09/26/2013 04:54 pm ET Updated Nov 26, 2013

HCAN Report: How the Republicans Are Suppressing Obamacare Enrollment (Updated)

Republicans at the state level aren't counting on Congress to repeal Obamacare. That's why they've been systematically using a tactic of their own to blow up the health law.

Governors and state legislators are adopting state laws and regulations to sabotage the work of "navigators," the community organizations that will help consumers sign up for care.
Republican governors in 21 states are already denying more than 5 million people health care by refusing to expand Medicaid. Navigator suppression is another way for the Obamacare haters to pile on and limit the reach of the law.

Navigator Sabotage. In a new report, Health Care for America Now conducted a detailed review of the most egregious laws and regulations found in 13 selected states: Arkansas, Florida, Georgia, Iowa, Illinois, Indiana, Maine, Missouri, Montana, Ohio, Tennessee, Texas and Wisconsin. These states are home to 17 million people without health insurance who are eligible for coverage under the health care reform law--fully 41 percent of the nation's uninsured.

The excessive requirements we found include such things as residency rules, extra fees, additional and unnecessary training requirements, superfluous certification exams, and prohibitions against navigators talking with consumers about the benefits offered by different plans. These measures constitute direct interference in the enrollment process.

We are witnessing navigator suppression, and the Republicans' objective is simple: deny the rights of millions of Americans to get the health care they need and interfere with the effective implementation of the Affordable Act..

For example, in Missouri, state and local officials are barred from providing any assistance to an exchange. In Florida, the Department of Health released a directive prohibiting navigators from conducting outreach at any of the county's 67 health departments. Fortunately, two big counties, Broward and Pinellas, are fighting back and ignoring the order.

And just this month, Texas Gov. Rick Perry ordered the Insurance Commissioner to write new navigator regulations that require, among other things, that navigators complete 40 hours of training in addition to the 20 hours required by the ACA and then pass a "rigorous" state exam. Perry is even trying to limit the hours of navigator operations to 8 a.m. to 5 p.m. None of these rules is going to help get people covered in Texas, which has the nation's highest percentage of uninsured residents.

Immediate Impact. These obstacles and restrictions have caused groups to withdraw from the program and return their navigator grants. Most recently, the Lower Rio Grande Valley Development Council along the Texas border with Mexico just returned $288,000 in navigator grant funds in response to Perry's attack, and four other Texas navigator groups reportedly may follow suit.

This is is the sort of obstacle President Obama referred to yesterday when he criticized the Republicans for creating "roadblocks" for the "churches and charities" working as navigators to educate the public about enrollment.

Possible Court Challenge. Attorney Jay Angoff, a former high-ranking official at HHS, is considering filing a class action lawsuit on behalf of various plaintiffs who may challenge the constitutionality of these laws because they violate the supremacy clause of the U.S. Constitution. In this case they prevent the application of the Affordable Care Act by restricting the ability of navigators to carry out prescribe duties under the law.

The Republicans claim these laws are about protecting consumers. But Georgia's commissioner of insurance cleared that up when he boasted on video that he was doing everything he could to be "an obstructionist" to Obamacare.

Some of the Obamacare opponents may think they're attacking the president or the law, but mostly they're hurting real people with real health care needs. They're making it harder for people to buy health care. This isn't just an abstract political debate. For people without health insurance, this is about whether or not they can get medical care and get it without going bankrupt.

That's why navigator suppression shocks the conscience: It perpetuates the systematic denial of affordable health care to huge numbers of the most vulnerable individuals in our society, especially those in minority and lower-income populations.

This blog post also appears in Politix.