Politics

The Left’s Hollow Obamacare ‘Sabotage’ Charge Against Trump

Democrats howl over reduction of health care 'navigators,' who produced lackluster results

President Donald Trump’s critics accused him Wednesday of undermining Obamacare through “sabotage” by cutting budgets for advertising and grants to “navigators” to help people sign up for insurance, but the record of both is dubious.

Launched in 2013, the navigator program was supposed to help match the uninsured with government-subsidized insurance on the online exchanges created by the Affordable Care Act. But data released last month by the Centers for Medicare and Medicaid Services indicate that navigators received $62.5 million in federal grants during the most recent open enrollment period but signed up only $81,426 people. That is less than 1 percent of enrollees.

Sen. Lamar Alexander (R-Tenn.) said at Wednesday’s hearing of the Senate Health, Education, Labor and Pensions Committee that only 22 percent of navigators met their own performance goals. He added that 17 navigators enrolled fewer than 100 people, at an average per-person cost of $5,000. The costliest 10 navigators received $2.7 million but enrolled just 314 customers.

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One navigator got a $200,000 grant but enrolled just one person.

“So maybe it’s an area that needs some oversight,” Alexander said.

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Those grim numbers did little to stop a round of Trump-bashing. Sen. Patty Murray (D-Wash.), the committee’s ranking Democrat, accused Trump of trying to inject uncertainty into the insurance market by cutting the advertising budget for the upcoming open enrollment period by 90 percent, to $10 million, and reducing consumer assistance by about 40 percent.

Teresa Miller, the former Pennsylvania insurance commissioner and acting human services secretary, predicted that more people will become uninsured.

“Reducing outreach efforts at the federal level, combined with a shortened open enrollment period for 2018, will do nothing but leave more people without coverage and could raise rates for people left in the market,” she said.

Some experts said the outreach programs have reached their limit of usefulness. Edmund Haislmaier, a health policy expert at the conservative Heritage Foundation, told LifeZette on Thursday that private insurance brokers have had far more success because they have the experience and training to help people choose the right insurance plans for them. He said navigators primarily helped people fill out paperwork and determine whether they qualified for government subsidies.

“Young, healthy people don’t sign up for insurance, but sick people do. To some extent, this is like talking about what coat of paint to put on the Titanic.”

“Essentially, it’s the difference between getting benefits, social welfare programs, vs. buying a financial product,” he said. “The problem is the exchange sort of mixed the two.”

Haislmaier, who will testify about the issue Tuesday in front of the Senate Finance Committee, said enrollments have tapered off after an initial surge in 2014. He pointed out that the entire individual insurance market — including those who receive subsidies and those who do not — actually shrank by about 600,000 from 2015 to 2016.

That drop occurred before Trump became president, so it cannot be attributed to sabotage efforts, said Haislmaier, who explained that it came after the previous administration doubled the outreach budget.

“We have, indeed, reached a point of diminishing returns here,” he said.

Michael Tanner, a fellow at the libertarian Cato Institute, said advertising probably had a big impact when Obamacare was new. Cutting it may have a modest impact on enrollment, he said, but most people are aware of the program.

The central problem, Tanner said, is that many people simply do not consider Obamacare plans worth the price.

“Young, healthy people don’t sign up for insurance, but sick people do,” he said. “To some extent, this is like talking about what coat of paint to put on the Titanic.”

Haislmaier agreed. He said Obamacare is most attractive to people whose incomes are low enough to qualify for subsidies and who are sick enough to be heavy users of insurance.

“That is an inherently limited population, and at some point, you’ve covered most of them,” he said. “You can throw money at them till the cows come home, but you’re not going to move the needle much.”

Tanner said that with the federal government mandating by law that people have insurance and providing billions of dollars in subsidies, it is not unreasonable to expect insurance companies to pay for their own advertising.

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“This is pretty clear corporate welfare,” he said.

Haislmaier said insurance companies initially advertised and paid fees to brokers to enroll people on the exchanges. But as they discovered the customer base skewed older, sicker and costlier, he said, they stopped advertising and cut broker fees.

The decision by the Department of Health and Human Services to reduce spending on navigators drew praise from eHealth Inc., which runs a private online marketplace for health insurance.

“The navigator program’s results are discouraging, but HHS’ decision to acknowledge that failure and try something else is a positive step for government,” the company’s CEO, Scott Flanders, said in a statement.

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