Tom Price failed to get the Affordable Care Act repealed and replaced during his brief tenure as Health and Human Services Secretary, but the surgeon-turned-congressman did manage to do some real damage to the annual ACA enrollment process before he left — making sure people have less time to sign up, less help getting through the process, and fewer reminders that the process has gotten more difficult this year.
Here is a quick rundown of four of the major ways in which the White House — through Price and the HHS’s various agencies — has cut back on both time and resources for a program that provided insurance to more than 12 million Americans nationwide last year.
1. Half The Time To Enroll
The ACA enrollment period for 2018 begins Nov. 1, but instead of going through to Jan. 31 as it has for previous years, the Trump administration has cut the enrollment window in half, ending it on Dec. 15.
The HHS’s Centers for Medicare and Medicaid (CMS) quietly announced this change last spring, shortly after Speaker of the House Paul Ryan pulled the first version of the GOP’s repeal-and-replace bill.
2. No Healthcare.gov On Sunday Mornings
If you live in one of the 39 states where ACA coverage is purchased through the Healthcare.gov online portal, you’d better find some other time than Sunday mornings to so sign up for your insurance.
HHS recently told navigator groups — organizations that help people sign up for ACA coverage — that Healthcare.gov will be taken down for 12 hours, from midnight until noon (presumably ET), every Sunday during the enrollment period except for the final Sunday, Dec. 10.
With five 12-hour windows of downtime during the already truncated enrollment period, that means there are effectively two-and-a-half fewer days to sign up.
3. Slashed Funding, Minimal Support
We previously mentioned so-called “navigator” groups, organizations around the country that receive funding to help ACA enrollees navigate the sometimes complicated process of selecting an insurance policy and then signing up for coverage.
HHS had initially promised that funding for navigator groups would remain intact, however it subsequently changed its mine, claiming they are a waste of taxpayer expense (at the same time as the HHS Secretary was traveling the globe on chartered and military jets), and cutting grants to navigators by 40%.
At the time of this about-face, HHS explained that navigator groups would be able to earn additional funding by meeting their enrollment goals. The idea, a rep for HHS told the Washington Post, was that “navigators will be funded in proportion to their performance.”
The problem with that, said critics, is that navigators’ goals are each set independently by the navigator, and not based on any sort of standard. Thus, a group who had established aggressive enrollment levels as a goal would continue to be underfunded simply because it hoped to sign up as many people as possible, while a group with that set its goals below its actual expectations would be rewarded for simply doing its job. And since the performance rewards are based on the previous year’s goals, navigators are not able to adjust their expectations for 2017.
What’s more, reports Kaiser Health News, a number of navigator groups say they are not getting the tech support they need — and which they’d previously received — from CMS with regard to the glitchy HHS-provided software they are required to use to do their work.
“It used to be… you got the impression they were trying to help you,” said the director of a Utah-based navigator organization. “Now it seems, passively, this is not their priority.”
4. No More Advertising
President Trump knows, better than any others who’ve sat in the Oval Office, the power of advertising and branding, yet HHS has cut 90% of the advertising budget for the upcoming enrollment period.
Its rationale? That Americans are already well aware of the program and don’t need to be reminded via advertising. HHS pointed out that this budget had doubled between 2015 and 2016 and did not result in any increase in ACA enrollments. In fact, the total number who enrolled during the 2016 sign-up window dropped by about 500,000 people.
Critics of the budget cut argue that this downturn is not sufficient enough reason to cut 90% from the budget. The new advertising budget is still only 20% of what the federal government spent in 2015 when enrollment peaked at 12.7 million.
“Many young people will not enroll in insurance without continuous marketing and outreach,” says our colleague Dena Mendelsohn, Senior Attorney at Consumers Union.
It’s particularly important, explains Mendelsohn, that HHS has the budget to continue marketing through through the final days of the enrollment window, as that is when most young adults are likely to sign up for coverage. Having more healthier, generally less-expensive, young adults enrolled in ACA coverage can help even out the insurance pool by providing a balance to older and higher-risk individuals.
“Not only is weak marketing likely to water down the quality of the enrollee pool, it is also likely to raise concerns from the carriers who need to know that they can rely on robust marketing by federal and state-based Marketplaces to promote enrollment and build a good risk mix,” says Mendelsohn.
With still a few weeks to go before the enrollment period ends, some are hoping that Acting HHS Secretary Don Wright will consider walking back some of these changes, making it less complicated for Americans to find decent health insurance.
In a letter [PDF] sent today to Wright, Consumers Union is calling on HHS to “reevaluate the choices it is making for the upcoming open enrollment period in light of the almost certain outcome: fewer consumers insured, destabilized individual and small group risk pools, fewer insurance options, and unnecessarily inflated health insurance premiums.”