The former head of the agency overseeing healthcare-reformimplementation disagreed with state officials Friday over the needfor insurance agents in the purchase of health insurance once theexchange system kicks in come January.

“The beauty of the exchange system is that, if it works, youdon't have to use an agent,” said Jay Angoff, the first head ofOffice of Consumer Information and Insurance Oversight at theDepartment of Health and Human Services in comments at a NationalConference of Insurance Legislators (NCOIL) panel discussion overhow the states are faring in implementing the law.

“You can go directly to the Internet, you don't have to use anagent, and if you want to use an agent, you can, but you don't haveto,” Angoff said.

“I would hate for exchanges to build in the extra expense thatrequires people to use an agent that raises the price of insuranceto be more than it should be based on the electronic system,”Angoff said.

Mila Kofman, executive director of the Washington, D.C.-basedHealth Benefit Exchange and former Maine Insurance Commissioner andformer NCOIL President Rep. George Keiser, R-N.D., disagreed.

Kofman replied to Angoff by saying that, under the exchangebeing created in D.C., consumers and small businesses can purchasehealth insurance without using the exchanges, and that D.C.residents and businesses won't be charged for using agents to gethelp. “The cost is built into the price health insurers charge, andis based on a per-member, or per-month fee,” she said.

Kofman added, “In the District…we are relying heavily on theinsurance agents and brokers, building them into our informationtechnology for the exchanges, so consumers using our onlineapplication system who want to talk to a broker, have questionsabout the different policy choices available to them—they can justclick on the button and choose among licensed, trainedhealthcare-insurance brokers for help.”

Keiser said, “We believe strongly, and we are different fromother states, in maintaining the integrity and value of the agentsand brokers, who are licensed, regulated and knowledgeable abouthealthcare sales, as we go about implementing the exchange in NorthDakota.”

Angoff, now in private practice in the district as a partner atMehri & Skalet in Washington, D.C. was the first head of theOffice of Consumer Information and Insurance Oversight at theDepartment of Health and Human Services. He left the agency lastfall.

The different views on how states are implementing the exchangesand the role they foresee for agents and brokers in the exchangetook place during a National Press Club Newsmakers program, titled,Obamacare on the Ground, How is the Affordable Care Act TakingShape in the States?

The law, the Patient Protection and Affordable Care Act,mandates establishment of health-insurance exchanges in every stateby Oct. 1. The system goes into effect Jan. 1.

The law requires every exchange—whether state-based orfederally-operated—to have a navigator program.

The law says that navigators must comply with any licensing,certification or other standards required by states.

At the same time, NCOIL, which held its spring meeting hereduring the weekend, adopted a resolution urging local policymakersto establish a state-based regulatory framework for navigators andin-person assisters that would ensure a strong role foragents.

Wes Bissett, outside senior counsel, government affairs for theIndependent Insurance Agents and Brokers of America, said, “TheIIABA welcomes NCOIL's recommendations concerning navigators andstrongly agrees that states are best suited to oversee this newcategory of entity and protect consumers. Ensuring that there isproper scrutiny over navigator qualifications and behavior is goodpublic policy.”

In their comments at the NPC Newsmakers event, Keiser and Kofmanagreed.

“We have grave concern in North Dakota about creating thousandsof navigators out there that were offering an additional service,such as AARP, Chambers of Commerce, labor unions, who did notunderstand insurance but were out there giving insurance advicewith no ability to control once it got out of the box,” Keisersaid. “They have no regulatory authority.”

He added, “So we felt strongly that we should maintain theintegrity of the 21,000 insurance agents and brokers in our state.It wasn't fence-building. We believe that providing advice onhealth insurance is extremely important.”

Kofman said one aspect of her job is helping people determinewhether they are eligible for Medicaid and to figure out whetherthey are eligible for premium tax credits. “We are focused on thebrokers to help people figure out what is the best health planoption that is best for that family or that small business,” shesaid.

At the same meeting, Sen. Neil Breslin, D-N.Y., said that in NewYork, “we are trying to make sure that navigators are objective,don't have an interest, are not likely to be questioned on theadvice they give.”

So far, he said, “that seems to be working well.”