Since 2013, the Ohio Association of Foodbanks has been tasked with helping individuals in Ohio sign up for insurance. And they’ve done their job well.
From the beginning of the Obamacare exchanges, the nonprofit, which oversees a statewide consortium of navigators, enrolled a little over 44,000 people in marketplace or Medicaid plans, which its executive director Lisa Hamler-Fugitt noted, adequately fulfilled the group’s mission. In April 2016, the Department of Health and Human Services released a report assessing that the Association of Foodbanks had both met the navigator eligibility requirements and found that its expenditures were “generally allowable.”
But this year, the organization will no longer assist in enrolling and educating consumers about their options and the affordability of plans. Their budget was slashed by 71 percent as part of the Trump administration’s massive cuts to all federal navigator programs—a slash from nearly $1.7 million to $485,000. On September 22, the group decided it had to exit the program, leaving Ohioans without a single federal navigator to help them with health care decisions and enrollment. It is the only state without any such aid, though advocates expect other states could join it soon.
“We were shocked, absolutely shocked,” Hamler-Fugitt told The Daily Beast on Tuesday. “After serious contemplations, lots of conversations, we just could not move forward. It’s really sad. It’s extremely disappointing.”
Unable to repeal and replace Obamacare, President Donald Trump has done virtually everything within his power to ensure its demise. His administration has made it more difficult to find, more expensive to purchase, and more likely to fail. It has cut budgets meant to advertise the law. It has signed executive orders weakening the mandates requiring individuals to purchase insurance. The Department of Health and Human Services has even produced videos designed to undermine public support for Obamacare, from funds intended for promotion.
The totality of the assault has led to a spike in premiums and broader instability within health care markets overall. It’s also raised questions about the president’s motivation. Asked point blank if the administration wanted to see as many people as possible sign up for health care through the existing exchanges, a White House official pointedly did not reply, “yes.”
“The President trusts Americans to know their own healthcare and coverage needs best—certainly more than the federal government does. They don't need the government telling them what's best for them when it comes to health insurance," the official said. Pressed again, the official added, “It’s not the Administration, but the American people that are rejecting Obamacare insurance in droves, and we will continue to reject multimillion dollar campaigns to try to convince people to purchase a product they don’t want and can’t afford.”
Of all the efforts Trump has made to discourage individuals from purchasing insurance through Obamacare, advocates say that the cuts to outreach programs will have the most impact. Television ads and email campaigns being rolled back will affect signup rates dramatically. So too will the cuts to the federal navigator program.
The program, which operates off of user fees paid by insurers, was designed to provide potential consumers with information on the availability of health care in addition to walking them through the process of signing up. It has not only helped individuals understand the often arcane elements of Obamacare, it has turned those individuals into salesman for the law, there to convince friends and family to sign up as well.
This year, Trump decided to cut the federal navigators budget by 41 percent, arguing that it more honestly lined up to the program’s success rates from past years. And with open enrollment for this year fast approaching (now just two weeks away), navigators throughout the country are grappling with the fallout.
Navigators in states like Michigan, Missouri and Montana have seen cuts of 90 percent or more. The other navigator program in Ohio, Resolute Certified Navigators, suspended its operations in the state in September, before the Ohio Association of Foodbanks announced it was pulling out too. Ohioans in need of assistance for their health care decisions will have to rely on local certified application counselors who don’t go through the same extensive training.
“We have not been controversial until the Trump administration,” Hamler-Fugitt said. Now, she added, “There won’t be any navigators in Ohio. Period none zip zero,”
States have been affected indiscriminately, with a number of southern states taking the brunt of the hit. In South Carolina, Larry Holman, president of the Beaufort County Black Chamber of Commerce saw his organization’s funding decrease by a margin of over 97 percent, falling from “424,000 and some change to $10,000,” as he put it. It used to average between 10 to 15 outreach events during the enrollment period and has now only scheduled two or three in December.
“I don’t know how effective we will be because we’re only doing two counties instead of 11,” Holman explained to The Daily Beast. “It takes more to educate people than it takes to enroll them. It is not like going to a retail store, picking up a purchase. Health care is not like that. You spend a lot of time on educating folk on picking the plan that’s right for them and their family.”
The likely outcome, as Holman and other officials noted, is utterly predictable: The fewer people aware of the availability of Obamacare the fewer people who will sign up for it.
Already, according to a Hart Research poll, only 31 percent of currently insured consumers know that the enrollment period begins on November 1; only 12 percent of uninsured consumers polled knew that was the date; while 54 percent of insured consumers and 59 percent of uninsured consumers “either believe that Obamacare will be cancelled and people will lose their health insurance coverage in 2018 or say that they are unsure.”
The uncertainty around the Affordable Care Act has already led some consumers, navigators say, to wonder if the law will even continue to exist.
“We have experienced a lot of confusion,” Chelsea Arnott, project manager at the ACCESS Project Consortium through the Saint Louis Effort for AIDS told The Daily Beast. Her organization’s budget was cut 92 percent from last year, meaning that they will now cover 13 counties as opposed to the 99 they covered last year.
Every time a new story comes out about the administration chipping away at the ACA, Arnott added, people “think the whole thing is done when really the ACA is still here and it’s still what we have to work with… You’re not just dealing with cuts, you’re dealing with this negative messaging that the program isn’t working.”
—Sam Stein contributed reporting.