Trump Administration Pulls Cities' Funding for Obamacare Enrollment

Health policy experts say the move could further destabilize the market.

A navigator helps someone with documents during an Affordable Care Act enrollment event at a library in Fort Worth, Texas.
A navigator helps someone with documents during an Affordable Care Act enrollment event at a library in Fort Worth, Texas.
(AP/LM Otero)
While Congress continues its negotiations to repeal and replace the Affordable Care Act (ACA), the Trump administration is taking steps that some say are an effort to weaken the law's impact.

"There's a clear pattern of the administration trying to undermine and sabotage the Affordable Care Act," Elizabeth Hagan, associate director of coverage initiatives for the liberal advocacy group Families USA, told the Associated Press. "It's not letting the law fail, it's making the law fail."

This month, the Trump administration ended contracts with two companies that helped people sign up for health insurance on the Obamacare marketplaces. The companies hired "navigators" in 18 cities to spread the word in the community -- at churches, libraries and sporting events -- and guide people through the often-complicated enrollment process.

“It takes multiple touches to get someone enrolled, and that requires human power,” says Linda Blumberg, a senior fellow of health policy at the Urban Institute.

The two companies with terminated contracts only signed up 14,500 people for the individual market -- a fraction of a percent of the 9.2 million who enrolled overall -- but they reportedly sought out younger, healthier people. Health policy experts say getting more young people to sign up is key to bringing premiums down and stabilizing the market.

“When you take away funding for training and provisions for assistance, you’re more likely to lose healthier people, and so you’re working against the soundness of the markets," says Blumberg. "These are the people who won’t move heaven and earth to get enrolled on their own." 

The ACA is credited with helping the U.S. achieve a record low uninsured rate. In the first nine months of 2016, just 8.8 percent of Americans lacked health coverage. But over the past couple of years, many parts of the country have seen drastic premium increases and an exodus of insurers from the marketplace. Their main reason: They can't afford to insure a population that largely consists of the oldest, sickest Americans.

In the last open enrollment period, 36 percent of enrollees were under the age of 35. The loss of more young people on the marketplaces, therefore, may exacerbate the existing problems. 

A representative from Centers for Medicare and Medicaid Services told the Associated Press that the contracts were never meant to be long-term. The federal government still funds navigator grants in 34 states, but all of them are scheduled to end in 2018.

The 18 cities that will no longer have federal money for enrollment assistance are: Atlanta, Austin, Charlotte, N.C.; Chicago; Cleveland; Dallas; Houston; El Paso, Texas; Indianapolis; Miami; McAllen, Texas; New Orleans; Orlando, Fla.; Philadelphia; Phoenix; Tampa, Fla.; and San Antonio.

The move is sure to strike a nerve among the leaders of the impacted cities.

“Access to affordable health care should not be a political game of volleyball,” wrote Tampa, Fla.’s mayor, Bob Buckhorn, in an email. “It was America's mayors who led the effort to enroll millions of Americans in the Affordable health-care plan, and Tampa will continue to work with local and state partners to promote and provide information on ways to enroll.”

Blumberg encourages other cities and states to fund their own navigator programs.

“It’s a relatively cheap, but important, piece to stabilize the markets,” she says.

The 2018 open enrollment season begins on Nov. 1 and ends Dec.15 -- half the time of previous years. Add in the uncertainty on Capitol Hill, and having people to help citizens navigate health care may be needed this year more than ever.

Mattie covers all things health for Governing.

Special Projects
Sponsored Stories
Creating meaningful citizen experiences in a post-COVID world requires embracing digital initiatives like secure and ethical data sharing, artificial intelligence and more.
GHD identified four themes critical for municipalities to address to reach net-zero by 2050. Will you be ready?
As more state and local jurisdictions have placed a priority on creating sustainable and resilient communities, many have set strong targets to reduce the energy use and greenhouse gases (GHGs) associated with commercial and residential buildings.
As more people get vaccinated and states begin to roll back some of the restrictions put in place due to the COVID-19 pandemic — schools, agencies and workplaces are working on a plan on how to safely return to normal.
The solutions will be a permanent part of government even after the pandemic is over.
See simple ways agencies can improve the citizen engagement experience and make online work environments safer without busting the budget.
Whether your agency is already a well-oiled DevOps machine, or whether you’re just in the beginning stages of adopting a new software development methodology, one thing is certain: The security of your product is a top-of-mind concern.
The World Economic Forum predicts that by 2022, over half of the workforce will require significant reskilling or upskilling to do their jobs—and this data was published prior to the pandemic.
Part math problem and part unrealized social impact, recycling is at a tipping point. While there are critical system improvements to be made, in the end, success depends on millions of small decisions and actions by people.