Oklahoma Insurance Commissioner John Doak

Earlier this month, Oklahoma Insurance ​Commissioner John Doak testified before a U.S. Congressional Committee that he wants Congress to eliminate Navigators,​​ the community workers who help enroll people in health care under the Affordable Care Act​. Doak told Congress that he opposes these Navigators because they compete with private insurance agents and brokers.​

Now, Commissioner Doak is ordering Oklahoma Navigators ​to turn over their enrollment data to his agency. ​Doak’s rhetoric when making the request implies that he plans to use the data to argue that these workers are a waste of federal dollars. But ​in both the letter to Navigators and his testimony to Congress, Commissioner Doak is not telling the whole story.

​Navigators are ​vital for assisting people who have not been insured before​ to get health care

Health insurance is complicated and expensive, and enrolling in insurance as an individual can be very difficult, even for people used to dealing with it. That’s why the Affordable Care Act authorized trained community workers known as Navigators to help enrollees understand their options (Medicare has a similar program). Unlike insurance brokers, Navigators can’t be paid more for steering enrollees to particular plans, and they are trained to help enrollees apply for Medicaid if they are eligible. There are more than 200 Navigators and similar workers registered in Oklahoma.

The Trump administration recently slashed Navigator funding, using out-of-context data to argue that the program is ineffective, and Doak has parroted this talking point. But reality is more complex.

Navigators are a crucial part of helping people enroll in health coverage, especially those who face challenges enrolling on their own. One in three of the clients who Navigators assist don’t have internet at home, limiting their ability to research on their own. One in ten people assisted speak a language other than English, while individuals with disabilities or complex medical needs need time to closely review their options, so helping a single enrollee can take a lot of time. Compared to private insurance brokers, Navigators help more individuals who are low-income and uninsured, and their clients are more likely to be Latino or require translation services.

Navigators are required to provide unbiased information to anyone who asks for assistance, but their biggest value comes with helping those who are least likely to be able to evaluate their options and enroll on their own. Doak’s insistence that Navigators are unnecessary is an attack on one of the only programs helping the most marginalized people in Oklahoma to get insured.

Attacking Navigators threatens an already fragile health insurance marketplace i​n Oklahoma

While ACA isn’t broken or failing in Oklahoma, it is delicate — and more confusion will only make the problem worse. Oklahoma’s uninsured rate has dropped by 22 percent since 2013 — a real accomplishment, but still much less of a drop ​than the US average, let alone similar states like Arkansas that have been bringing all of the ACA’s benefits home for their people.

Oklahoma’s comparative lag in covering the uninsured is due to both national and local factors. Last January, the Trump administration cut off advertising in the final weeks of Open Enrollment, driving enrollment down. In Oklahoma, headlines trumpeting record premium spikes (which generally didn’t mention that most enrollees saw no increase in costs due to premium subsidies) almost certainly depressed enrollment, especially since only about half of uninsured adults are aware that premium subsidies and other financial help are available.

News of insurers leaving the state’s Healthcare.gov marketplace may also have suppressed enrollment. However, the remaining insurer, Blue Cross Blue Shield, has from the beginning covered the majority of people in Oklahoma and continues to offer plans in all 77 counties. Enrollment in Oklahoma is also lower because many uninsured Oklahomans remain stuck in a coverage crater while the state refuses federal money to expand Medicaid​. This gap in eligibility for Medicaid and eligibility for tax credits to buy insurance on Healthcare.gov makes it harder for Oklahomans to know if they qualify for the tax credits — and about a fourth of Oklahoma’s current uninsured population would actually qualify. A long record of Oklahoma officials attacking the ACA and spreading misinformation about the law likely hasn’t helped.

Commissioner Doak ​has a history ​​of spread​ing​ misinformation about the A​ffordable ​C​are ​Act​

Doak has a long record of disingenuous claims about the health care law. Before enrollment on the ACA’s individual marketplace first opened in 2013, Commissioner Doak forecasted “skyrocketing premiums,” a claim that was not based on real data and that did not turn out to be true. A few months later, after enrollment concluded, Doak blasted the cost of the Healthcare.gov website per enrollee, neglecting to recognize that the cost would be spread out over successive enrollments periods.

Commissioner Doak warned this spring that Oklahoma’s remaining insurer was in danger of leaving the state without presenting any evidence to support his claim. In June, an Insurance Department press release vaguely referenced “many insurers…resorting to double digit premium increases,” while failing to mention that Oklahoma’s marketplace insurer had requested one of the smallest premium increases in the US this year — just 8.7 percent. And testifying before Congress with a panel of state Commissioners earlier this month, Doak argued against the bipartisan fixes that are favored by a large majority of Democratic and Republican insurance commissioners across the country.

The bottom line

Speaking before Congress in early September, Commissioner Doak reiterated his opposition to the ACA and to Navigators in particular. Now his agency is ordering Oklahoma’s Navigators to turn over their enrollment data by the end of the month. Given past experience, we can expect that the data will be used out of context to ​try to sabotage enrollment — just before this year’s Open Enrollment period starts on November 1.

Let’s hope this doesn’t happen. After all, with Navigators’ federal funding still uncertain, with a shortened enrollment period and almost no advertising planned, with the state trying out a new and ambitious reinsurance plan, and with the third-highest uninsured rate in the country, it would be highly irresponsible for the state Insurance Commissioner to destabilize Oklahoma’s health insurance marketplace further.