Clashes between state and federal law continue with Missouri lawmakers advancing proposed changes to the federal Affordable Care Act (ACA).
In Missouri or other states, similar conflicts have arisen concerning gun laws, same-sex marriage and marijuana legalization.
To help people enroll in health insurance, the ACA created navigators, defined in the federal law as "any private or public entity that is ... qualified, and licensed if appropriate, to engage in navigator activities ..."
Some state lawmakers seek more specifics.
The state Senate last week approved a law that would require navigators to pass a written examination and undergo a criminal background check. Separate legislation would require navigators to purchase a $100,000 bond in case they are sued for sharing confidential information.
These proposals come in the aftermath of a law passed last year that requires navigators to be licensed, which includes receiving 30 hours of training and payment of a small fee. A federal judge last month issued a preliminary injunction against the state law on the grounds that it imposes requirements not specified in federal law.
The state efforts to alter the ACA are largely the work of Republicans, who contend they are trying to shield Missourians from unqualified or fraudulent navigators. "This doesn't prevent people from using the exchange," said Sen. Kurt Schaefer, R-Columbia. "All we are trying to do is protect Missouri citizens."
Opponents, primarily Democrats, see the state laws as impediments. "My biggest concern is that all we are doing is adding barriers for people to get health care," said Sen. Paul LeVota, D-Independence.
Erecting barriers is the default strategy when efforts to eliminate fail, and Democrats are acutely aware of repeated unsuccessful efforts by congressional Republicans to nullify the ACA.
Missouri Senate Minority Leader Jolie Justus, D-Kansas City, sees the state alterations as attempts to change the rigging after the boat has sailed. The federal government gave states the option of operating their own exchanges or deferring to the federal government, and Justus makes a strong case that when Missouri accepted the federal exchange, it forfeited its authority to make changes.
If Republicans are motivated by protection rather than obstruction, we believe they attained their goal with passage of last year's licensure law. We are inclined to await a final court ruling on that law before advancing similar bills that may be invalidated.