On August 31, 2017 the Trump Administration announced a devastating reduction in support for outreach and enrollment efforts for the Affordable Care Act (ACA or Obamacare) Marketplace. According to federal officials, the administration plans to slash funding for ACA Marketplace advertising and outreach from $100 million to a mere $10 million. In addition, they will cut funding to community groups known as “navigators” from $63 million to $36 million this year.
Signing up for health care can be complicated, and enrollment assistance is the best way to make the process easier. Marketing and in-person enrollment assistance are vital to the success of the ACA Marketplaces especially this year. After the change in administration and the subsequent failed efforts in Congress to repeal much of the ACA, many people are confused about whether they can still get ACA coverage and how to enroll. Marketing and assistance is especially important for younger healthier people because without major healthcare needs they are less motivated to seek coverage but their enrollment is essential to the stability of the market. The more healthy people who enroll, the lower the premiums for everyone.
In Texas, 10 organizations received Navigator funding in 2016 that ranged from small grants of $150,000 to large grants of more than $2.2 million. In total Texas organizations received $9 million in navigator funding for 2016. A cut of this size to this program for 2017 will vastly reduce the availability of trained, local, in-person assistance for consumers.
The reduction in funding to the Navigator groups will come from tying payments to the number of people a group has enrolled. But there are flaws in this system. First, Navigators are tasked with far more than just enrollment, including outreach, education, and post-enrollment support. Also, this measure will short-change Navigators, because they can only count a person as “enrolled” if they fully complete the enrollment process, including signing up for a plan during their appointment. The many consumers who get through the application process with the Navigator, but then finalize the plan selection later on their own, would not be credited to the Navigator.
In addition, the future success of these organizations in hitting their enrollment goals is inextricably contingent on effective administration and support of the federal-facilitated Marketplaces from the U.S. Department of Health and Human Services. If the Healthcare.gov website or call centers aren’t properly supported or there isn’t sufficient advertising, how can Navigators be expected to hit enrollment goals that were based on the assumption of a continued strong federal partner in this effort? Instead, the 90 percent reduction in marketing dollars signals that there will be minimal support from the administration during the upcoming enrollment cycle.
This latest blow is only one instance in a series of efforts from the administration to undermine the ACA and erode the stability of the Marketplaces. Others include:
- Canceled federal contracts for outreach and enrollment assistance in 15 cities. Six of those cities are in Texas.
- Relaxed enforcement of the individual mandate, which serves to encourage participation by healthier enrollees
- No long-term commitment from the federal government to make good on “cost-sharing reduction” payments that are critical to maintain the value and affordability of coverage.
- New regulations that hinder enrollment, increase out-of-pocket costs, and shrink plan networks.
And the list goes on…(For a more complete list, see Families USA’s ACA sabotage tracking page.)
President Trump has said on a number of occasions that he wants to “let Obamacare fail,” but these actions are far from passive. These policies are direct sabotage by the administration that is responsible for implementing the federal law. This slash in funding will make it harder for Texans to get good information about available coverage, and assistance with their enrollment. This will result in fewer people signing up, especially young and healthy consumers who may be new to the system. This in turn will drive up premiums, creating more instability in the individual market, and fewer Americans with have access to affordable health coverage.