Obamacare: Outreach groups nervous as Trump remains silent on funding

A year after steep cuts to a key Affordable Care Act outreach program, the Trump administration has remained quiet on how much it will fund nonprofit and grassroots groups that help people sign up for health insurance.

The federal navigator program funds groups that help people sign up for health insurance on the Obamacare federal and state insurance exchanges or assist low-income adult and children sign up for Medicaid coverage.

Navigator groups located in federal exchange states are funded through September but have no idea how much money will be available beyond then. The six-week open enrollment period that allow consumers to choose a plan for the upcoming year begins Nov. 1.

In past years, U.S. Department of Health and Human Services (HHS) announced funding opportunities in April and required navigator groups to apply for grants by mid-June. That allotted HHS staff enough time to review applications and award grants before open enrollment begins.

“It’s definitely late in the year for this,” said Karen Pollitz, a senior fellow at Kaiser Family Foundation. “When you do the math, we’re running out of days.”

The Trump administration, which has been critical of the efficiency of these groups, has reshaped the Obama-era program to operate with limited resources, according to a HHS draft rule.

Under new  HHS regulations that took effect June 18, navigator groups would no longer need to be physically located in the states they serve. The new regulations also eliminate a requirement that at least one navigator group in a community be a consumer-focused nonprofit.

The Trump administration has pursued other changes to Obama's signature health-care law. A new Labor Department rule unveiled this week allows small businesses and self-employed individuals to band together and buy potentially less-expensive "association" plans that don't carry all the benefits required by the health law.

President Donald Trump also is expected to expand the use of short-term health insurance plans that are often less expensive but don't have the same consumer protections as exchange plans.

Last year, the Trump administration ended a key payment to insurers that helped lower the cost of insurance for low-income Americans who purchased marketplace insurance.

And the Justice Department declared this month it will no longer defend the health law in a federal court case filed by 20 states, leaving vulnerable a provision that protects consumers from being denied coverage based on existing medical conditions.

Cuts 'undermine' health law

Administration officials would not say when the funding details will be publicly released, leaving navigator groups in limbo on budgets to prepare for this year's six-week enrollment starting Nov. 1.

Last year, the Trump administration cut funding to the navigator program more than 40 percent weeks before the the start of signups. While the administration has not publicly revealed budgets for this year, HHS officials noted that limited resources are a driving factor for the proposed regulatory overhaul this year.

Critics of the administration's handling of the Affordable Care Act say the delayed navigator funding and program changes are more proof that the administration has continued to target Obama's signature health-care law.

"This is one more attempt to undermine the Affordable Care Act," said Lisa Hamler-Fugitt, executive director of the Ohio Association of Foodbanks.

Hamler-Fugitt's group discontinued navigator work last year after its grant funding was slashed 71 percent. She said her group now refers marketplace customers to others, such as license insurance brokers or the federal marketplace website.

"It was heartbreaking," Hamler-Fugitt said. "We had clients we worked with from the very beginning," when the health-law exchanges began in 2014.

Other navigator groups who provide in-person assistance through these nonprofits worry that changes could make it more difficult for consumers who need hands-on help. It may open the door to out-of-state organizations that provide assistance over the phone or bolster the role for private health insurance brokers.

Tampa resident Lori Martell has relied on a University of South Florida navigator group to explain the fine print of insurance plans and health-law subsides that allow her to maintain coverage.

The 60-year-old woman has glaucoma and needs three types of prescription eye drops that collectively cost about $1,200 each month. Without health insurance, she couldn't afford the medication, she said.

In addition to a once-a-year appointment during enrollment, Martell calls the University of South Florida navigator group several times during the year when she has questions about her insurance plan.

She trusts and relies on the advice of the navigator group because she has limited financial resources. She's unemployed and depends on withdrawals from a retirement-saving account for living expenses — an account that would dwindle quickly if she chose the wrong insurance plan.

Jodi Ray, director of Florida Covering Kids & Families navigator group at the University of South Florida, said her organization is bracing for changes.

Last year's cuts forced the Florida group to trim the number of employed navigators. She worries that further cuts and program changes could harm the state's vulnerable residents who rely on the organization's services.

“The challenge will be the in-person assistance has been so vital for those people who have transportation issues, language and cultural barriers, trust issues," Ray said.

Others worry that navigators' role will diminish as consumers face more difficult decisions with short-term plans. These plans don't have the same protections as marketplace plans. Insurers that sell these plans can exclude people or not cover existing medical conditions.

The Obama administration limited short-term plans to 90-day terms, but Trump administration officials have advocated plans that would last 364 days. The lower-priced plans may entice some consumers who are not aware of all the coverage limitations.

Dan Derksen, a doctor who oversees a navigator program at the University of Arizona in Tucson, Arizona, worries that consumers will need more guidance with these at-times risky plans.

"At a time when people have more questions, it's very likely there will be fewer people to help them in person," Derksen said.

WPXI