Rural, Non-English Speakers Could Fall Off Obamacare Enrollment

Recent cuts in funding for Affordable Care Act “navigators” have renewed a debate about their effectiveness.

Affordable Care Act navigators help guide those looking for insurance during an enrollment event at Southwest General Hospital on Jan. 29, 2016, in San Antonio.
AP Photo/Eric Gay
Sept. 21, 2017, 8 p.m.

Hard-to-reach groups of people—such as very rural communities or those that do not speak English—could fall off enrollment in the Obamacare marketplaces due to cuts in funding for organizations that steer them into the system.

Created under the Affordable Care Act, navigators help people learn about their options and assist with enrollment in the exchanges. But the Centers for Medicare and Medicaid Services at the end of August expressed doubt about the navigators’ effectiveness, and announced that it would slash funding to the program by about 40 percent.

“During the most recent open-enrollment period, navigators received over $62.5 million in federal grants while enrolling 81,426 individuals,” said CMS. “Seventeen navigators enrolled less than 100 people each at an average cost of $5,000 per each enrollee. Seventy-eight percent of navigators failed to achieve their enrollment goal.”

Navigators last week began to see what kind of budget numbers their futures hold. “Many were cut and many of them dramatically,” said Karen Pollitz, senior fellow at the Kaiser Family Foundation who met with a group of navigators soon after they were informed of their level in funding.

“Some of them were cut 75, 80, 90 percent,” she added. “Some of them, I don’t even know if they can work.”

Among the services on the chopping block, Pollitz said, navigators expressed concern about their ability to travel out to rural areas and to communicate with non-English speakers. “They were worried about being able to keep staff that are proficient in the language that their client speaks,” she said.

Some experts think that the overall effects on enrollment will be marginal and argued that the navigators’ role in helping people was rather limited.

“I want a navigator who will help me navigate through the entire health care system, not just get in the front door for a health care plan,” said Thomas Miller, resident fellow at the American Enterprise Institute. He also said that supporters of the Affordable Care Act often want better marketing and advertising but do not question the product being sold.

Edmund Haislmaier, an expert in health care policy and markets at the Heritage Foundation, said that navigators have probably already brought in most of the people that Obamacare marketplaces will get and questioned the value of continuing their role. He added that even hard-to-reach demographics would likely find another route into the system if they need care.

“The people who need medical care are going to be motivated to come in or they’re going to go to providers who are motivated to put them in,” he said.

But Covered California, a state-based marketplace which cut its navigator funding after the first two years, said in a recent report that these organizations do serve a key function for certain demographic populations.

“Navigators enroll a higher proportion of key demographic populations, which are often more difficult and expensive to reach, including Latino and African-American communities and those speaking languages other than English,” the report states.

Additionally, the director of the Alaska Division of Insurance told members of the Senate health committee earlier this month that the state relies heavily on these organizations to inform people about the basics of enrolling in the exchanges.

“There’s also a part that is very cultural in Alaska, in the fact that we have a variety of languages and the navigators cross that bridge in being able to talk … the native languages of Alaska. … They provide that service. We don’t have that very readily in the insurance community,” said Lori Wing-Heier.

Alaska’s funding for outreach was reduced by 26 percent, according to analysis by The Washington Post. The state with the highest cut is Indiana, followed by Nebraska and Louisiana.

The metric that CMS is using to base individual navigator funding could create perverse incentives, said Pollitz. The agency is basing resources to navigators on their ability to meet their enrollment goals during the previous year.

“If they’re going to get paid only on signups, that is a perverse incentive that would lead a program to not spend a lot of money to go out to a rural county,” she said.

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