State’s insurance chief slams ACA funding cuts

Trump administration plan targets navigators

Pennsylvania’s top insurance official on Wednesday sharply criticized the Trump administration over planned funding cuts to a federal program that helps individuals sign up for health insurance.

The Centers for Medicare and Medicaid Services on Tuesday said it would award up to $10 million nationally for the Affordable Care Act navigator program for the year beginning this fall — down from $36 million for the current year.

CMS says the program has not been cost-effective but state officials suggested the move is part of a wider effort to undercut the ACA.

The reduction “is one more attempt to undermine this successful law, and deprive Pennsylvanians of access to health insurance,” said Insurance Commissioner Jessica Altman. Noting that this follows a cut from $100 million to $37 million a year earlier, “This year’s cuts result in a combined 90 percent reduction in funding for this critical program,” she said in a statement.

Ms. Altman said she has “seen personally what a difference these trained people make” and gave assurance of Gov. Tom Wolf’s continuing commitment to the ACA marketplace, which since its inception has seen Pennsylvania’s uninsured rate drop from 10.8 percent to 5.6 percent.

“We will follow through to make sure Pennsylvanians continue to have the information they need to make decisions about their coverage.”

The navigator program is meant to help individuals shopping for health insurance on the Affordable Care Act marketplace find the best plan, but CMS says the program’s results do not justify the cost.

In its news release, CMS said navigators enrolled less than one percent of those on the marketplace exchange for 2018 — resulting in an average cost of $5,000 per enrollee — with nearly 80 percent of the navigators failing to meet enrollment goals.

By contrast, the release said, insurance agents and brokers helped 42 percent of those enrolling in an ACA plan at a cost of $2.40 per enrollee.

“The per enrollee cost does not look good. I totally, totally get that,” said Lou Ann Jeremko, executive director of the Consumer Health Coalition on the North Side, the major marketplace navigator in the Pittsburgh region and one of the largest in the state.

Ms. Jeremko said the North Side

operation enrolls about 1,400 individuals in plans each year for less than $100 per enrollee. Total funding for the coalition and its partners statewide was $592,527, down from $726,902 two years ago.

Combined, they had enrolled 4,063 individuals through June 1, she said, costing about $146 per enrollee “without counting the thousands that the navigators have provided assistance, outreach and education to as part of their jobs.” Some may find they are eligible for medical assistance, for example.

As for CMS’ finding that navigator enrollments cost $5,000 per individual, she said, “I don’t know if that’s accurate or what methodology they came up with. But I can tell you as a business manager, if I saw those numbers I would want to change something, too.”

The change could have major implications for the coalition.

Just a few months are left in its current contract with CMS, “I don’t know that we will get funding” for next year, Ms. Jeremko said. “I’m not even sure we’re eligible.”

Because the CMS funding represents about 70 percent of the coalition’s annual budget, she said any significant funding cut may force them to look to outside sources, such as local foundations, for help.