They are the public face of the Affordable Care Act in North Carolina for legions of residents stumped by the complexities of health insurance. But next year, ACA navigators — the trained instructors who explain health benefits and help people enroll — will be harder to find as a result of federal funding cuts.
The Trump administration announced Tuesday it would cut nationwide funding for navigators by 72 percent, from $36 million to $10 million. In North Carolina, which has consistently had some of the nation’s highest enrollments, the navigator budget will be cut by 85 percent — from $3.4 million to $500,000.
“These are significant cuts,” said Mark Van Arnam, director of the N.C. Navigator Consortium. “There’s a large portion of the population that we talk to that doesn’t understand the ACA and needs assistance.”
The nonprofit consortium was the largest recipient of federal navigator funds in North Carolina last year, handling more than $2.4 million to cover the expenses of 219 navigators across the state. The consortium also deployed 76 volunteer navigators for education and outreach on the ACA.
Navigators have been on the forefront on ACA enrollment for five years in North Carolina. This year they helped sign up nearly 520,000 people for health insurance sold through the ACA exchange in North Carolina.
The law requires most Americans to have health insurance and provides federal financial subsidies for lower- and middle-income applicants who buy individual policies on federal or state exchanges, but the mandate will be phased out next year. The ACA also prohibits insurers from rejecting applicants with pre-existing conditions and from charging older people exorbitantly high rates because they are higher financial risks.
The future of the Affordable Care Act remains unclear as Republicans have for years tried to undermine its effectiveness. Republicans oppose the ACA on philosophical grounds that it forced citizens to purchase an expensive product they might not want or need, and on practical grounds that the ACA drove up costs because it required coverage for benefits many insurers didn’t offer in past years unless customers paid extra.
Democrats were quick to denounce the administration’s latest action. Sen. Ron Wyden of Oregon, the senior Democrat on the Finance Committee, told The New York Times the president was on a “sabotage crusade” to kill the law since he couldn’t Congress to repeal it.
The Centers for Medicare and Medicaid Services, the federal agency that oversees ACA funding, said in a statement that navigators are inefficient, signing up a fraction of all ACA customers, and unnecessary as the ACA enters its sixth year and the public is increasingly familiar with health insurance. The agency also said that the people confused by health insurance benefits can use insurance agents and brokers for help.
“It is appropriate to scale down the Navigator program to reflect the enhanced public awareness of health coverage through the Exchanges,” the agency said.
And to win a federal grant for next year, navigator organizations will have to be willing to steer the public away from the Affordable Care Act to consider other options, like association health plans and short-term temporary insurance that the Trump Administration is promoting as a cheaper alternative to the ACA. These options, not widely available, can typically charge more for pre-existing conditions and charge a hefty premium to older customers.
North Carolina’s $500,000 allocation for navigators is based on the number of uninsured people in the state who may need help enrolling. According to the agency, North Carolina has just over 1 million uninsured residents.
The funding cuts follow CMS’s announcement that it would no longer subsidize insurers who enroll large numbers of unhealthy people, a move that insurers and ACA advocates said would drive up premiums.
Van Arnam disputed the federal characterization of navigators as inefficient, particularly the claim that some navigators signed up fewer than 100 people at an average cost of $5,000 per enrollee. Van Arnam said many people spend considerable time learning about health insurance options from a navigator, but enroll later at home. The navigator is typically listed on the application only if the person signs up with the navigator sitting across the table, he said.
Kurtis Taylor, executive director of Alcohol/Drug Council of North Carolina, said that $33,333 in navigator funding paid for three part-time navigators this year. Taylor said his organization won’t be applying for funding next year, because any paltry sum it receives would not cover the cost of effort to apply and to comply with the law’s strict requirements to submit data and demonstrate effectiveness.
“It wouldn’t make any sense for us to apply,” he said.