help them enroll in a QHP.
93 The ACA establishes different types of consumer assisters, including Navigators and Certified Application Counselors.
Navigators are federally qualified and funded to provide assistance.
94 Certified Application Counselors (CACs) are federally created and regulated to
provide assistance to individuals who live in states where the federal government is operating the Exchange.
95 The ACA preempts state laws that
prevent the application of the ACA consumer assistance provisions.
As of July 2013, nineteen states had enacted laws that restrict the activities of federally approved consumer assisters,
97 which prompted litigation to
enforce the ACA provisions. In one such case, a federal court temporarily
enjoined a Tennessee law regulating consumer assisters, finding that the
law was an unconstitutional restraint on speech in violation of the First
In January 2014, a federal court in Missouri enjoined a state law restricting consumer assisters.
99 In St. Louis Effort for Aids v. Huff, a federally certified CAC, along with other entities and individuals who wanted to help
uninsured Missourians enroll in health coverage, argued that the state navigator law violated the Supremacy Clause, the First Amendment, and the
Due Process Clause.
The court granted the plaintiffs’ request for a preliminary injunction
based on the Supremacy Clause, which provides that the laws of the United
States “shall be the supreme Law of the Land . . . any Thing in the Constitution or Laws of any State to the Contrary notwithstanding.”
101 The court enjoined state provisions that required individuals to be licensed as insurance
agents in Missouri to engage in certain enrollment activities.
to the court, “[S]tate laws that make operation of the FFE [federally facili-
42 U.S. C. § 18031(b)( 1) (West, WestlawNext through Pub. L. No. 113-93 (
excluding Pub. L. No. 113-79) approved Apr. 1, 2014); 45 C.F.R. § 155.225 (West,
WestlawNext through May 22, 2014; 79 Fed. Reg. 29,379).
94. 42 U.S. C. A. § 18031( i)( 3); See Exchange Establishment Standards and Other Related Standards Under the Affordable Care Act, 45 C.F.R. § 155.210, 155.215.
95. See 45 C.F.R. § 155.225(d)( 4).
42 U.S. C. A. § 18041(d).
97. See Peter Shin et al., Assessing the Potential Impact of State Policies on Community
Health Centers’ Outreach and Enrollment Activities, GEORGE WASHINGTON UNIV. OF PUB.
7 (Jan. 14, 2014), available at
_PolicyResearchBrief_ 35.pdf (finding greater outreach and enrollment challenges in states
with restrictive consumer assister laws).
98. Temporary Restraining Order at 1-2, No. 3:13-1090 ( D. Tenn. Oct. 7, 2013); See
Plaintiffs’ Suggestions in Support of Motion for Preliminary Injunction at 9, 11, 13, No.
2:13-cv-4246 (W. D. Mo. Nov. 26, 2013).
99. St. Louis Effort for Aids v. Huff, No. 13-4246-CV-C-ODS, 2014 WL 273201, at
* 10 (W. D. Mo. Jan. 23, 2014).
100. Id. at 2.
101. Id. at 2-3; U.S. CONST. art. VI, cl. 2.
102. St. Louis Effort for Aids, 2014 WL 273201, at 5-6.