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

The Bradenton Herald (Sunday) - - Nation & World - BY ROBERT PEAR


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


“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 per- cent 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, in- clud­ing in­sur­ance agents and bro­kers.

Con­sumers can sign up for health in­sur­ance un­der the Af­ford­able Care Act start­ing Thurs­day. Last year, 8.7 mil­lion peo­ple en­rolled at Health­, and 3 mil­lion more se­lected plans on in­sur­ance ex­changes run by states.

Con­sumers can go with­out in­sur­ance next year with­out fear of a penalty, as Con­gress re­pealed the un­pop­u­lar tax sur­charge im­posed on peo­ple who lack cov­er­age.

Many health pol­icy ex­perts say that fed­eral fi­nan­cial as­sis­tance is more im­por­tant than the in­di­vid­ual man­date in in­duc­ing peo­ple to buy in­sur­ance. Those sub­si­dies will still be avail­able to low- and mod­er­ate-in­come peo­ple for in­sur­ance that com­plies with the Af­ford­able Care Act and is pur­chased through the pub­lic mar­ket­place. The sub­si­dies can­not be used for short-term poli­cies.

“The vast ma­jor­ity of the peo­ple we serve, over 90 per­cent, are mo­ti­vated to have in­sur­ance be­cause they want cov­er­age for their fam­ily and them­selves,” said Matthew Slon­aker, ex­ec­u­tive di­rec­tor of the Utah Health Pol­icy Project, a non­profit. “It’s not be­cause they oth­er­wise would have to pay a penalty.”

Av­er­age pre­mi­ums for the most pop­u­lar types of in­sur­ance pur­chased by in­di­vid­u­als and fam­i­lies will be rel­a­tively sta­ble next year and, in some states, will ac­tu­ally de­cline, the ad­min­is­tra­tion says.

Un­der new stan­dards is­sued by the ad­min­is­tra­tion, nav­i­ga­tors this year are en­cour­aged to in­form con­sumers of the full range of cov­er­age op­tions, in­clud­ing short­term plans that do not pro­vide all of the ben­e­fits and con­sumer pro­tec­tions re­quired by the Af­ford­able Care Act.

Pres­i­dent Don­ald

Trump has pro­moted the short-term poli­cies as an inexpensive al­ter­na­tive to the Af­ford­able Care Act, and he said those plans would be “much more widely avail­able” as a re­sult of an ex­ec­u­tive or­der he signed last year to over­turn re­stric­tions im­posed by Pres­i­dent Barack Obama.

Democrats have made health care a ma­jor theme in midterm elec­tion cam­paigns, and they say the short-term poli­cies show how the Trump ad­min­is­tra­tion threat­ens pro­tec­tions for peo­ple with pre­ex­ist­ing con­di­tions.

Short-term poli­cies, which can ex­tend up to 364 days and then be re­newed for two ad­di­tional years, of­ten pro­vide no cov­er­age for pre-ex­ist­ing con­di­tions, pre­scrip­tion drugs, preg­nancy, ma­ter­nity care or the treat­ment of men­tal dis­or­ders and drug abuse.


Is­rael re­sponded with airstrikes Satur­day to a salvo of rock­ets fired by mil­i­tants from the Gaza Strip into its ter­ri­tory overnight, say­ing it held Gaza’s rulers, Ha­mas, re­spon­si­ble for the flare-up and that it had ev­i­dence that Iran’s Rev­o­lu­tion­ary Guards’ al-Quds force was be­hind the lat­est es­ca­la­tion.

Is­raeli army spokesman Lt. Col. Jonathan Con­ri­cus said jets had struck more than 80 tar­gets across the Pales­tinian en­clave, in­clud­ing com­mand posts, weapons man­u­fac­tur­ing fa­cil­i­ties and a four-story build­ing hous­ing Ha­mas’ gen­eral se­cu­rity agency.

“We hold Ha­mas re­spon­si­ble for ev­ery­thing com­ing from Gaza,” Con­ri­cus said. “All vi­o­lence and provo­ca­tions are Ha­mas’ re­spon­si­bil­ity. The hu­man­i­tar­ian im­prove­ments made re­cently should have caused Ha­mas to rein in the ter­ror, but it al­lows a vi­o­lent at­mos­phere to con­tinue.”

It has been Is­rael’s long­stand­ing pol­icy to hold Ha­mas, the mil­i­tant Is­lamist group that rules Gaza and is viewed as a ter­ror­ist or­ga­ni­za­tion by Is­rael and the United States, re­spon­si­ble for each round of vi­o­lence, even if other Gaza-based fac­tions claim re­spon­si­bil­ity for the at­tacks.

Con­ri­cus said the army was aware Pales­tinian Is­lamic Ji­had, Gaza’s sec­ond largest mil­i­tant group, was be­hind the lat­est round of rock­ets.


Open en­roll­ment starts Thurs­day for 2019 Af­ford­able Care Act plans. The bud­get for the in­sur­ance coun­selors known as nav­i­ga­tors has been cut more than 80 per­cent. In nearly one-third of the 2,400 coun­ties served by Health­, no nav­i­ga­tors have been funded by the fed­eral gov­ern­ment.

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