Another Trump attack on the Affordable Care Act

By Madison Hardee and Brendan Riley - Special to The Observer Editorial Board

Last week, the Trump administration delivered another major blow to the Affordable Care Act by drastically cutting funding for “navigators” — counselors at nonprofits who help people enroll in health insurance. Next year, total North Carolina navigator funding will drop a jaw-dropping 84 percent, from more than $3 million to $500,000.

In announcing the cut, federal officials claimed that navigators are inefficient, noting that they signed up less than one percent of ACA enrollees last year. This vastly underrepresents navigators’ value. Enrollment percentages are an inaccurate measure of effectiveness and don’t account for the needs of communities that navigators assist. In addition to helping with enrollment, navigators connect consumers to other community resources and conduct outreach in libraries, churches, and public health departments. Navigators’ work has played a key role in North Carolina’s high enrollment numbers – especially following the Trump administration’s 90 percent cut last year for ACA advertising and promotion.

A Romanian immigrant couple in Charlotte working in low-wage jobs demonstrates the vital role of navigators in underserved communities. A Charlotte navigator helped Elena and Nicolas (not their real names) enroll in ACA coverage and their daughter in Medicaid. When their financial assistance was incorrectly terminated and the monthly premium increased by more than $300, Elena contacted the navigator, who helped the couple file an appeal to reinstate their subsidies. When Elena found out she was pregnant with their second child, the navigator helped Elena complete a Medicaid application for prenatal care and delivery and discontinue her ACA coverage.

Once the baby is born, her navigator will help Elena rejoin her husband in the ACA marketplace. During tax season, the navigator will assist the family with necessary paperwork. This comprehensive assistance will appear as just two enrollments in the federal database, demonstrating that the statistic used to show efficiency of navigators doesn’t reflect their value.

Slashing navigator funding is part of the Trump administration’s “death by a thousand cuts” campaign against the ACA. Last fall, the administration abruptly canceled reimbursements to health insurers for discounted plans offered to low-income consumers. That caused Blue Cross Blue Shield of North Carolina to raise North Carolina premiums by 14.1 percent. Since then, the administration has attempted to reintroduce junk insurance plans that discriminate against people with pre-existing conditions and offer bare-bones coverage. In ongoing litigation the federal government is arguing that ACA’s pre-existing conditions protections are unconstitutional. If Trump’s Justice Department prevails, over 1.6 million North Carolinians with pre-existing conditions could be denied coverage.

On top of that, the administration continues to make it harder for people to enroll and remain in the ACA by adding new paperwork requirements to prove their income and changes in circumstance — like a move or having a baby — which permit access to coverage outside of the open enrollment period. Failure to adhere to these burdensome requirements and strict timelines can lead to termination of their financial assistance or coverage altogether. Without assistance from a navigator, many individuals would be unable to juggle the many deadlines and requirements.

While the Trump administration seems intent on undoing his predecessor’s legislative accomplishments, the political war being waged has human consequences. The victims will be the thousands of North Carolinians who rely on the ACA’s financial assistance and in-person help to navigate a complex health insurance landscape.

Madison Hardee is a senior policy analyst/ attorney at the Center for Law and Social Policy. She was formerly the director of the health insurance navigator program at Charlotte Center for Legal Advocacy. Brendan Riley is a policy analyst at the North Carolina Justice Center and an advisory board member of the NC Get Covered Coalition.