Health and Human Services officials have informed grass-roots groups that assist with enrollment under the Affordable Care Act that their funding will be reduced by as much as 92 percent, a move that could upend outreach efforts across the country.
The groups, which fund organizations known as "navigators," had been braced for the cuts since the Trump administration announced two weeks ago that it would shrink overall program funding by 41 percent and slash the department's ACA advertising budget from $100 million to $10 million. At the time of the announcement, HHS officials said the outreach wasted taxpayers' money.
But advocates of the navigator program, including congressional Democrats and some Republicans from rural states, said Thursday that the deep cuts would undermine work to help consumers get insurance coverage once open enrollment begins on Nov. 1. And the depth of some funding reductions, which were made official late Wednesday, raised questions about those state programs' viability and the fairness of the administration's method for deciding how much money each group gets.
"There is no way you can run what we had on $328,000," said Sarah Sessoms of Insure Georgia, which was hit with a massive cut from the $2.2 million it received last year. The HHS email notice arrived at 11:53 p.m. Wednesday, and "I thought — it was disbelief — that something had to be wrong."
Enroll Michigan executive director Dizzy Warren, whose group serves all of the state's 83 counties though a network of more than two dozen groups, is contemplating shutting down within a matter of months now that its $1.2 million grant was slashed to $129,899.
"As you can imagine, this decimates our entire organization," he wrote in an email. The collective effort there enrolled 16,290 Michiganders in health plans last year.
Navigator groups perform a range of services during the ACA's annual enrollment season and throughout the year. They help individuals learn which health plans offered on state and federal insurance exchanges would best suit them, walk consumers through the sign-up process and conduct general outreach to communities about how to obtain coverage under the law. The program's supporters argue that it is particularly critical during the upcoming six-week enrollment period, which is half as long as last year and comes after Republicans' high-profile attempt to repeal the 2010 health-care law.
"I don't know how the people who need this help are going to get it," said Sessoms, adding that Insure Georgia is now exploring its options, including potentially legal ones.
HHS officials in the Trump administration have repeatedly questioned the value of paying navigators. They note that these groups received $62.5 million last year but signed up less than 1 percent of total enrollees. Seventeen of them enrolled less than 100 consumers each, according to the department, at an average cost of nearly $5,000 per enrollee.
"Navigators have been notified of their awards for the upcoming open enrollment period," HHS spokesman Matt Lloyd, "and the next step is for the grantees to work … to align their activities to the awarded amount and accept the terms of the contract."
Sen. Tammy Baldwin (D-Wis.), a member of the Health, Education, Labor and Pensions Committee said in a statement Thursday that the cuts reflected the president's broader effort to undermine the ACA.
"This is nothing short of sabotage," Baldwin said. "The Trump administration is actively creating chaos and making it harder for Wisconsinites in communities across the state to get covered. That's just wrong, and it will further destabilize the market and can lead to higher costs for everyone."
But some conservatives backed the administration's action.
"The administration clearly has done a cost-benefit analysis in determining if the money that had been spent on the navigator program produced the needed results," Grace-Marie Turner, president of the Galen Institute, said in an email. "Programs were significantly under performing in their cost per enrollee."
Although Lloyd said the metric used to determine grant levels was the number of people a group had enrolled in ACA health plans, some organizations that reached past enrollment goals are facing major cuts while others were not touched.
The Kansas Association for the Medically Underserved, where officials said all targets had been met, received full funding, as did Planned Parenthood of St. Louis. Yet Karen Pollitz, a senior fellow at the Kaiser Family Foundation, said New Jersey's Center for Family Services had its grant go from $805,000 to $291,000 "despite the fact that they exceeded all of their numbers."
"There doesn't seem to be a pattern," she said. "It looks like this could drastically cut back on the availability of in-person assistance in a lot of the heavily impacted states."
At the Missouri Association of Area Agencies on Aging, which spread nearly $920,000 in navigator money among seven agencies across the state last year, executive director Catherine Edwards learned early Thursday morning that amount would be cut by 62 percent to just under $350,000.
Take Care Utah, a network of nonprofits with roughly 90 navigators, enrollment specialists and insurance brokers, suffered a 61 percent cut, from $740,000 to $289,584. Its director, Randal Serr, noted that Utah had the country's third-highest increase in federal marketplace enrollment last year, behind Hawaii and South Dakota.
"We will have to make some tough decisions, there's no way around it," he said in an email.
At this point, navigators are scrambling to rework their approach for this fall's enrollment period. As recently as May, federal officials had told Edwards that her association in Missouri could expect to receive a similar grant as last year. Having prepared a budget based on its 2016 award, she now is wondering how she can proceed with the digital and social media campaign planned, especially if many individual navigators are at risk of being laid off.
"At what point does it become ineffective to do any of that?" she asked.
Even before the emails began popping up in organizations' inboxes, HHS's abrupt announcement about an overall drop in funding had created havoc for enrollment helpers around the country. It came at the exact time of year when their work becomes intense, ramping up for the always feverish enrollment season, and left them with no money to spend during the first two weeks of September because their previous grants had expired as of Sept. 1.
According to notices sent to organizations late Wednesday, these groups now have just two weeks to send HHS a revised budget and work plan, which federal officials then must approve. They will be allowed to use 10 percent of their award to cover costs they have incurred since Sept. 2, and the reimbursement will be restricted to certain expenses.
HHS informed recipients that their award figures "are considered private and confidential and should not be shared."
In addition to enrolling consumers, navigators typically advise consumers on how to provide proof of health coverage when filing their taxes; how to find a primary doctor and how to address issues related to premium payments and insurance billing. They also work with employers on fulfilling their obligations under the ACA.
"They don't count all the other ways we help people," Serr emailed from Utah. "This is completely a political decision, and not a decision made by people who do this for a living."
While congressional Democrats have been most critical of the administration's plan to cut navigator cuts, some GOP officials have warned it could hurt their constituents as well.
Lori Wing-Heier, director of the Alaska Department of Commerce, Community and Economic Development's insurance division, testified on Capitol Hill last week that in some remote parts of the state "there's not an insurance broker or a consultant to be found."
"We are very concerned that it will have a major impact on our enrollment," Wing-Heier told the Senate hearing. "This would be devastating, to our population."
Funding for the state's two navigator groups, Alaska Primary Care Association and United Way of Anchorage, were cut by 24 percent and 27 percent, respectively.