The Washington PostDemocracy Dies in Darkness

On cusp of Biden’s new ACA enrollment period, details of outreach strategy are scant

President Biden signs an executive order Jan. 28 to reopen the federal Affordable Care Act marketplaces.
President Biden signs an executive order Jan. 28 to reopen the federal Affordable Care Act marketplaces. (Doug Mills/New York Times/Bloomberg)

After promising to launch a $50 million campaign to draw attention to an extra shopping period for Affordable Care Act health plans that starts Monday, the Biden administration has been slow to disclose details of its outreach strategy and is providing no assistance to community groups that coach consumers to sign up for coverage.

The absence of money for these enrollment helpers has prompted warnings from the groups, known as navigators, which limped along with sharply diminished funds under President Donald Trump and reserved little for an unprecedented, extended sign-up ordered by President Biden two weeks ago.

“I’m concerned it’s going to be a bit of a bust,” Allison Espeseth, director of Covering Wisconsin, that state’s only remaining navigator group, said of the new enrollment period, which runs through May 15.

Like counterparts around the country, Espeseth said her organization used up most of its federal grant during the regular six-week enrollment period late last year. They say they do not have much left to pay staff to find and work with the consumers targeted by the administration — those who qualify for ACA coverage and subsidies but have not gotten them in the past. This time, that group includes Americans who lost jobs and insurance in the economic fallout of the coronavirus pandemic.

Meanwhile, federal health officials had been saying they would unveil on Friday the marketing campaign that the president’s
health-policy aides believe is critical for the enrollment period’s success. A news release Friday from the Centers for Medicare and Medicaid Services echoed those broad strokes but furnished no fresh detail.

A senior official at the Department of Health and Human Services, speaking on the condition of anonymity Friday evening to discuss information that had not been made public, said the agency is working quickly to set up the enrollment period within weeks of the president’s order. He said it had made a national television ad buy, to start Monday, for the early days of the sign-up and would purchase more over the next three months. The official said that television advertising is intended to be the biggest purchase within the allotted $50 million, with digital ads the second-largest chunk.

The official did not disclose the wording of ads but said they would focus on affordability of ACA health plans because of the federal subsidies for which most customers qualify — the same theme as during the earliest years of HealthCare.gov, the online federal insurance marketplace relied on by three-dozen states where enrollment is about to resume. Research has shown that consumers’ perceptions about the price tag of health plans are the biggest enrollment stumbling block.

The department also has just finished a new analysis of where the nation’s uninsured live, and some of the outreach efforts will target such communities, the official said.

Still, the official cautioned, “this is a start of a process that will take some time. Years went by [during the Trump presidency] when people weren’t being told it was possible to enroll.”

Meanwhile, HealthCare.gov showed no indication Friday that a special enrollment period is imminent. A CMS spokeswoman said the website will be updated late Sunday.

Within HHS and among some outside specialists, speculation circulated Friday that preparations for the outreach campaign may have been hindered by the reality that the Biden administration remains a work in progress. The president has not yet nominated an administrator to lead CMS, the agency within HHS that oversees most aspects of the ACA marketplaces. And other political appointees, who typically provide direction to the agency’s career staff, are not yet in place.

The reopening of HealthCare.gov “was an executive order, and there’s not a lot in the middle,” said one individual familiar with HHS, who spoke on the condition of anonymity about the department’s current inner workings.

Randy Pate, who directed CMS’s Center for Consumer Information and Insurance Oversight through nearly all of the Trump years, said, “Look I sympathize. I don’t necessarily agree with pouring $50 million into an open enrollment when we just had one, but I do understand why it could be difficult . . . in a very short period of time. You have to buy ads, you have to shoot them. That’s a tremendous amount of work.”

The administration’s outreach efforts come after Democrats have argued for three years that, under Trump, health officials choked what had been robust efforts to alert Americans to the opportunity each year to buy ACA year plans. In slashing the funds for outreach and navigators, Trump health officials and other Republicans countered that by 2017, the fifth year people could buy ACA health plans, most people who needed such coverage already knew about it.

During his campaign, Biden emphasized that he regards the sprawling 2010 health-care law as a potent tool to make health care more accessible. The executive order the president signed Jan. 28 was his first concrete step to employ the ACA to advance his goal of helping more Americans gain health insurance.

The ACA’s federal insurance marketplaces were created for people who do not have access to affordable health benefits through a job. Fourteen states and the District of Columbia run their own marketplaces under the law. While not covered by Biden’s order, most are giving similar sign-up opportunities because of the pandemic.

The vagueness surrounding the outreach campaign for the impending enrollment time contrasts with the detailed annual presentation of the ACA outreach strategy before each enrollment period under President Barack Obama, whose aides put intense effort into marketing the health insurance created under the law that he helped shepherd through Congress. Biden was Obama’s vice president and often touts his role in the ACA’s creation.

The lack of extra funding for the navigators comes despite the fact that HHS has built up a pot of $1.2 billion in user fees, paid by insurers that sell health plans, which can be used for outreach activities.

The HHS official said that “right now, we are taking a look at navigator funding . . . what’s possible in terms of timing.” He did not say whether the goal was to increase grants within the three-month sign-up or whether that was more likely in time for the regular enrollment period in the fall.

“I worry about it. My staff worries about it. We didn’t budget for a three-month open enrollment,” said Jodi Ray, director of Florida Covering Kids and Families. The group received $5.9 million a year during the Obama administration and now receives $1.6 million. When she asked why her funding was not being increased, Ray said, “I don’t know I got a why.”

In Wisconsin, Espeseth said that even the federal program officer for her group’s grant expected navigators’ funding to increase. Just after Biden ordered the extra enrollment time, Espeseth said, the program officer contacted her to say that, if she had staff she’d needed to let go or whose hours she’d had to reduce because of Trump budget cuts, she should bring them back.

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