Navigating ObamaCare

HHS tries to save money on insurance advisers who do little advising.

 
 

Affordable Care Act navigators hold an enrollment event at the Fort Worth Public Library in Fort Worth, Tx., Feb. 12, 2015.
Affordable Care Act navigators hold an enrollment event at the Fort Worth Public Library in Fort Worth, Tx., Feb. 12, 2015. PHOTO: LM OTERO/ASSOCIATED PRESS
 

One of the more evidence-free claims on the left is that the Affordable Care Act worked brilliantly before Republicans tried to dismantle it. Witness the claim this week that the Trump Administration is trying to tank the law’s exchanges, which are struggling from lack of consumer choice and affordability, not from a lack of government marketing.

Health and Human Services announced on Thursday that the agency will alter the funding structure for ObamaCare “navigators.” These are the community outfits the Obama Administration paid to steer folks through the Affordable Care Act’s subsidies and penalties. Last year the Obama Administration handed out $62.5 million in grants for open enrollment for 2017, and the period arrives again in November.

The Trump Administration will tie grants to performance, and this is a classic government jobs program. One grantee took in $200,000 to enroll a grand total of one person. The top 10 most expensive navigators collected $2.77 million to sign up 314 people, and it would have been much cheaper to offer to pay all of their premiums for a year. 

All told, the navigators last year enrolled about 81,000 people, less than 1% of the total. In fairness to the navigators, it would be tough to sell any product that millions of people are paying fines to avoid buying.

HHS will reduce funding for enrollment advertising—television ads, for example—to $10 million from $100 million last cycle. The new budget is about the figure for promoting Medicare Part D and Medicare Advantage, HHS has noted. The money will be directed to targeted campaigns like emails and texts.

Critics accuse the Trump Administration of trying to sabotage the exchanges, and it’s amusing to imagine that the problem with ObamaCare is that not enough people have heard about it. Navigators will receive funding based on enrollment goals; a grantee that enrolled 50% of projections will receive 50% of last year’s funding. More than $36 million will be paid out. So those who are competently enrolling people will still receive funding, and why pay those who aren’t?

Last year’s marketing blitz—double the $50 million spent in 2015—produced no bump in enrollment, so classify as bogus the complaint that such moves “will create chaos in the health marketplaces,” as Democratic Leader Nancy Pelosi claimed in a statement this week. Individuals who want to sign up for ObamaCare can find Healthcare.gov easily enough, and the website lists a number for staffed call centers. Another false contention is that this won’t save taxpayer money because much of the funding comes from fees on insurers, as if that isn’t a tax passed onto consumers and individuals that will end up in larger taxpayer subsidies.

HHS is in the unenviable position of having to manage a broken law that the GOP failed to repeal, and the agency has an obligation to direct resources to their best use. There are more urgent health-care priorities than informing the public about insurance that Americans know is available but may not want or can’t afford.

Appeared in the September 2, 2017, print edition.

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