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.”
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.
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.
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.
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