In this task, you are given a text of many news articles seperated by special token "|||||". Your task is to summarize them.
Q: Nine states have passed laws limiting how health care "navigators" can help customers buy insurance and learn if they are eligible for federal help to pay for it. 
  
 Yolanda Madrid of Miami, left, talks with navigator Daniela Campos while signing up for health insurance under the Affordable Care Act, in Miami. (Photo: Lynne Sladky, AP) Story Highlights Nine states have passed navigator laws and not expanded Medicaid 
  
 Study was conducted by the George Washington University School of Public Health and Health Services 
  
 Health care enrollment data was released Monday by Department of Health and Human Services 
  
 WASHINGTON — States that have not expanded Medicaid as part of the Affordable Care Act and also passed laws limiting the ability of health care "navigators" to advise customers have compromised their residents' ability to gain access to health care, a new study released Tuesday shows. 
  
 Nine states have passed laws limiting how health care "navigators" can help customers buy insurance and learn if they are eligible for federal help to pay for it and also declined to expand Medicaid as permitted under the law. 
  
 "The navigator laws ostensibly are designed to make sure information about selecting a specific plan comes from licensed agents," said Sara Rosenbaum, the senior author for the study by the George Washington University School of Public Health and Health Services. 
  
 The laws, which required that only licensed navigators give out information about insurance plans, have created a culture of fear for health clinic employees who explain the law to the uninsured, Rosenbaum said. Combined with the states' decision to not expand Medicaid, that means residents of those states have fewer opportunities to gain access to health care, the study said. 
  
 "All they know is that they're not supposed to be telling anyone about plans; they're only allowed to talk about subsidy determination," Rosenbaum said of the navigators. 
  
 Nine states have passed navigator laws and declined to expand Medicaid: Florida, Georgia, Indiana, Maine, Missouri, Montana, Tennessee, Texas and Wisconsin. Nineteen states have passed navigator laws. 
  
 State officials said the laws were meant to keep personal information private and make sure the navigators were fully trained. 
  
 "In Texas, we are being vigilant about safeguarding privacy and keeping personal information out of the wrong hands," Insurance Commissioner Julia Rathgeber said in a statement in December. "These proposed rules address insufficiencies in federal regulations and make the training and qualifications of navigators in our state more readily apparent to consumers and service providers." 
  
 STORY: Most insurance enrollees older than 45, records show 
  
 The George Washington University survey included 247 health centers in states with Medicaid expansion and 136 states that didn't. Findings included: 
  
 • States that did not expand Medicaid are less likely to notify patients of potential eligibility. Only 65% of the clinics in restricted states notified patients, while 81% of health clinics in states with expanded Medicaid did so. 
  
 • Clinics in restricted states are much less likely to help people gather documents they need to apply for the federal exchange, with 56% able to do so, compared with 77% of full-implementation states. 
  
 • Health clinic workers are less likely to help fill out paper enrollment forms, with 78% doing so vs. 86% in full-implementation states. 
  
 • Restricted state clinics are much less likely to have enrollment forms and assistance in other languages, as 60% of those states have that information available in clinics while 76% those in full-implementation states do. 
  
 • Clinics in restricted states are less likely to help select a health plan; only 29% of clinics in restricted states did that compared to 51% in states with full implementation of the law. 
  
 "What shocked me was how significant some of the findings were," Rosenbaum said. "This was not a case of some of this was a close call; they're huge differences." 
  
 She said it was remarkable that even for existing state-based programs, such as Medicaid, the center workers had access to fewer resources. 
  
 About 1,250 health centers are required by the law to help enroll medically underserved people, and the Health Resources and Services Administration gave out $150 million in grants to those clinics to assist people. That averages about $130,000 per health center, according to the researchers. 
  
 Rosenbaum said the report shows that the navigator rules did exactly the opposite of what they were purported to do. 
  
 "If anyone has any doubt, this should put it to rest," she said. "The navigator laws combined with opting out of Medicaid really stopped outreach in its tracks." 
  
 Follow @KellySKennedy on Twitter. 
  
 Read or Share this story: http://usat.ly/1eBvoKy ||||| Obamacare State efforts to block Obamacare are working, study finds Jan. 14, 2014 at 12:01 AM ET 
  
  
  
  
  
 Joe Raedle / Getty Images 
  
 States whose governments are hostile to Obamacare are hindering efforts to get people signed up for health insurance, according to a study released Tuesday. 
  
 Laws restricting outreach and enrollment efforts have handicapped community health centers that are a key component of plans to get health insurance to millions of Americans who lack it, researchers at George Washington University found. 
  
 “This is the first study to attempt to measure the impact of restrictive state policies,” said Sara Rosenbaum, who led the team at GW’s Department of Health Policy that did the study. “The navigator laws are having a real effect.” 
  
 The 2010 Affordable Care Act seeks to get health insurance to the 15 percent of Americans who don’t have it in several ways: with online health marketplaces called exchanges, by expanding Medicaid and by changing insurance laws so that companies cannot refuse to cover certain people or stop their coverage once it gets expensive. 
  
 To sign people up, the Obama administration recruited and trained so-called navigators, assistants to help people choose which plans would be best for them among the dozens of choices in some states. And community health centers launched their own efforts, because many of their clients fall into the groups most in need of health insurance. 
  
 But after the Supreme Court gave them the option, many states decided not to expand Medicaid — even though the federal government will pay for the entire cost until 2017. Around 20 have decided against it. 
  
 In addition, states such as Missouri, Montana, Texas and Florida have passed law restricting what navigators and others can ask and say in helping people enroll in health care. They're all states that have refused to expand Medicaid or to operate exchanges, forcing the federal government to step in and do it. 
  
  
  
 The Missouri law requires the navigators to pass an exam and pay a fee before they can be licensed by the state. Texas is requiring extra training and testing for navigators, while Florida forbids navigators from working in state offices. 
  
 Supporters of the laws say it's important to ensure that people working with private information — names, addresses, Social Security numbers and income details — be properly trained and vetted. The Obama administration calls it "bullying." 
  
 "This is a blatant attempt to add cumbersome requirements to the navigator program and deter groups from working to inform Americans about their new health insurance options and help them enroll in coverage,” U.S. Health and Human Services department spokesman Fabien Levy said in September after Texas passed its law. 
  
 Some of the laws were passed to address issues raised by licensed insurance agents and brokers, Rosenbaum says. But it has affected efforts to help people sign up. 
  
 “The big smoking gun as far as I am concerned is assisting in selecting a health plan,” Rosenbaum told NBC News. “There is a highly significant difference between the restrictive states and the non-restrictive states in community enrollment assisters who are actually helping people figure out the health plans.” 
  
 Don McBride of ACCESS Family Care in Neosho, Mo., says he’s seen it. “We have been handicapped,” McBride told NBC News. “But with everything that is going on, I think we are making the best of it.” 
  
 “We haven’t been able to reach as many people,” agreed Kally Taul, outreach coordinator and a navigator at the clinic system. 
  
 But McBride, Taul and others say they are not simply being hobbled by state laws. It’s more complex than that, they say. “It’s not the funding. The main thing is the negative publicity,” Taul said. 
  
 Bad publicity had made people mistrustful, McBride agreed. “They call it ‘Obamacare’ and it’s like the atom bomb,” he said. “It is definitely going to take some time to build trust.” 
  
 Rosenbaum’s team surveyed 606 out of the nation’s 1,198 federally qualified community health centers. They compared the answers from health centers in states that have embraced health reform to those that have been less welcoming and found that community health centers in restrictive states had smaller enrollment staffs and workers there expected more of the patients they assisted to remain uninsured. 
  
 At least 19 states have passed laws that limit what navigators or other assisters may say and do, or that add hours of training and licensing requirements on top of what the federal governments asks. 
  
 “Health centers in restrictive states reported approximately half the staffing capacity maintained by health centers in full implementation states,” the report reads. 
  
 “Of particular significance in measuring the impact of navigator restrictions is the fact that health centers in restrictive states were significantly less likely to assist with plan enrollment,” it adds. 
  
 This can hurt because the people signing up at health centers are those who are the least likely to understand health insurance in the first place, Rosenbaum says. 
  
 “The significantly lower rate of plan enrollment assistance suggests that the regulatory burdens created by navigator laws are affecting not only the work of certified navigators but community outreach and enrollment efforts more generally,” the report concludes. 
  
 “When you change the policy environment and put the brakes on things, it really trickles down to the community,” Rosenbaum said. 
  
 The survey was done last year and it's too soon to say whether actual enrollments were affected. The Obama administration said Monday that 2.2 million people have signed up for private health insurance on the exchanges, and more than 3 million more have newly qualified for Medicaid, the state-federal health insurance plan for the low-income. 
  
 Follow NBCNewsHealth on Facebook and on Twitter 
  
 Follow Maggie Fox on Facebook and on Twitter 
  
  |||||
A: 
A number of states opposed to ObamaCare have managed to slow its progress, a new study finds. Reports center on the navigator program, in which assistants, or "navigators," advise Americans on how to sign up for plans under the health law. Nineteen states, including Florida, Missouri, Montana, and Texas, limit navigators’ activities; in Florida, for instance, they can’t work in state offices, while Missouri makes them take an exam and pay a fee for state licenses, NBC News reports. Backers of these laws say they’re aimed at vetting people handling sensitive personal information. Nine states have also rejected ObamaCare's Medicaid expansion. A George Washington University team reviewed 606 of 1,198 community health centers backed by the federal government, comparing those in states with “restrictive” ObamaCare laws to those in states with “full implementation” of the health law. “Health centers in restrictive states reported approximately half the staffing capacity maintained by health centers in full implementation states,” says researcher Sara Rosenbaum, and “health centers in restrictive states were significantly less likely to assist with plan enrollment.” In short, the study says, people living in restrictive states face more limited health care access, USA Today explains. Adds Rosenbaum: “If anyone has any doubt, this should put it to rest. The navigator laws combined with opting out of Medicaid really stopped outreach in its tracks."