In what seems an endless stream of administrative actions to undermine the Affordable Care Act, the Trump administration has cut navigator funding from the 2016 level of $63 million to $37 million in 2017 to a meager $10 million for the upcoming fall (2018) open enrollment period.
It also looks like the administration is trying to cut out the expert consumer-oriented, nonprofit organizations serving as navigator entities like Florida Covering Kids and Families or the Arizona Primary Care Association, just to name two. While there is not an outright prohibition on these more common navigator entities in place today, the administration previously eliminated the requirement that there be two navigator entities in each state with one being a community and consumer-focused non-profit. And the CMS press release states that grants will go to eligible grantees such as chambers of commerce, small businesses, and trade associations, although they also list faith-based organizations.
This latest round of cuts means that people who have worked diligently to enroll hard-to-reach populations and drive the uninsured rate down to historic lows will lose their jobs.
The minimum funding level is $100,000 for each state served by the Federal marketplace. But seriously, that barely covers one full time employee when travel, phone, materials, and other administrative costs are included. How is one person able to cover an entire state? Particularly when you consider how difficult it is to identify and reach the targeted ‘left behind populations’ – individuals who are disproportionately without access to health insurance coverage or who may be unaware of different types of coverage options available to them.
Now, in addition to significantly less funding, navigators are expected to devote those scarce resources to make consumers aware of highly inadequate coverage options such as short-term, limited duration and association health plans. Such plans don’t have to comply with Affordable Care Act requirements and include large gaps in benefits, unlimited deductibles and out-of-pocket costs, and annual and lifetime limits. And short-term plans can discriminate against people with pre-existing conditions. Greater enrollment in such plans would actually make the marketplace less stable, driving up premiums and discouraging insurer participation. I sure hope they do the right thing and explain the serious shortcomings of these skimpy, risky options that may become available in a given state.
The CMS press release casts a shadow on the effectiveness of navigators in past years. But by evaluating performance only on enrollment in QHPs in the marketplace, the agency fails to credit navigators with assisting Medicaid enrollees. It cites the relatively low cost of training brokers and agents without calculating the hidden premium cost, largely paid for by federal tax credits that cover broker and agent commissions. CMS also fails to credit navigators with the important role they play in outreach and public awareness or in helping individuals with cultural or linguistic barriers or low insurance and computer literacy.
I know many of the organizations that have faithfully and tirelessly served as navigator entities, having provided training and technical assistance to many of them. And this latest round of cuts means that people who have worked diligently to enroll hard-to-reach populations and drive the uninsured rate down to historic lows will lose their jobs. They will leave big shoes to fill and a void that will continue to reverse the gains we have made in assuring that everyone, particularly low-income, vulnerable populations, has access to affordable health care.