Lack of ACA Navigator Funding Leads to Consumer Confusion, Decreased Enrollment

Open Enrollment is over in most states, and enrollment numbers are down slightlyfrom 8.8 million plan selections on healthcare.gov for plan year 2018 to 8.4 million plan selections for plan year 2019. Navigators thought the 2018 Open Enrollment was challenging, after a slew of policy changes including massive Navigator grant funding cutsshortened enrollment period, 90 percent cuts to federal advertising, and the end to cost-sharing reduction payments (CSRs). But this year may have been even more so.

Several federal policy changes went into effect this year, including loosened restrictions for short-term limited duration insurance (STLDI) plans and association health plans (AHPs), and repeal of the federal individual mandate penalty. Federal navigator grants were further reduced to less than 16 percent of 2016 funding levels, with no increase in federal advertising funds. CMS also rolled back certain requirements of the Navigator program.

New year, new challenges for Navigators

Last year, we talked with Navigators to learn about how they reached consumers despite major funding cuts. This year, we checked in with Navigators and assisters from five states on how they fared in this year’s Open Enrollment, and the challenges ahead.

Community partnerships are vital to getting consumers in the door.Navigator were unanimous: establishing themselves as community partners was imperative to their success. Because these programs have been beneficial to many community organizations, partners were quick to help get the word out and direct consumers who needed coverage to enrollment help. For example, when Navigator grantees weren’t able to put boots on the ground in some rural areas, local clinics partnered with them to ensure that trained volunteer assisters would be available to those who needed help. In some states, state departments of insurance and local lawmakers also served as outreach partners, using their public platform to help spread the word. In other cases, local community service organizations offered free office space, and helped amplify Navigators’ outreach messages through their listservs and membership outreach.

Efficiency comes at a cost. Most Navigator groups created hotlines or joined the 2-1-1 service, a community information and referral system hotline in each of the 50 states. New this year was the ability for Navigators to complete applications and enroll in insurance on behalf of consumers on the phone, instead of exclusively in-person. While Navigators were positive about this system, many reported that their hotlines were often overwhelmed due to lack of staff, and phone appointments cut into the time allocated for in-person assistance. Navigators were also forced to prioritize more populous areas for in-person assistance to maintain efficiency, but that often left rural consumers, who are more likely to be without a computer, without unbiased in-person assistance.

Consumers felt confused. Top news stories about the Affordable Care Act (ACA) this year centered on the repeal of the individual mandate penalty and the lawsuit that may result in the law being deemed unconstitutional. However, a few states have enacted their own individual mandates, including New Jersey. Navigators in that state reported that consumers were confused about the state-level obligation, most likely because there was insufficient time and resources to educate them about it.

Additionally, navigators shared stories of consumers confused by websites selling fake health plans (an exceedingly urgent issue for consumers), asking for help interpreting misleading or vague statements in marketing materials for STLDI, and experiencing unexpected medical bills after enrolling in non-ACA compliant products. One navigator also described frequent late-night television infomercials selling “Obamacare plans” from insurers that do not, in fact, sell ACA-compliant plans.

Depending on donations of money and time is not sustainable. The organizations that donated generous amount of money and airtime during the 2018 open enrollment period greatly dwindled this year. Navigators also reported a decline in local media interest, inhibiting their ability to get the word out.

Despite challenges, Navigators remain hopeful

Navigators expressed satisfaction about serving their communities, sharing anecdotes about returning customers sighing with relief knowing their local navigators are still around, and other consumers driving hours in order to meet with a navigator. These Navigators have become embedded in their communities. As a volunteer assister myself, I have strong relationships with the clients I assist. I have several who return every year, others who reach out mid-year with questions, and many who refer friends and family members to the organization, a testament to the trust they have in us. They know that we aren’t in this to sell them something or make a quick buck. We give them unbiased, accurate information, help them make choices that are best for the health and financial situation, and are there for them if they encounter problems after they enroll. While our ability to serve all the consumers who need our help has been drastically reduced thanks to funding cuts, I and the Navigators we interviewed remain strongly committed to this work.

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