As the fate of the Affordable Care Act dangled dramatically in the Senate last month, the Trump administration abruptly canceled contracts with two companies that have helped thousands of Americans in 18 cities find health plans under the law.
The suspension of the $22 million contracts, which ends enrollment fairs and insurance sign-ups in public libraries, is one of the few public signs of how an administration eager to kill the law will run the ACA’s approaching fifth enrollment season.
With that sign-up period less than three months away, the government appears to be operating on contradictory tracks, according to insurers, state insurance commissioners, health-policy experts and leaders of grass-roots groups that have worked to enroll the roughly 10 million consumers around the country who now have ACA coverage.
President Trump continues to stage photo ops at the White House and on travels with people he terms “Obamacare victims.” The Department of Health and Human Services is issuing weekly maps showing the few dozen counties that might lack an ACA health plan for next year. And despite the failure of Senate Republicans to abolish much of the law, Trump and his top aides have not entirely relinquished hopes of a victory in Congress this fall.
Yet many layers down in the government, the part of HHS that directly oversees the ACA’s insurance marketplaces and the federal HealthCare.gov enrollment website has been carrying out much, if not all, of its regular work — convening its annual meeting in June with “navigators” who help steer consumers toward ACA health plans and telling them their grants will continue, according to three participants.
Officials provided no assurances at that meeting, however, about whether the administration would continue the government’s other usual enrollment activities or promotion. (In January, it had halted most advertising aimed at encouraging consumers to sign up in the final crucial days before the deadline for 2017 coverage.)
“Every time the question was brought up . . . the only answer we received is they were working on it, and they hadn’t made a final decision about whether they were going to have a marketing campaign this year,” said Daniel Bouton, manager of a consortium that helps people enroll across North Texas.
The internal dissonance and information vacuum reflect the profound political shift that occurred in January when the administration of President Barack Obama, which relentlessly championed the sprawling 2010 law, was replaced by its ACA-naysaying successor. While the GOP’s recent legislative pyrotechnics have attracted the greatest attention regarding the law’s future, the most practical test of the Trump administration’s intent is whether it will help or hinder the marketplaces, designed for people who cannot get affordable health benefits through a job.
Just a week ago, HHS Secretary Tom Price twice said during a television interview that “our responsibility is to follow the law” — before again bad-mouthing it.
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For now, the largest mystery looming over the upcoming enrollment season is whether the president will carry out his stated resolve to end payments made to insurers on behalf of about 7 million lower-income customers to help them afford their ACA plans’ deductibles and copays. Without those subsidies — the subject of a federal lawsuit — policy premiums are widely predicted to spike for 2018, and more insurers may defect.
White House aides had said a decision would be made last week, but none was announced. Insurers planning to participate in the marketplaces next year must submit final rates in less than 10 days.
“It’s entirely opaque to us,” said Julie McPeak, Tennessee’s insurance commissioner and the incoming president of the National Association of Insurance Commissioners. She said that she and colleagues have contacted officials at HHS, the Justice Department, the White House’s intergovernmental affairs office, and its Office of Management and Budget, trying to learn which part of the government would make the decision about these cost-sharing payments and when.
“And we can’t get a clear picture,” McPeak said. As a result, she noted, Tennessee cannot plan its own outreach efforts because it is impossible to provide consumers accurate information about insurance prices and choices for the coming year.
There are other unknowns that also will shape — or upend — the enrollment period when it begins Nov. 1: Will the government contact the roughly 10 million people with ACA coverage to alert them that sign-ups will last just 45 days, about half as long as in the past three years? Will HHS run call centers for consumers who need help as they look for plans? Will the HealthCare.gov computer system be adjusted to accommodate a possible crush of shoppers given the shorter time frame?
And how will automatic enrollment be handled? In previous years, notices have been sent out in mid-December, informing customers with coverage about price changes for their current health plan and urging them to shop around. This year, Dec. 15 is when enrollment will end.
Federal health officials declined Thursday to answer questions about a half-dozen specific facets of the impending enrollment season. Instead, a spokeswoman for HHS’s Centers for Medicare and Medicaid Services issued a generic statement: “As open enrollment approaches we are evaluating how to best serve the American people who access coverage on HealthCare.gov.”
An hour later, the spokeswoman, Jane Norris, requested that the statement be withdrawn, saying that she did not have permission to release it. Asked again for detailed answers, neither she nor anyone else at HHS responded further.
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Mike Leavitt, a health-care consultant and former Utah governor who served as HHS secretary under President George W. Bush, considers the Trump administration’s handling of the marketplaces a metaphor for its overarching view that government should play a smaller role.
He predicts that the two ACA contracts cut last month — with the Northern Virginia-based companies Cognosante and CSRA — will not be the last to go. The White House is likely to “cancel enough contracts . . . to make it very clear the future is going to be very different than the past,” he said.
Still, Leavitt predicted the government is unlikely to back away entirely from its role in the marketplaces in the administration’s first year. “If you are the secretary of health, you don’t want to buy yourself a huge mess at the end of the year . . . by creating such an abrupt shift that the administration gets that blame,” he said.
At the liberal consumer-health lobby Families USA, the staff grew accustomed over the past four years to frequent meetings with HHS staff members and other consumer groups to talk over eligibility and related issues for open enrollments. There have been no such meetings since Trump took office, and federal officials have sometimes replied to written questions by saying no decision has yet been made, according to Eliot Fishman, the organization’s senior director of health policy.
Heather Korbulic, executive director of the Silver State Insurance Exchange in Nevada, is feeling daunted by a similar lack of answers. She has tried to find out whether HHS intends to contact Nevadans with ACA health plans to remind them to enroll — a particularly pressing issue because the state exchange operates under a hybrid system and pays about $5 million to rely on HealthCare.gov. She also has tried to get federal officials to provide a list of currently enrolled residents so the state can notify them directly.
“I ask this question every week,” Korbulic said. “It’s verbal, written, and to different levels of management . . . We are desperately seeking answers.”