ACA Navigator Funding Tied To Performance

The Washington Post

Washington — The Trump administration is gutting federal funds to help Americans sign up for health coverage under the Affordable Care Act, cutting grants to grass-roots groups that assist with enrollment by 40 percent and slashing an advertising budget from $100 million to $10 million.

The announcement late Thursday afternoon, just nine weeks before the start of the fifth annual enrollment season, is the first indication of how an administration determined to overturn the health care law will oversee the window for new and returning consumers buy coverage for 2018.

In a conference call with reporters, three federal health officials extended the White House’s pattern of denigrating the ACA and its effectiveness. They also reversed a promise that Health and Human Services staff had made two months ago to nearly 100 organizations receiving “navigator” grants that their funding would be renewed.

While the administration is not eliminating either the grants or the advertising, the magnitude and abruptness of the cuts sparked an immediate outcry from the Senate’s top Democrat, consumer advocacy groups and members of the Obama administration, who had relentlessly championed ACA enrollment until they left office eight months ago.

“I’m stunned,” said Jodi Ray, project director of Tampa-based Florida Covering Kids and Families, whose previous $5.8 million navigator grant was the largest in the country.

She said the funding decrease will be especially problematic for the 2018 enrollment period, which starts on Nov. 1 and lasts only six weeks this fall instead of three months. Sign-ups will take place with many consumers confused by the high-wattage political fighting in Washington over whether the law and its marketplaces will continue to exist.

The HHS officials, who briefed reporters on condition of anonymity, said that they had decided to begin tying the grant awards to navigator groups’ performance. All groups would receive at least $10,000, they explained. Beyond that, the size of a group’s grant would hinge on the percentage of its target enrollee total that it met last year. Groups that exceeded their targets will not get extra money, however.

In a statement following the briefing, HHS spokeswoman Oakley Caitlin called the navigator program under the Obama administration “ineffective,” saying that “during the upcoming enrollment period, navigators will be funded in proportion to their performance.”

Ben Wakana, a senior HHS spokesman in the Obama era, responded with two words: “That’s insane.” Since each navigator group decides its own enrollment target, he said, the new funding approach will mean some aggressive organizations that set ambitious targets will now be penalized if they fell short this past year. And low-performing groups that met anemic targets will be rewarded.

In total, funding for navigators will be reduced from $62.5 million for the 2017 enrollment to $36.8 million — a 41 percent drop.

The decimation of the ACA advertising budget reprises a move the Trump administration made during its first days in office. At the instruction of the White House, health officials canceled advertising and other outreach activities as the 2017 enrollment period was closing. They ended up relenting to allow already paid ads to continue.

In announcing the $10 million ad budget for the coming enrollment season, officials said the Obama administration had doubled its advertisement spending to promote enrollment from $50 million in 2015 to $100 million in 2016. But sign-ups dipped — from 12.7 million to 12.2 million, they said. Critics of the Trump administration contend the dip was tied to the cuts in advertising and promotion.

The health officials said they set the new amount based on ad budgets for entrenched federal health programs for older Americans — for Medicare drug benefits and managed-care versions of Medicaid. Their reasoning is that, as ACA signups go into their fifth year, the public is familiar with the process by now.

Advertising and other outreach activities this fall will be focused on telling consumers about the starting and ending dates new dates and will rely on digital media, email and text messages. They said promotional efforts will target specific demographics and geographic areas, which they did not identify.

Senate Minority Leader Charles Schumer, D-N.Y., quickly lambasted the cuts. “The Trump administration is deliberately attempting to sabotage our health care system,” he said in a statement. “When the number of people with health insurance declines and costs skyrocket, the American people will know who’s to blame.”

At the liberal consumer health lobby Families USA, Elizabeth Hagan, associate director of coverage initiatives, said that the de-emphasizing assistance for people enrolling in ACA health plans “is just one more example of the administration undermining” the law. Hagan predicted that the lessened help and shorter sign-up time “will have a profound effect on enrollment.”