Patient Groups Express Frustration With ACA Navigator Cuts in Letter to HHS, CMS

Close to 200 organizations wrote to CMS and HHS this week to express concerns with the Trump administration’s plans to cut millions of dollars from the Affordable Care Act (ACA)'s marketing and outreach budget, saying that they are “frustrated by CMS’ assertions that the need for these services has decreased as the number of uninsured or underinsured Americans continues to grow.”

Earlier this month, the administration cut the budget of the ACA navigator program to $10 million, and, for the first time, is encouraging the navigators to also sign people up for health insurance that provide a narrower level of coverage than plans compliant with the ACA. Since 2016, the budget for ACA marketing and enrollment has been cut by more than 80%.

Navigators do more than help people sign up for insurance, the organizations said. They “must provide fair, accurate, unbiased, and culturally appropriate information” and provide “in-person help to low-income and rural communities, consumers with limited English proficiency, people with disabilities, and other populations for whom such assistance is not often available.”

Navigators also helped people find the most appropriate insurance, even finding that some people were eligible for Medicaid and did not know it, said Erika Sward, national assistant vice president, advocacy, American Lung Association (ALA).

“These resources are critical,” she said in an interview with The American Journal of Managed Care^® (AJMC^®). “Everyone who should get care could get care,” Sward said.

Sward said the ALA, through its 1-800-LUNGUSA helpline, has been certified by CMS as a navigator since the navigator program began, but it receives no funding. It will continue to assist people who call.

The other big concern noted in the letter is that CMS wants navigators to steer people away from ACA plans and into the short-term, limited duration health plans or association health plans (AHPs). The administration has been promoting these plans as a way for people to afford health insurance with less expensive premiums, but the plans are not compliant with ACA essential health benefits.

“The plans, frankly, are too skinny for what Americans need,” said Sward.

“AHPs and short-term plans have a long history of leaving enrollees saddled with medical debt while also denying coverage for even basic medical care. We believe that increasing access to these products will harm consumers and contribute to higher premiums for the millions of Americans with pre-existing conditions who rely on the marketplaces for comprehensive coverage,” the letter stated.

Asked about the letter during a press call with reporters, CMS Administrator Seema Verma said the old navigator program was not effective. She added that the agency was better off working with partners in the corporate sector and that the previous method cost as much as $5000 to enroll an individual.