Agents Beat Nonprofit Navigators: HealthCare.gov Boss

Seema Verma, the Trump administration official in charge of administering federal Affordable Care Act (ACA) programs, testified Wednesday that agents and brokers have been better at getting people to sign up for coverage through HealthCare.gov than nonprofit navigators have been. "We looked at the numbers, and we found that the navigator programs weren't reaching their goals," Verma said on Capitol Hill, at a House Energy & Commerce oversight subcommittee hearing that was streamed live on the web. "Sometimes we were spending $5,000, or $7,000, per person for these navigator programs." (Related: Trump Administration Memo Reveals ACA Exchange Policy Disagreements) Verma is the administrator of the Centers for Medicare and Medicaid Services (CMS). CMS is the arm of the U.S. Department of Health and Human Services that's in charge of the Center for Consumer Information and Insurance Oversight. The CMS center runs the ACA premium tax credit subsidy system for health insurance. The center also runs HealthCare.gov.

HealthCare.Gov

An ACA public exchange program, or web-based health insurance supermarket, helps people buy health coverage from private insurers. The public exchange system came to life in October 2013, with the first coverage sold taking effect in 2014. Exchange users who earn more than minimum level and less than 400% of the federal poverty level can use federal ACA premium tax credit subsidies to cut their share of the monthly premium bills. The subsidies are especially high for premium tax credit users who earn less than 250% of the federal poverty level. For an individual in most states in 2019, the 250% of federal poverty level cutoff is $30,150. HealthCare.gov has been running ACA public exchange programs for 39 states this year, and it will be running public exchange programs for 38 states for coverage that takes effect in 2020. The ACA provided temporary funding for navigators, or independent ombudsmen programs that were supposed to help consumers understand how to use the ACA public exchange system, but not to recommend or sell coverage. Under President Donald Trump, CMS has been cutting spending on HealthCare.gov navigators and on HealthCare.gov advertising. HealthCare.gov started February with 10.6 million paid users. The number of paid users was down from 11.4 million in February 2018. The open enrollment period for 2020 coverage, or time when people can buy coverage without showing they have a special reason to be shopping for coverage, is set to start Nov. 1 and end Dec. 15 in most of the country.

The Democrats' Perspective

Leaders of the House Energy & Commerce oversight subcommittee gave the ACA hearing the title, "Sabotage: The Trump Administration's Attack on Health Care." Rep. Diana DeGette, D-Colo., the subcommittee chair, opened the hearing by declaring that "it's no secret that the Trump administration has worked to sabotage health care in this country." "On his very first day in office, President Trump issued an executive order directing all federal agencies to dismantle the Affordable Care Act, quote, 'to the maximum extent by law,' end quote, and ever since then the Trump administration has worked tirelessly to undermine the ACA and other critical health programs at every turn," DeGette said. The administration has tried to defund the ACA, and it's now refusing to defend the ACA against the Texas v. United States lawsuit, which is now under appeal at the 5th Circuit Court of Appeals, DeGette said. (Related: 5th Circuit Questions House Democrats' Standing to Defend ACA) Rep. Jan Schakowsky, D-Ill., described the administration's navigator program funding cuts as being part of the Trump administration's ACA sabotage effort. "For 2018 open enrollment, you cut the outreach advertising budget by 90%, which resulted in as many as 1 million fewer people gaining access to coverage," Schakowsky said. "You ordered the [exchange program] regional directors to stop participating in open enrollment events in 18 cities, including my hometown of Chicago." The Trump administration also slashed funding for nonprofit navigator groups, even as CMS has awarded millions of dollars to communications consultants that help Verma write her speeches, Schakowsky said. "We received a report yesterday that premiums will go down by 4%, but imagine how much more money Americans could have saved if you were uplifting and the ACA and helping them to get coverage," Schakowsky said. Rep. Betty Castor, D-Fla., cited figures from the Kaiser Family Foundation and the U.S. Government Accountability Office supporting the position that the navigators have been cost-effective. "Brokers are fine," Castor said. "But navigators do not have allegiance to an insurance company. They have an allegiance to the consumer and often help them sort through all of their options. So, it's really unwise to eliminate navigators."

Navigator Bills and HealthCare.gov Operations

Rep. Michael Burgess, R-Texas, said navigators received $62.5 million in grants for 2017 and helped 81,000 exchange users, for a cost of about $771 per exchange user. One group of 17 navigators helped fewer than 100 people sign for coverage and cost about $5,000 per exchange user, Burgess said. "In contrast, agent brokers are able to enroll people at a much more cost-effective rate," Burgess said. Verma said that she believes that relying on agents and brokers, and on digital ads, has helped HealthCare.gov run the program in a much more efficient fashion. HealthCare.gov has improved the call center user satisfaction rate for the open enrollment period to 90%, and that's also helped, Verma said. The ACA requires members of Congress and some staffers to get their health coverage from the ACA public exchange system. Most members of Congress get their coverage through the small-group arm of the District of Columbia's public exchange program, which is operated by the District of Columbia, rather than by HealthCare.gov. Burgess called the HealthCare.gov call center improvement figures incredible. Back in October 2013, "I did not take the special deal that members of Congress afforded themselves," Burgess said. "I went through HealthCare.gov, and that phone interaction took four months to actually accomplish. It was one of the most miserable experiences I'd ever been through in my life, so, thank you for improving the customer experience at that end. A lot of times, people don't care about the politics. They just need the deliverable, and it sounds like you are you are working hard on that."

Texas v. USA

Democrats on the subcommittee asked Verma repeatedly about what CMS would do if the 5th Circuit Court of Appeals or the U.S. Supreme Court throws out the entire ACA. "If the court strikes down the ACA in this lawsuit, what happens then?" Rep. Frank Pallone, D-N.J., asked. "What is [the president] going to do next? What is his plan to deal with the reality that all these people wouldn't have health insurance?" "We have planned for a number of different scenarios," Verma said. "But we need to hear from the courts. The president has made his commitment clear that he wants to make sure that people with pre-existing conditions have protections." "You're not giving me any details, other than saying that [the president] is going to give us something," Pallone said.

The Moderately Broke

Verma said one of her main concerns now is about people who earn more than 300% of the federal poverty level. "These are people who do not qualify for large ACA subsidies," Verma said. About of the 85% of the 1.9 million people who were newly uninsured in 2018 had incomes in the over-300%-of-the-federal-poverty-level category, Verma said. (Related: Number of High-Income Individual Health Prospects Soars) To help those people in the current framework, policymakers need to find ways to lower the full, unsubsidized health coverage premiums, Verma said.

Resources

Links to resources related to the House Energy & Commerce oversight subcommittee ACA hearing, including a link to a video recording of the hearing, are available here. — Read HHS Officials Face Their Customers, on ThinkAdvisor. — Connect with ThinkAdvisor Life/Health on Facebook, LinkedIn and Twitter.