Some ACA backers say they are putting together their own enrollment-boosting efforts.

Sept. 5—The Trump administration is cutting back outreach to those who may qualify for individual health insurance amid concerns about effectiveness.

The advertising budget for open enrollment both in and outside the Affordable Care Act (ACA) marketplaces will be cut from the $100 million spent by the Obama administration last year to $10 million. The Trump administration also will cut funding for navigators, who help people sign up for coverage, from about $63 million last year to $36 million.

Instead, federal outreach funding will flow to educating consumers on the new dates of open enrollment—Nov. 1 to Dec. 15, 2017—through digital media, email, and text messages.

The Trump administration said the reductions are in response to the shortcomings of the advertising campaign and the navigator service.

For instance, during the open-enrollment period for 2017 coverage, the Centers for Medicare & Medicaid Services (CMS) doubled its 2015 outreach spending but saw first-time enrollment decline by 42 percent and effectuated enrollment decline by approximately 500,000 individuals. In total, 12.2 million people selected or automatically reenrolled in ACA marketplace plans for 2017, but effectuated coverage dropped to 10.1 million.

The change in approach brought a call from Protect Our Care, which backs the ACA, for Congress to block the administration.

“It is impossible to make up for what the administration is failing to do,” Leslie Dach, campaign director for the group, said in a call with media.

Dach cited the lost federal funding as particularly daunting and raised concerns about the administration’s ability to know who has accessed and to contact them with follow-up emails.

Protect Our Care and other ACA backers plan to adopt their own outreach efforts to enrollees, “but we’re not quite yet ready to talk about it,” Dach said.

In the case of navigators, members of the administration complained that $62.5 million in federal grants produced only 81,426 enrollments. They highlighted that 17 navigators enrolled fewer than 100 people each at an average cost of $5,000 per enrollee.

The new approach will base a navigator’s funding relative to 2017 on the percentage of enrollments that the individual or organization was able to achieve relative to this year’s goal. Seventy-eight percent of navigators failed to achieve their enrollment goal.

“These performance-based adjustments will ensure accountability within the Navigator program and avoid rewarding grantees that have failed to meet their performance measures,” a CMS release stated.

The agency also said that for 2018 coverage—the final year of a three-year grant cycle—navigators will be asked to assist consumers with plan selections, particularly focusing on consumers who are currently enrolled in coverage in areas where insurers have reduced or eliminated plan offerings.

The navigator groups, which include six hospitals and health systems, are based in the 38 states with federally operated ACA marketplaces. The 12 other states run their own marketplaces and fund their own enrollment programs.

Navigators are paid out of the operational budget of each state’s ACA marketplace and in most states are funded by an assessment on premiums for health plans sold in the marketplace. In contrast, certified application counselors (CACs), which function similarly to navigators, are funded by private, local, state, or federal sources or can repurpose existing funding to support their programs, according to a report by Families USA.

Impact on Hospitals

Hospitals worried about the impact of reduced navigator funding.

“Because of this program, our health system has saved millions of dollars because people who were previously uninsured now are insured, so we get reimbursed something,” said Craig Cooper, a spokesman for Genesis Health System, which last year garnered a $79,181 navigator grant (2017 funding for each navigator grantee has not been announced).

The grant has helped the system fund two navigators who have assisted “thousands” in signing up for insurance coverage, Cooper said in an interview.

In 2015, according to the most recently available data from the American Hospital Association (AHA), 2,763 hospitals, or 58.4 percent of reporting hospitals, said they offered some sort of enrollment assistance service.

“America’s hospitals and health systems have long helped connect consumers with coverage and will continue to do so as open enrollment gets underway on Nov. 1 for 2018 coverage,” said Molly Smith, vice president of coverage for the AHA. “Over the coming weeks and months, the AHA will be providing our members with resources to help make this year’s enrollment process as easy and accessible as possible.”

The five other hospitals and health systems receiving navigator grants are (with 2016 funding listed):

  • Pekin Memorial Hospital, $260,850
  • Ascension Health, $215,471
  • Randolph Hospital, $265,036
  • Sacred Heart Health System, $1,503,391
  • Memorial Hospital of Laramie County, $427,286


One-on-one assistance, such as that provided by navigators and CACs—particularly for “underserved communities”—was described as a best practice for successful outreach and enrollment by Enroll America, which was established by former Obama administration officials to boost ACA sign-up efforts.

A 2016 Health Affairs analysis (login required) of health survey results found that those who remained uninsured were much more likely to have relied only on the marketplace website than to have sought other assistance, which included obtaining information from navigators and CACs.

Despite the administration’s concerns about the effectiveness of navigators, a 2015 survey of assister programs by the Kaiser Family Foundation concluded that those programs—along with CACs, in-person assisters, insurance agents, and brokers—helped an estimated 10.6 million consumers obtain coverage during the first year of ACA marketplace enrollment.

Rich Daly is a senior writer/editor in HFMA’s Washington, D.C., office. Follow Rich on Twitter: @rdalyhealthcare

Publication Date: Tuesday, September 05, 2017