Last year, the Trump administration cut more than 40 percent from the navigator program, which funds non-profits and grassroots groups that help people sign up for health insurance. Using words like "immoral" and "cold-hearted", they saw it as the Republicans' latest act of sabotage against the sweeping health law.
Open enrollment for 2019 coverage begins in November.
The move is just the latest in a line of decisions by the Trump administration to undermine the ACA.
Navigators will be "encouraged to demonstrate how they provide information to people who may be unaware of the range of available coverage options in addition to qualified health plans, such as association health plans, short-term, limited-duration insurance and health reimbursement arrangements", the CMS statement said.
She pointed out that they helped with fewer than 1 percent of enrollments in 2017 - though she counts navigators as "helping" only if consumers sign up in their presence. But the justification was flimsy - a ruling last February by a judge in New Mexico that the government's method of calculating the payments was flawed.
"The longer we are in the market, the more confident we've gotten", Schlosser said. The administration said Saturday that it would temporarily suspend the payments because a federal judge earlier this year ruled the program's formula was flawed. The navigator is typically listed on the application only if the person signs up with the navigator sitting across the table, he said. These are people who are not going to go to an insurance agent or broker.
These "association health plans" are just one more facet of Trump's Obamacare sabotage, cheap plans with limited coverage meant to draw healthy people out of the Obamacare markets. "We see, in all these various places we're in, that people want the product we have".
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Some states that operate their own marketplaces, however, are continuing to invest in these grass-roots aides.
Since efforts in Congress to repeal Obama's signature health care law failed, the Trump administration to pursue administrative changes to chip away at the 2010 law.
But his administration has not stood idly by.
"Without this program, insurers might have taken on less risk in the market, especially in rural counties", said Mike Kreidler, Washington state's insurance commissioner.
Under the risk adjustment program, insurers with healthier patients pay those with sicker patients. The assault on pre-existing condition protections may make its way to the Supreme Court soon, and if Brett Kavanaugh is sitting on the bench, affordable health care for all will be at serious risk. Also, navigators assist people with enrolling in Medicaid, which is not reflected in the numbers.
This adds to the concern about the lack of navigator funding.
Additionally, Congress scrapped the ACA's requirement that all individuals purchase health coverage, and Trump is set to allow skimpier plans to be sold more widely. "There is a need to analyze insurers case-by-case and account for their competitive landscapes", said Tinglong Dai, an associate professor of operations management and business analytics at the Johns Hopkins University Carey Business School. The strategy can also help the companies control costs because the hospitals and insurers both benefit from lower medical spending. "The Trump administration needs to stop playing Russian Roulette with our health care system". She's hoping to land a full-time job with health insurance before she has to renew her coverage.