Currently Viewing:
Currently Reading
Report Finds Wide Variation in Average Cost of Healthcare Across the US
November 15, 2018 – Jaime Rosenberg
HCCI Report Shows Visits to Nurse Practitioners, Physician Assistants Soaring
November 15, 2018 – Allison Inserro
CD47 Antibody With Rituximab Produces Durable Response in R/R Lymphoma
November 15, 2018 – David Bai, PharmD
New Cholesterol Guidelines Call for Personalized Care
November 15, 2018 – Mary Caffrey
What We're Reading: Michigan Drug Pricing Experiment; ACA Enrollment; Gun Laws and Gun Deaths
November 15, 2018 – AJMC Staff
AHIP Packages Healthcare Affordability Recommendations; ACA Enrollment Dips
November 14, 2018 – Allison Inserro
Study Identifies High Burden of Invasive Infections in Neutropenic Patients
November 14, 2018 – Jaime Rosenberg
Higher BMI Decreases Risk of Breast Cancer in Premenopausal Women
November 14, 2018 – David Bai, PharmD
Provider Stigma Toward HIV Slows Prevention Goals
November 14, 2018 – Jaime Rosenberg

CMS Cuts Budget for ACA Marketing to $10 Million for 2019 Plan Year

Allison Inserro
CMS cut the amount of money it is awarding to organizations that help individuals enroll in insurance for 2019 plans under the Affordable Care Act (ACA) by $26 million, and, for the first time, is encouraging the so-called “navigators” to also sign people up for health insurance that provides a narrower level of coverage than the plans under the ACA.
The Trump administration Tuesday cut the amount of money it is awarding to organizations that help individuals enroll in insurance for 2019 plans under the Affordable Care Act (ACA) by $26 million, and, for the first time, is encouraging the so-called “navigators” to also sign people up for health insurance that provide a narrower level of coverage than the ones under the ACA.

“It’s time for the Navigator program to evolve, which is why we are announcing a new direction for the program today. 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,” CMS Administrator Seema Verma said in a statement.

CMS is making $10 million available to help publicize and market the plans in the 34 states where ACA exchange plans are facilitated by the federal government. For the 2018 year, it provided $36 million. In 2017, it provided $63 million.

The navigators, typically employed by nonprofits, did not enroll a “meaningful amount of people,” CMS said. In addition, marketplace insurers also have their own outreach plans.

CMS said navigators did not enroll nearly as many people as private agents and brokers. During the 2018 and 2017 open enrollment periods, navigators enrolled less than 1% of those who enrolled. Agents and brokers “assisted with 42%” of those who enrolled in 2017.

For the 2019 plan year, the funds provided by CMS will also be used to promote association health plans and short-term limited duration health plans. The administration has been promoting the plans because they may have less expensive monthly premiums, but critics of the plans say they do not provide the 10 essential health benefits as do ACA plans, and may not provide coverage for serious illnesses such as cancer. They are also allowed to charge higher premiums for pre-existing conditions.

Energy and Commerce Ranking Member Frank Pallone, Jr, D-New Jersey, said the move amounts to another effort to gut the ACA.

“The Trump administration is once again attempting to sabotage the ACA at any cost regardless of its impact on the American people,” Pallone said in a statement. “Gutting funding for the Navigator program—which helps people sign up for affordable health insurance—will further increase premiums for consumers and potentially leave many without access to health coverage.”


Senate Finance Committee Ranking Member Ron Wyden, D-Oregon, blasted the decision to allow navigators to promote plans that are not compliant with the ACA.

“This move amounts to federally-funded fraud: paying groups to sell unsuspecting Americans on junk plans that allow insurance companies to deny care on a whim and charge whatever they want is nothing but a scam,” Wyden said. “Trump’s sabotage crusade is making it harder and harder for families to afford quality insurance that isn’t filled with loopholes and exceptions that benefit insurance companies.”

This weekend, CMS said it has halted collections or payments under the risk adjustment program, including amounts for the 2017 benefit year, established by the ACA for the 2014-2018 benefit period. The risk adjustment program, finalized by CMS in 2013, included the use of a statewide average premium in order to maintain a budget neutral program. The provision resulted in the creation of a “risk pool” by participating health insurers to help balance the costs of insurers who have high-risk enrollees. However, the program has seen constant challenges since its inception, particularly for the individual and small-group insurance marketplace.

Related Articles

ACA Helped Cut Overall OOP Spending, but Premiums Fell Only for Poorest
Expanding Association Health Plans Would Hurt ACA Markets, Analysis Finds
Following ACA Implementation, Cancer Survivors Still Experienced More Barriers to Accessing, Affording Healthcare
CBO Projects Additional Uninsured Through 2028 After ACA Changes
New Rule Allows Creation of Association Health Plans That Skirt ACA Regulations, Protections
Copyright AJMC 2006-2018 Clinical Care Targeted Communications Group, LLC. All Rights Reserved.
Welcome the the new and improved, the premier managed market network. Tell us about yourself so that we can serve you better.
Sign Up

Sign In

Not a member? Sign up now!