do they are allowed to do,
and what they cannot do without further training,
identification, bonding and the like, that Texas asserts its
full authority.
Dr. Farris, I want to particularly thank you. This was not
easy. You came here to answer tough questions at a time in
which a program is new, but it is a program that I think we all
understand affects countless millions of people, and although
it has promise for some, it has peril for many.
And with that, I would also like to thank the Texas
delegation. I found myself saying ``the gentleman from Texas,
the gentleman from Texas, the gentleman from Texas,'' and I
think back to when I interviewed with Johnson & Johnson in
Sherman, Texas, and I am saying there but for getting hired by
Johnson & Johnson, one of you could be my congressman.
[Laughter.]
Chairman Issa. I thank you.
We stand adjourned.
[Applause.]
[Whereupon, at 3:24 p.m., the committee was adjourned.]
APPENDIX
----------
Material Submitted for the Hearing Record
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]