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.