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

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

Kofman added, "In the District…we are relying heavily on the insurance agents and brokers, building them into our information technology for the exchanges, so consumers using our online application system who want to talk to a broker, have questions about the different policy choices available to them—they can just click on the button and choose among licensed, trained healthcare-insurance brokers for help."

Keiser said, "We believe strongly, and we are different from other states, in maintaining the integrity and value of the agents and brokers, who are licensed, regulated and knowledgeable about healthcare sales, as we go about implementing the exchange in North Dakota." 

Angoff, now in private practice in the district as a partner at Mehri & Skalet in Washington, D.C. was the first head of the Office of Consumer Information and Insurance Oversight at the Department of Health and Human Services. He left the agency last fall.

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

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

The law requires every exchange—whether state-based or federally-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 here during the weekend, adopted a resolution urging local policymakers to establish a state-based regulatory framework for navigators and in-person assisters that would ensure a strong role for agents. 

Wes Bissett, outside senior counsel, government affairs for the Independent Insurance Agents and Brokers of America, said, "The IIABA welcomes NCOIL's recommendations concerning navigators and strongly agrees that states are best suited to oversee this new category of entity and protect consumers. Ensuring that there is proper scrutiny over navigator qualifications and behavior is good public policy."

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

"We have grave concern in North Dakota about creating thousands of navigators out there that were offering an additional service, such as AARP, Chambers of Commerce, labor unions, who did not understand insurance but were out there giving insurance advice with no ability to control once it got out of the box," Keiser said. "They have no regulatory authority."

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

Kofman said one aspect of her job is helping people determine whether they are eligible for Medicaid and to figure out whether they are eligible for premium tax credits. "We are focused on the brokers to help people figure out what is the best health plan option that is best for that family or that small business," she said.

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

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