DES MOINES — Low-income Iowans hoping to get health insurance through a federal program may not have as much help as has been available in recent years, health care officials and experts warn.
The federal government recently announced significant reductions for advertising and staffing designated to help individuals sign up for health insurance under the Affordable Care Act, known as Obamacare, saying previous funding levels were extraneous.
Local health care officials said they are concerned the reduction will hamper efforts to reach low-income Iowans who wish to obtain health insurance under the federal program, or to educate those who may not be aware they are eligible for the program and its financial assistance.
“We don’t know (the impact) yet, but people are worried,” said Karen Pollitz, a senior fellow who studies health care reform at the Kaiser Family Foundation, a national nonprofit devoted to health care issues.
Under the federal Affordable Care Act, which was created in 2009 under Democratic former President Barack Obama, low-income individuals are able to purchase health insurance plans and receive financial assistance to help pay for monthly premiums.
Through the rest of Obama’s tenure, which ended in early 2017, the federal health department created extensive advertising and funded staff across the country to inform individuals about the law and help eligible people sign up for health insurance.
On Aug. 31, Republican President Donald Trump’s administration announced it will significantly reduce spending on both the sign-up staff — known as navigators — and advertising ahead of this year’s enrollment period, which runs from Nov. 1 through Dec. 15.
The administration will grant $37 million for navigators, down from $63 million in 2016, and plans to spend $10 million on advertising and promotional materials. That is one-tenth the $100 million spent by the Obama administration in 2016.
The health department, in literature distributed to reporters, cited navigators who received large grants but enrolled few individuals.
The administration said it will fund navigators only to match their enrollment levels the previous year. For example, the federal health department said, a navigator who reached only 30 percent of its enrollment goal the previous year will receive no more than 30 percent of that previous year’s funding.
“Judging effectiveness by the amount of money spent and not the results achieved is irresponsible and unhelpful to the American people,” federal health department press secretary Caitlin Oakley said in an emailed statement. “Under the Trump administration, we’re committed to more responsible, effective government. Obamacare’s navigator program has been ineffective. During the upcoming enrollment period, navigators will be funded in proportion to their performance.”
But local health care officials who help individuals enroll for health insurance under the law say the loss of navigators could fall on them, making it harder for them to reach people in need of assistance.
Many Iowans could lose access to those navigators and the free, in-person assistance they provided, said Katie Owens, engagement director for the Iowa Primary Care Association.
The association provides technical assistance and training to the state’s community health centers, which work with underserved communities. Community health centers have been crucial providers under the Affordable Care Act, and many have received grant funding through the law.
Owens also said navigators help cover gaps in rural areas of the state where community health centers are less likely to be able to meet the demand.
“The decrease in navigators helping to educate consumers would be hurtful to Iowa,” Owens said in an email.
Pollitz said uncertainty is being felt among navigator programs across the country, and in previous years funding was consistent and established Sept. 1 ahead of the enrollment period. This year, the spending reductions were announced Aug. 31.
“(Navigator) programs, they don’t know what to do. They don’t know when they’re going to get paid, they don’t know how much they’re going to get paid, they don’t even know if when they get paid it will get paid retroactive back to Sept. 1,” Pollitz said. “So some smaller programs, they’ve closed. (Or) they’ve laid off staff.”
The reduction in advertising likely will hamper local enrollment efforts as well, officials said. They said television and radio advertisements and mailed literature helped inform people about the law, its features and its enrollment deadlines.
The health department asserts there has been no proved correlation between advertising spending and enrollment figures.
Owens said without that advertising, community health centers may be forced to spend more time performing outreach and educating individuals, which could cost them time available to actually enroll people in the program.
“We fear that many consumers will not know about the shortened dates for the open enrollment period, therefore resulting in our assisters spending more time trying to spread the word instead of actually enrolling consumers in coverage,” Owens said.
Pollitz said even now the law is nearly 8 years old and has been in the news much of that time, education remains important because many people still do not understand the law or its features. She cited recent Kaiser polling that showed nearly 9 in 10 uninsured people either were unaware of enrollment deadlines or gave the wrong dates.
And the population that is eligible is constantly turning over, Pollitz noted, so new people every year become eligible for assistance under the law — for example young adults who are no longer eligible for coverage under their parents, older adults who retire before being eligible for Medicare or those who lose their employer-based insurance.
“The outreach is never done. It’s not like you tattoo somebody and then they know and they always know,” Pollitz said. “The outreach is always important.”
In addition to paid advertising, the Obama administration would educate individuals on and promote the law through earned media — holding public events that were likely to be covered by media outlets, Pollitz noted.
The Trump administration has instead advocated for a complete overhaul of the Affordable Care Act and its features.
Oakley noted some of the law’s shortcomings in her emailed response to questions about the outreach and advertising funding levels.
“A health care system that has caused premiums to double and left nearly half of our counties with only one coverage option is not working,” Oakley said. “The Trump administration is determined to serve the American people instead of trying to sell them a bad deal.”
That is likely to impact enrollment numbers, Pollitz said.
“Now the administration is sort of using its profile and its bully pulpit to discourage enrollment,” Pollitz said. “Beyond the cuts, I think that was the other concern that this would create barriers to awareness or to enthusiasm about signing up that would need to be overcome in order for people to end up covered in open enrollment.”