State officials say they need 20,000 people for the job of signing up millions of Californians for health insurance in the coming months, but a battle is brewing over whether these workers should undergo background checks and fingerprinting.
At issue is the level of screening these "assisters" should receive before they handle confidential information about the people they are enrolling this year in the state's new health insurance exchange, called Covered California.
These enrollers, who will earn $58 from the state for every application completed, would have access to highly sensitive consumer information such as Social Security numbers, dates of birth, income data and tax returns.
Covered California, the state agency implementing the federal healthcare law, says these enrollment advisors must be thoroughly screened to deter fraud and protect consumers. But critics say the state's proposal is overly intrusive and will prevent too many minorities from helping at a time when enormous manpower and quick action are required.
"I understand some form of background check is likely, but I have fears about adding bureaucratic mountains that slow us down," said Robert Ross, a Covered California board member and chief executive of California Endowment, a healthcare foundation. "There are people who have turned their lives around and who are trusted by the most difficult-to-reach populations. Not having their talent and expertise could be a problem."
These 20,000 assisters across California would not be government employees. Nonprofit and other community groups that are working with the state on outreach and enrollment will be responsible for recruiting and hiring many of them.
The federal law calls for these assisters to play a crucial role in explaining an array of new insurance options as well as complex terms such as deductibles and cost sharing to a range of Californians, many of whom don't speak English or have easy access to the Internet.
The state's goal is to enroll 1.4 million Californians next year and eventually reach more than 5 million residents who are uninsured or may qualify for federal premium subsidies. By January, most Americans must buy health insurance or pay a penalty under the federal Affordable Care Act.
Carla Saporta, health policy director at the Greenlining Institute, a nonprofit group that advocates for racial and economic justice, has urged the state insurance exchange to proceed carefully.
"Background checks would create barriers for a lot of communities of color and disproportionately exclude African American and Latino men from participating," she said. "We need a massive amount of people to help with outreach."
Next week, the exchange board is expected to discuss this issue and establish its rules for background checks. Other states are wrestling with similar issues as they scramble to implement the federal healthcare law in time for enrollment to begin in October.
California insurance officials, insurance agents and other patient advocates say they are surprised by the level of resistance to rigorous screening.
"I was just shocked that groups that represent the consumer interest summarily dismiss what I think is a very real probability of immense consumer fraud," said California Insurance Commissioner Dave Jones. "I'm very concerned we will have a host of problems without a system of background checks, fingerprinting and monitoring, which weeds out criminals."
Health insurance agents in the state undergo fingerprinting and background checks every two years. Since January 2011, state officials have revoked licenses of 514 agents or brokers on all forms of insurance. Some of the most common complaints include misrepresentation, fraud and improper handling of premiums.
"Regrettably, we see far too many cases of identity theft, embezzlement and outright fraud," Jones said.
The proposal for fingerprinting enrollers, in particular, has encountered the most criticism. Ross said "fingerprinting can come across in many of these diverse, ethnic communities as a scary, big-government thing."
Jones said fingerprinting is essential for searching law enforcement databases for information that a mere background check would not reveal.
The exchange board also faces decisions on what types of offenses should warrant disqualification. Some community groups argue that certain cases of drug possession or driving under the influence shouldn't bar someone from working as an assister.
Paul Stephens, director of policy and advocacy at the Privacy Rights Clearinghouse in San Diego, said background checks are far from perfect and sometimes contain errors that can harm well-qualified job applicants. But he said he doesn't see how strict screening measures will harm the state's enrollment effort.
He said people with a checkered past can still help spread the word, but they don't need to be handling applications and financial information on consumers.
"Companies and organizations tend to have more stringent screening when they're dealing with sensitive information or an extremely vulnerable population like this," Stephens said.
Peter Lee, executive director of Covered California, said the agency stands by its proposal for background checks and fingerprinting to "ensure that people who will have very sensitive information like Social Security numbers are treating it with care." He said the screening process could be refined to reflect some of the concerns that have been raised.
If the state does proceed with its proposal, some healthcare advocates say Covered California should foot the $1.4-million cost for the background checks during the first year. State officials have said that enrollers and the organizations that employ them should bear the one-time $65 fee for a background check and fingerprinting.
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