While officials contend the program has not been a cost-effective use of federal funds, proponents of the ACA see yet another attempt to undermine implementation of the Obama-era law.
For the second time in two years, the Trump administration has dramatically slashed funding for a grant program that helps Americans sign up for health insurance under the Affordable Care Act exchanges.
The program, which supports outreach organizations and so-called "navigators" to assist consumers through the enrollment process, had received $63 million for the open enrollment period in fall 2016. But that funding was cut last year to $36 million, and it will drop again this fall to a maximum of $10 million, the Centers for Medicare & Medicaid Services announced Tuesday. That's a reduction of more than 84% in two years.
While the administration says the cuts are motivated by a need to allocate federal resources prudently, Democrats and proponents of the ACA contend that this is yet another attempt by the Trump administration to undermine implementation of the Obama-era law.
"This decision reflects CMS' commitment to put federal dollars for the Federally-facilitated Exchanges to their most cost effective use in order to better support consumers through the enrollment process," CMS Administrator Seema Verma said Tuesday, adding that it's time for the navigator program "to evolve."
Despite spending tens of millions of dollars in 2016 and 2017, navigators have enrolled less than 1% of the beneficiaries who signed up for coverage on the exchanges each year, CMS said. Agents and brokers, however, have assisted with 42% of enrollments for the current plan year, the agency added.
- About that evolution: Beyond simply cutting funds, CMS is pushing to overhaul the program's mission. Navigators will now be encouraged to provide consumers with information on non-ACA-compliant plans, such as short-term limited-duration options and association health plans, CMS said. The administration has been criticized for touting these cheaper alternatives as a release valve of sorts for rising premiums in ACA-compliant plans.
- Impact on in-person help: "This is a huge cut to navigator programs across the country. It will virtually eliminate face-to-face in-person assistance," Fred Ammons, who oversees the navigator organization Insure Georgia, told The New York Times. "It means less help, much less help, to underserved, hard-to-reach populations, people who live in rural areas or have low literacy or don't speak English as their primary language."
- Critics cite context: Those who argue the Trump administration is taking every opportunity it gets to hack away at the ACA point to a series of recent moves, including not only its push for skimpier coverage options but also its freezing of $10.4 billion in risk-adjustment payments to insurers, and its decision to quit defending key provisions of the ACA against a legal challenge by conservative states.
- Rounding error? "It's not the most consequential act of sabotage we've seen. But it is among the most revealing," said Huffington Post healthcare reporter Jonathan Cohn in a series of tweets Wednesday about the slashed navigator funding. The program's less-than-$40 million price tag last year is "not even a rounding error" in the context of federal healthcare spending, and the program doesn't exist to maximize overall enrollment numbers, he said: "It's to provide assistance to people who need it."
In its payment notice, CMS also removed the requirements that each exchange have a minimum of two navigators and that navigators maintain a physician presence in the area being serviced.
"Removing these requirements will help to lower operating costs and focus on enrolling consumers as well as enable grantees to engage in digital and online outreach to reach a broader audience," CMS said.
A minimum of $100,000 will be awarded to grantees in each of the 34 federally facilitated exchanges starting this fall.
Steven Porter is editor at HealthLeaders.
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