CMS on Thursday announced that it will spend $10 million to promote enrollment in exchange plans during the Affordable Care Act's (ACA) upcoming open enrollment period, down 90 percent from the $100 million CMS spent during the last open enrollment period.
Advertising and outreach funding
CMS said it will focus its enrollment advertising and outreach efforts on making sure U.S. residents know that the upcoming open enrollment period will be shorter than it previously had been. The open enrollment period for the 2018 coverage year is scheduled to begin Nov. 1 and end Dec. 15. In previous years, consumers were able to enroll through the end of January.
CMS said it will conduct such outreach through digital media, email, and text messages, which the agency said "have proven" to be "the most effective in reaching existing and new enrollees." The agency added that it would target the outreach "based on specific demographic and geographic data."
According to CMS, the "approach is not only based on previous evaluation of past exchange outreach efforts, but is also consistent with promotional spending on Medicare Advantage and Medicare Part D."
CMS also announced that it will provide $36.8 million in funding for so-called "navigators," which help individuals enroll in exchange plans, for the upcoming open enrollment period, down from $62.5 million during the ACA's last open enrollment period. In addition, CMS said it is changing how navigators will receive the funding.
Under CMS' new system, navigators that met their enrollment goals for the previous open enrollment period will receive the same funding they were given last year. Navigators that did not meet their enrollment goals for the previous open enrollment period will be given less funding, based on a sliding scale that correlates with how they performed against that goal. For example, navigators that hit 80 percent of their enrollment goal for the last open enrollment period will receive 80 percent of the funding they had received last year.
Reasons for the funding reductions
Trump administration officials said CMS is scaling back the funding because previous spending on enrollment advertising and navigators did not provide sufficient value.
For instance, officials said the government has seen "diminishing returns" on advertising investments, with one official saying, "People are generally aware of Obamacare and the exchanges."
In addition, officials said some navigators have helped relatively few people enroll in exchange plans. According to the officials, the 98 navigator programs that receive federal funding last year helped fewer than 82,000 people enroll in exchange plans during the last open enrollment period, representing just one percent of total exchange plan enrollees. Overall, one in five navigators met their performance goals for the last open enrollment period, and 17 enrolled fewer than 100 people each, according to HHS.
HHS spokesperson Caitlin Oakley in a statement said, "Judging effectiveness by the amount of money spent, and not the results achieved, is irresponsible and unhelpful to the American people."
CMS said the new navigator funding system will "ensure accountability within the navigator program and avoid rewarding grantees that have failed to meet their performance measures."
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ACA supporters criticize cuts
Democratic lawmakers accused the administration of trying to undermine the ACA by scaling back funding to encourage enrollment.
House Minority Leader Nancy Pelosi (D-Calif.) said the funding cut represents a "cynical effort to lower enrollment," which could cause "chaos" in the exchange market and ultimately result in higher premiums.
Senate Minority Leader Chuck Schumer (D-N.Y.) said the administration "is deliberately attempting to sabotage our health system."
Other experts also expressed concerns. For instance, Tim Jost, a professor emeritus at Washington and Lee University, said the cutbacks are "very likely to result in fewer people being aware of the need to enroll in [exchange] coverage for 2018." He added, "People with health problems are more likely to find out about coverage on their own, while young and healthy people are less likely to find it. This is very likely to result in deterioration of the risk pool."
Similarly, Andy Slavitt, who served as acting CMS Administrator under former President Barack Obama, said, "A 90 percent funding cut will mean a dramatic cut to enrollment next year, which means a worsening risk pool, higher government outlays, less competition, and higher premiums paid by American families."
Navigator groups said reduced funding could force them to reduce staff and outreach efforts, which could inhibit their ability to help people enroll in exchange plans. Jodi Ray, who leads the University of South Florida's navigator program, said, "It's going to be a really big challenge and doing a lot of extra work with fewer people on the ground and doing the work in half the time" (Alonso-Zaldivar, AP/Sacramento Bee, 9/1; CMS notice, 8/31; Small, FierceHealthcare, 8/31; Sullivan, The Hill, 8/31; Goodnough/Pear, New York Times, 8/31; Pradhan, Politico, 8/31; Armour/Wilde Mathews, Wall Street Journal, 8/31; Bluth/Galewitz, Kaiser Health News, 8/31).
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