Shop­ping for ACA health plan? Don’t ex­pect much help

The Charlotte Observer (Sunday) - - Nation & World - BY ROBERT PEAR New York Times

When the an­nual open en­roll­ment pe­riod be­gins in a few days, con­sumers across the coun­try will have more choices un­der the Af­ford­able Care Act, but fewer sources of un­bi­ased ad­vice and as­sis­tance to guide them through the labyrinth of health in­sur­ance.

The Trump ad­min­is­tra­tion has opened the door to ag­gres­sive mar­ket­ing of short-term in­sur­ance plans, which are not re­quired to cover pre­ex­ist­ing med­i­cal con­di­tions. In­sur­ers are en­ter­ing or re­turn­ing to the Af­ford­able Care Act mar­ket­place, ex­pand­ing their ser­vice ar­eas and of­fer­ing new prod­ucts. But the bud­get for the in­sur­ance coun­selors known as nav­i­ga­tors has been cut more than 80 per­cent, and in nearly one-third of the 2,400 coun­ties served by Health­, no nav­i­ga­tors have been funded by the fed­eral gov­ern­ment.

“There is likely to be a lot of con­sumer con­fu­sion about the var­i­ous plan op­tions that may be avail­able this year,” said Sab­rina Cor­lette, a re­search pro­fes­sor at Ge­orge­town Univer­sity’s Health Pol­icy In­sti­tute. “It will be a bit of a Wild West – buyer be­ware!”

“Oba­macare health plans,” short-term plans and “Chris­tian health shar­ing plans” are all dis­played on the same page of some shop­ping sites such as Af­ford­ableHealth-In­, which de­scribes it­self as a free re­fer­ral ser­vice for in­sur­ance shop­pers.

Con­sumers may have dif­fi­culty sort­ing through their op­tions af­ter the ad­min­is­tra­tion sliced the bud­get last sum­mer for in­sur­ance nav­i­ga­tors to $10 mil­lion this year, from $36 mil­lion in 2017 and nearly $63 mil­lion in 2016.

“Nav­i­ga­tors play a vi­tal role in help­ing con­sumers pre­pare ap­pli­ca­tions to es­tab­lish el­i­gi­bil­ity and en­roll in cov­er­age through the mar­ket­places,” the Depart­ment of Health and Hu­man Ser­vices says on its web­site.

But 797 coun­ties served by Health­ will not have any nav­i­ga­tors this year, ac­cord­ing to a tab­u­la­tion of fed­eral data by the Kaiser Fam­ily Foun­da­tion. That is a sharp in­crease from 2016, when 127 coun­ties lacked such as­sis­tance.

“If you are con­fused and you want some­body’s help to try to fig­ure out what’s right for you – what’s junk and what is le­git­i­mate – there will be fewer peo­ple to help you in most states,” Cor­lette said.

Fed­eral of­fi­cials said they were not pro­vid­ing funds for nav­i­ga­tors in Iowa, Mon­tana or New Hamp­shire be­cause no or­ga­ni­za­tions had ap­plied for the money in those states.

Cleve­land, Dal­las and large ar­eas of Michi­gan and other states will also be with­out nav­i­ga­tors.

Texas will be hit hard. The state has the largest num­ber and the high­est per­cent­age of peo­ple who are unin­sured, with 4.8 mil­lion peo­ple, or 17 per­cent of res­i­dents, lack­ing cov­er­age, ac­cord­ing to the Cen­sus Bu­reau.

“North Texas re­mains one of the most unin­sured ar­eas in the coun­try,” said the chief ex­ec­u­tive of Dal­las County, Judge Clay Lewis Jenk­ins. “The ad­min­is­tra­tion’s de­ci­sion to de­fund all nav­i­ga­tors across North Texas will hurt our abil­ity to en­roll in­di­vid­u­als in health in­sur­ance and re­sult in some work­ing fam­i­lies los­ing cov­er­age. Only 45 of Texas’ 254 coun­ties have any nav­i­ga­tor cov­er­age.”

Seema Verma, ad­min­is­tra­tor of the Cen­ters for Medi­care and Med­ic­aid Ser­vices, de­fended the cuts.

Af­ter five years, she said, “the pub­lic is more aware of the op­tions for pri­vate cov­er­age” avail­able through the mar­ket­place, so “it is ap­pro­pri­ate to scale down the nav­i­ga­tor pro­gram.” In ad­di­tion, she said, in­for­ma­tion and as­sis­tance are avail­able from other sources, in­clud­ing in­sur­ance agents and bro­kers.

Con­sumers can sign up for health in­sur­ance un­der the Af­ford­able Care Act start­ing Thurs­day.


Open en­roll­ment starts Thurs­day for 2019 Af­ford­able Care Act plans, but the bud­get for the in­sur­ance coun­selors known as nav­i­ga­tors has been cut more than 80 per­cent.

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