Friday, September 1, 2017

After little action on Obamacare, Trump administration says it will cut enrollment advertising 90%, in-person helpers 41%

The Trump administration announced Thursday that it will cut Obamacare advertising 90 percent and the "navigator" program to help people enroll by 41 percent, with "the deepest cuts to the enrollment workers who have signed up few health law enrollees," Sarah Kliff reports for Vox.

Navigators helped San Franciscans sign up for Obamacare
in 2015. (Photo by Jim Wilson, The New York Times)
"Administration officials cited 'diminishing returns' from outreach activities," Kliff reports. "They said that most Americans already know about the Affordable Care Act. . . . Obamacare advocates, however, worry that these type of budget cuts will be devastating to the law, making it difficult for potential enrollees to learn about the benefits."

Washington & Lee University law professor Tim Jost told Kliff, "The surest way to kill the exchanges is to keep them a secret. Sick people will find them, but getting younger and healthier people enrolled is the problem."

Doug Hogan, spokesman for the Cabinet for Health and Family Services said in an e-mail that a federal cut in funding for navigators, called application assisters in Kentucky, shouldn't impact their involvement in the rollout of the state's new Medicaid plan, upon its approval.

"We are not in a position to speculate on any potential impact without first seeing a specific federal proposal," Hogan said. "That said, this should not have any effect on the implementation of Kentucky HEALTH or on the use of assisters for Kentucky HEALTH, upon approval of the 1115 waiver by the Trump administration."

The Obama administration spent $100 million on digital and broadcast ads for Obamacare in the last enrollment period, and $62.5 million for the navigator program, "which trains individuals and organizations to provide people with unbiased information and help them sign up," Kliff notes. The Trump administration will spend $10 million and $36 million, respectively, amounting to a 72 percent overall cut in outreach.

Department for Health and Human Services official, who declined to be named, said, “The Obama administration doubled spending on advertising and saw a 5 percent decline in enrollment. Despite a doubled budget, there are diminishing returns.”

However, enrollment was on track to be about the same as the year before until the Trump administration "abruptly canceled $5 million in advertisements after taking office," Kliff notes. "Officials said they had not done any studies of the efficacy of enrollment advertising or whether public awareness is indeed quite high."

Little research has been done on Obamacare ads, but a 2017 study published in the journal Health Affairs said “Counties exposed to higher volumes of local insurance advertisements during the first open enrollment period experienced larger reductions in their uninsurance rates than other counties.”

Consumer advocates "argue that this is the exact moment when advertising is needed, given all the uncertainty over the health law’s future the recent congressional debate has created," Kliff reports.

She reported earlier, "Reports from conservative outlets have cast doubt on the value of enrollment-outreach programs, and HHS has highlighted those stories to other reporters." The law requires a navigator program, but doesn't say how robust it must be. Decisions about the program must be made soon.

President Trump has repeatedly said that the Patient Protection and Affordable Care Act is "imploding," and has talked about letting it collapse of its own weight, but until now his administration isn't doing much hasten its demise, Kliff reported earlier.

Kiff and Robert Pear of The New York Times reported on a briefing by another HHS official who declined to be named and said: "We want people to have access to quality health care. I think people want stability in the marketplace. We want the health-care market, the individual marketplace, to function, and to function well. It is not functioning, the way it is today."

Several U.S. counties that had been forsaken by insurance companies selling individual Obamacare plans now have at least one insurer, but many counties (including most rural counties) have only one insurer, which decreases competition and increases premiums.

Since the failure of Senate Republicans to pass a repeal-and-replace bill, and insurance companies' agreements to offer Obamacare policies in counties that were being left out, the spotlight has shifted to HHS, headed by Secretary Tom Price, a physician who as a congressman from Georgia railed against Obamacare.

Paige Winfield Cunningham notes in The Health 202The Washington Post's daily digest of health news and analysis, that Price "slashed in half the sign-up season, which used to run through the end of January. Some state insurance officials complain they’re not hearing as much from the Trump administration unlike the communication they had with Obama's government. But things seem to be chugging along behind the scenes at HHS, according to the National Association of Insurance Commissioners. 'They are doing everything they have done in the past to make sure the exchange is up and running and everything is loaded,' said a spokesperson for the NAIC."

"Price is facing a hard reality pitting politics against practicality," Cunningham writes, quoting former Republican Senate Finance Committee staffer Chris Condeluci: “I think HHS and the administration find themselves in a precarious position because on one hand they want to keep up the political rhetoric but they still can’t let the markets crater.”

In April, HHS finalized "a number of stricter rules that insurers had said are necessary to help them stabilize the individual markets next year and beyond," including one the Obama administration wrote, requiring people who want to enroll outside the open enrollment period in November and December to prove they had major life changes such as a divorce or a new baby. Mike Adelberg, a former top director at the Center for Consumer Information and Insurance Oversight at HHS’ Center for Medicare and Medicaid Services, told Cunningham, “Frankly, if they were really trying to kill the program this is something they could have thrown the brakes on.”

In May, HHS issued a policy easing sales of Obamacare plans by online brokers such as eHealth and HealthSherpa. "ACA supporters have raised concerns that online brokers might not present consumers with their full range of options, but even they admit the strategy could boost enrollment numbers by giving shoppers even more venues from which to sign up," Cunningham reports.

No comments:

Post a Comment