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.

What We're Following See More »
AVOIDS SHUTDOWN WITH A FEW HOURS TO SPARE
Trump Signs Border Deal
1 weeks ago
THE LATEST

"President Trump signed a sweeping spending bill Friday afternoon, averting another partial government shutdown. The action came after Trump had declared a national emergency in a move designed to circumvent Congress and build additional barriers at the southern border, where he said the United States faces 'an invasion of our country.'"

Source:
REDIRECTS $8 BILLION
Trump Declares National Emergency
1 weeks ago
THE DETAILS

"President Donald Trump on Friday declared a state of emergency on the southern border and immediately direct $8 billion to construct or repair as many as 234 miles of a border barrier. The move — which is sure to invite vigorous legal challenges from activists and government officials — comes after Trump failed to get the $5.7 billion he was seeking from lawmakers. Instead, Trump agreed to sign a deal that included just $1.375 for border security."

Source:
COULD SOW DIVISION AMONG REPUBLICANS
House Will Condemn Emergency Declaration
1 weeks ago
THE DETAILS

"House Democrats are gearing up to pass a joint resolution disapproving of President Trump’s emergency declaration to build his U.S.-Mexico border wall, a move that will force Senate Republicans to vote on a contentious issue that divides their party. House Judiciary Committee Chairman Jerrold Nadler (D-N.Y.) said Thursday evening in an interview with The Washington Post that the House would take up the resolution in the coming days or weeks. The measure is expected to easily clear the Democratic-led House, and because it would be privileged, Senate Majority Leader Mitch McConnell (R-Ky.) would be forced to put the resolution to a vote that he could lose."

Source:
MILITARY CONSTRUCTION, DRUG FORFEITURE FUND
Where Will the Emergency Money Come From?
1 weeks ago
THE DETAILS

"ABC News has learned the president plans to announce on Friday his intention to spend about $8 billion on the border wall with a mix of spending from Congressional appropriations approved Thursday night, executive action and an emergency declaration. A senior White House official familiar with the plan told ABC News that $1.375 billion would come from the spending bill Congress passed Thursday; $600 million would come from the Treasury Department's drug forfeiture fund; $2.5 billion would come from the Pentagon's drug interdiction program; and through an emergency declaration: $3.5 billion from the Pentagon's military construction budget."

Source:
TRUMP SAYS HE WILL SIGN
House Passes Funding Deal
1 weeks ago
THE DETAILS

"The House passed a massive border and budget bill that would avert a shutdown and keep the government funded through the end of September. The Senate passed the measure earlier Thursday. The bill provides $1.375 billion for fences, far short of the $5.7 billion President Trump had demanded to fund steel walls. But the president says he will sign the legislation, and instead seek to fund his border wall by declaring a national emergency."

Source:
×
×

Welcome to National Journal!

You are currently accessing National Journal from IP access. Please login to access this feature. If you have any questions, please contact your Dedicated Advisor.

Login