Senior officials at the Department of Health and Human Services (HHS) told reporters Thursday that the agency will gut its budget for promotion of and education about the Affordable Care Act ahead of the first full open enrollment period of the Trump administration.
Last year, the officials said, the Obama administration spend about $100 million on educating Americans about their health insurance choices and urging them to enroll. This year, HHS will spend just $10 million.
Additionally, HHS will nearly cut in half the funding for hundreds of navigator groups across the country who provide in-person assistance to people signing up for health insurance, making the grants conditional on how many people each group signed up last year.
“Judging effectiveness by the amount of money spent and not the results achieved is irresponsible and unhelpful to the American people,” said HHS Press Secretary Caitlin Oakley in a statement defending the cuts. “Under the Trump Administration, we’re committed to more responsible, effective government.”
On the Thursday call, HHS officials argued that the aggressive outreach and education work the federal government has carried out every year since 2013 is no longer worth fully funding, characterizing it as a “bad deal.”
“There are diminishing returns from this spending,” one senior official said. “People are generally aware of Obamacare and the exchanges. They are aware of the products out there and aware they can sign up.”
However, when a reporter on the call asked if the HHS had conducted any analysis of public awareness about the ACA since the last open enrollment period, officials admitted they had not.
“We haven’t done a specific study related to public awareness of the program,” one of the officials on the call said. “I think that many many, most Americans are aware of the program at this point in time.”
Grassroots groups who have partnered with the government in past years on open enrollment promotion say this is not true and that outreach and education is particularly crucial this year. They say the public is more confused than ever about the status of Obamacare because Republicans have spent all year casting public doubt on the program. President Trump has repeatedly claimed the Affordable Care Act was “imploding.” HHS has engaged in an anti-Obamacare media campaign. The GOP-controlled Congress lambasted Obamacare as it repeatedly tried and failed to repeal the law.
HHS says they will focus the $10 million they plan to spend this year on emails and texts to existing enrollees, and on radio and digital ads highlighting the newly shortened open enrollment period, which the Trump administration cut in half.
One official said the decision to drastically reduce open enrollment ad spending was based on the “diminishing returns” of last year’s campaign, where the Obama administration beefed up its ad budget but enrollment still declined. He added that they also looked to the models of other HHS programs, such as Medicare Advantage, to come up with the outreach plan.
Former HHS officials blasted the outreach plan as woefully inadequate, and warned it would leader to a smaller, sicker, more expensive, and less stable insurance pool.
“The idea that the administration is living up to their responsibility to help people learn about their options and sign up for health care is a complete joke,” Lori Lodes, the former Director of the Office of Communications for the Centers for Medicare and Medicaid Services (CMS), told TPM. “Only spending $10 million on ‘educational activities’ and not spending anything on national television means that people will not know the deadline is December 15 and will miss their opportunity to sign up. Slashing navigator funding by over a third means that those people who need in-person assistance the most will slip through the cracks.”
Additionally, amid concerns about the Trump administration abandoning partnerships with dozens of groups that specifically promoted open enrollment to Latinos—the community with the lowest insurance rate—HHS officials also could not give specifics on plans for Latino open enrollment outreach this November.
“There’s a couple of separate contracts that we have for Spanish-speaking and then also for Chinese and a couple other language. So we will have to follow up,” one HHS official said.
The officials additionally explained that navigator groups, which received more than $60 million last year, will now have their budget determined by their “performance” last year. For example, if a group in a particular state only met 30 percent of their enrollment goal, they will only get 30 percent of their expected funding this year.
This, one official explained, will help them “avoid rewarding grantees who have failed.”
No navigators will be cut from the grant program entirely due to a poor performance in the previous year; there will be a floor to the grants of $10,000 per navigator entity. However, those navigators who exceeded expectations will not receive any additional grant money this year, and overall, the new methodology represents a 41 percent cut to the program.
The officials on the call were asked if the HHS under Trump would have an open enrollment target, as had been the practice of the Obama administration. One official said they would set a target but that the specific number had not been finalized yet.
In a response to the news, America’s Health Insurance Plans, the industry’s largest trade group, stressed the importance of outreach in a statement.
“Effective education ensures that consumers understand their coverage options and encourages broader participation of healthy individuals,” AHIP spokesperson Kristine Grow said. “Marketing, outreach, and education are critical to ensure that all consumers are aware of the upcoming open enrollment period, understand new timelines, and enroll by the deadline.”
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