Bills
| 3.23.22

Should the Obamacare Patient Navigator Programs Be Funded? (H.R. 7102)

Do you support or oppose this bill?

What is H.R. 7102?

(Updated June 30, 2020)

This bill — known as the ENROLL Act — would amend the Patient Protection and Affordable Care Act (aka Obamacare) to guarantee funding for Navigator initiatives that help people pick the best health plans for themselves and their families. It’d also boost outreach and educational activities to raise the accessibility of information about coverage options and financial assistance to help purchase coverage. Funding for this bill would come out of the user fees imposed on participating health insurance issuers in insurance marketplaces. In each of the fiscal years 2019 through 2021, the Dept. of Health and Human Services (DHS)  would allocate $100 million of user fee revenue towards Navigator initiatives.

The bill’s full title is the Expand Navigators’ Resources for Outreach, Learning and Longevity (ENROLL) Act.

Argument in favor

Navigators play an important role in helping individuals navigate the Obamacare marketplace to find the best health insurance plans for themselves. They reach out to under-served communities, help people with language barriers, and provide information about subsidies — all of which improves enrollment rates.

Argument opposed

Navigators sign up only a small fraction — under one percent — of individuals, and it’s expensive to fund navigator programs. The role that they fulfill can also be performed by agents and brokers reimbursed by health insurance plans, which is a better option that saves federal funds for other uses.

Impact

Health insurance consumers; uninsured individuals and families; ACA marketplaces; ACA navigator initiatives; DHS; and the ACA.

Cost of H.R. 7102

A CBO cost estimate for this bill is unavailable. However, the bill text calls for $100 million a year to fund Navigator initiatives, with funds coming from user fees collected on participating health insurance issuers.

Additional Info

In-Depth: Rep. Kathy Castor (D-FL) introduced this bill to secure the vital service that independent healthcare Navigators provide during ACA open enrollment:

“Families in Florida and across America have been aided every year by independent Navigators that help them find the best option for their health insurance. In Florida, over 1.7 million of our neighbors – more than any other state – signed up for a marketplace policy last year, often with the help of a Navigator. This year the President and Republicans in Congress have made it more difficult for hardworking families to sign up for affordable health care due to their sabotage, including massive cuts for national outreach and enrollment efforts. The Trump administration has slashed funding by 80 percent since 2016 for health care Navigators who help our neighbors find the best policy in the HealthCare.gov Marketplace. That is why I am introducing the ENROLL Act to safeguard the vital service health care Navigators provide to our neighbors before, during and after open enrollment… Consumers want lower costs, quality choices and a healthy insurance market and our health care Navigators can help them gain the right coverage for their needs.”

Young Invincibles, an organization aimed at amplifying young adults’ voices in the political process, supports this bill. Young Invincibles’ Director of Training and Consumer Education, Erin Hemlin, adds that the Navigator program has been a critical resource in the effort to empower and educate young people in particular:

“The ENROLL Act is an important step forward for young adults, and consumers everywhere, who need assistance enrolling in health coverage. The Trump administration’s drastic and arbitrary cuts to these programs are purely politically motivated – a cruel action intended to hurt those consumers who need help the most. Lack of awareness about coverage options, particularly financial help and deadlines, is one of the biggest barriers in reaching the remaining uninsured. If we want to help those ‘hard to reach’ populations get covered, we need to invest in making sure they know that coverage is available and accessible. The Navigator program has been a critical resource in this effort to educate and empower consumers. For young people, who are often purchasing insurance for the first time, restoring this funding would mean that they would once again get the impartial, expert guidance that only Navigators can provide, and could help those who don’t know about open enrollment and the ACA marketplace find coverage before it’s too late. When first learning about their coverage options, young people need all the information they can get, and both in-person outreach and advertising make a difference in getting them covered. Fully funding Navigator and outreach programs will vastly improve consumers’ ability to cut through the confusion and enroll in the coverage they need."

Kathy Ko Chin, president and CEO of the Asian & Pacific Islander American Health Forum (APIAHF), adds that Navigators also provide important translation and outreach services for AAPIs:

“Navigators provide an essential role to the community by providing culturally and linguistically tailored outreach for communities of color, immigrants and limited English proficient populations. Through their work, Navigators have helped to cut the uninsured rate of Asian Americans and Pacific Islanders in half under the Affordable Care Act. We applaud U.S. Reps. Castor and Blunt Rochester for introducing the ENROLL Act and for working to eliminate barriers to enrollment and ensuring that everyone has accurate information about their health insurance options.”

The Trump administration has cut funding for the Navigator program twice as part of its efforts to either do away with the ACA entirely or undermine it through defunding. Since President Trump’s inauguration in 2016, HHS has cut navigator funding by over 80 percent, leaving only $10 million to spread across the country in 2018 (versus $36 million 2017 and $63 million in 2016). Announcing the most recent budget cut in July 2018, Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma said it was time for the navigator program “to evolve,” and called the budget cut reflective of CMS’ commitment to the most cost-effective use of funds:

“This decision reflects CMS' commitment to put federal dollars for the Federally-facilitated Exchanges to their most cost effective use in order to better support consumers through the enrollment process.”

HHS officials in the Trump administration have repeatedly questioned the value of paying navigators, noting that such groups received $62.5 million in 2016 but signed up under 1 percent of total enrollees. According to HHS, seventeen programs enrolled under 100 consumers each, at an average cost of nearly $5,000 per enrollee.

HHS claims that agents and brokers reimbursed by health insurers can offset the loss of navigator programs; however, the Center on Budget and Policy Priorities (CBPP) points out a significant distinction between the two: agents and brokers, unlike impartial navigators who provide information about all marketplace health plan options, promote the specific plans that pay them. Additionally, the CBPP points out that navigators provide services that agents and brokers generally don’t, including helping eligible individuals enroll in Medical or the Children’s Health Insurance Program (CHIP). Finally, navigator outreach programs are specifically designed to reach vulnerable and hard-to-reach communities.

This bill has the support of one cosponsor, a Democrat. It also has the support of Young Invincibles, Community Catalyst, the APIAHF, and Planned Parenthood Federation of America.


Of Note: Navigator programs raise awareness of marketplace plans’ availability, help people apply for federal subsidies, provide impartial information about plan options, and help consumers with other important issues, including filing appeals and submitting documentation to prove their eligibility. The ACA requires all marketplaces to have navigators to help people enroll.

The Commonwealth Fund, a private foundation that seeks to promote a high-performing health care system that achieves achieves better access, improved quality, and greater efficiency, particularly for society’s most vulnerable, found in September 2017 that many adults remained unaware of their healthcare options under the ACA seven years after its passage. The Commonwealth Fund’s survey of 4,813 working-age adults found that 40 percent of un-insured adults were unaware of the ACA marketplaces.

The Commonwealth Fund’s survey also found that personal assistance significantly improved enrollment, particularly among people eligible for subsidies. Among adults who received personal coverage when shopping for coverage, the enrollment rate was 66 percent — 18 percent higher than the 48 percent enrollment rate among adults who didn’t receive assistance.


Media:

Summary by Lorelei Yang

(Photo Credit: iStockphoto.com / vinnstock)