Obamacare Outreach Cuts Expected to Undermine Exchanges

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By Sara Hansard

Cuts in Obamacare’s outreach funding for 2018 are expected to further undermine the insurance exchanges by decreasing the population of younger, healthier people.

People who have health-care problems “will figure out a way to sign up,” but healthy individuals aren’t likely to seek out coverage on their own, Jennifer Tolbert, director of state health reform for the Kaiser Family Foundation, told Bloomberg BNA Sept. 1. “It is those young and healthy adults who are critical to making these markets work that are less likely to sign up and need that extra outreach,” she said. The Department of Health and Human Services announced Aug. 31 that the advertising budget for the 2018 open enrollment period would be cut from $100 million to $10 million, and funding for groups that assist people in signing up would be cut 39 percent from the $62.5 million allocated for 2017.

The Trump administration announcement about the funding cuts comes the week before the Senate Committee on Health, Education, Labor and Pensions begins hearings on ways to stabilize the individual insurance markets for 2018. Those markets, which include the Affordable Care Act exchanges, have been roiled by premium hikes and reduced insurance participation as Republicans have unsuccessfully tried to repeal major parts of the 2010 law and as President Donald Trump has repeatedly Tweeted that the law will fail.

Grants Based on Meeting Goals

Grants for organizations in the Navigator program, created under the ACA to help people choose health plans and enroll in the exchanges, will be based on their ability to meet the enrollment goals they set for themselves during the previous year, according to officials who spoke on an Aug. 31 telephone press briefing on condition that they not be identified. For the 2017 open enrollment period, in which 12.2 million people signed up, the Navigators enrolled 81,426 individuals, the HHS’s Centers for Medicare & Medicaid Services said in a release.

But 17 navigators enrolled fewer than 100 people apiece, at an average cost of $5,000 per enrollee, and 78 percent of navigators failed to achieve their enrollment goals during the previous year, the CMS said.

If a grantee achieved 100 percent or more of its enrollment goals for 2017, it will receive the same funding as last year, the agency said. Grantees’ funding for 2018 will be based proportionally on how well their met their goals for 2018, CMS officials said in the telephone press briefing.

There are 98 navigator organizations receiving grants in 2017, CMS officials said in the telephone press briefing.

Moreover, during the 2017 open enrollment period that started last fall, the CMS spent nearly double the amount that was spent in 2015, but first-time enrollees declined by 42 percent and the number of people staying in the exchanges declined by about 500,000 individuals, the CMS said.

`Ineffective,’ HHS Says

“Obamacare’s Navigator program has been ineffective,” HHS press secretary Caitlin Oakley said in an email Aug. 31. “A healthcare system that has caused premiums to double and left nearly half of our counties with only one coverage option is not working. The Trump Administration is determined to serve the American people instead of trying to sell them a bad deal.”

ACA supporters and congressional Democrats were quick to call the funding cuts the Trump administration’s attempt to “sabotage” the law.

The cuts are “outrageous,” Leslie Dach, director of the Protect Our Care Campaign, said in a statement. “It’s one thing to tweet about your opposition to a law. It’s another to undermine it, sabotage it and refuse to do your duty.”

Health insurers also signaled that outreach efforts shouldn’t be reduced.

“Effective education ensures that consumers understand their coverage options and encourages broader participation of healthy individuals,” America’s Health Insurance Plans spokeswoman Kristine Grow said in a statement. “Marketing, outreach, and education are critical to ensure that all consumers are aware of the upcoming open enrollment period, understand new timelines, and enroll by the deadline.”

Not Held to Goals Previously

In the Obama administration the navigator groups were not held to meeting the enrollment estimates they made for the ACA qualified health plans (QHPs), according to Shelli Quenga, director of programs at the Palmetto Project, Inc., a navigator program for South Carolina. Palmetto, which is slated to receive about $1.1 million for 2017, has enrolled people in about 1,900 QHPs in 2017, while it has estimated it would enroll people in 2,200 for the year, she said.

Moreover, the goals must be set in June, before information is available the cost of the plans is known, which insurance carriers will be in the exchanges, and how many plans will be available, Quenga said. In the South Carolina exchange the only carrier is BlueCross BlueShield of South Carolina.

Palmetto has projected enrolling about 1,200 people in QHPs during the 2018 open enrollment period, but any cuts will reduce the number of people that can be helped, Quenga said.

Broader Responsibilities

In addition to helping people enroll in QHPs, the navigators are also responsible for referring people who are eligible for Medicaid, assisting the health insurance appeals, assisting with tax filings, and providing health insurance literacy, Quenga said. In 2017 Palmetto fielded nearly 80,000 inquiries about coverage options over the course of the current grant period, from Sept. 2, 2016, through Sept. 1, she said.

The 2018 open enrollment period was shortened by the Trump administration from three months in previous years to six weeks, so it lasts from Nov. 1 through Dec. 15. That makes it more important to have adequate funding for people to assist enrollees, Tolbert said.

“Health insurance is complicated,” Tolbert said. “People don’t understand the concepts of health insurance. Many are intimidated by the process of having to apply online,” and they need assistance, especially if they run into problems about how to apply or if they get an unfavorable determination for their eligibility to enroll through the exchanges or to receive tax credit subsidies, she said.

To contact the reporter on this story: Sara Hansard in Washington at shansard@bna.com

To contact the editor responsible for this story: Kendra Casey Plank at kcasey@bna.com

For More Information

Policies Related to the Navigator Program and Enrollment Education for the Upcoming Enrollment Period is at http://src.bna.com/sbN.Recipients of 2016 grant awards, which did outreach and education for the 2017 open enrollment period, is at http://src.bna.com/scI.The rule shortening the 2018 open enrollment period is at https://www.gpo.gov/fdsys/pkg/FR-2017-04-18/pdf/2017-07712.pdf.

Copyright © 2017 The Bureau of National Affairs, Inc. All Rights Reserved.

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