News & Commentary

GAO Says ACA Needs More TLC


There’s not enough money being spent on advertising or navigators for the ACA, according to a report by the Government Accountability Office (GAO). HHS counters that it is taking a leaner and smarter approach to both.

The report notes that HHS under the Trump administration cut money for paid advertising for the 2018 open enrollment period by 90%; from the $100 million for the 2017 enrollment period, down to $10 million for 2018.

TV advertising went from $26.6 million under the Obama administration’s final year allocation to zero under President Trump, even though another earlier HHS study found that TV was one of the most effective ways to reach new and returning enrollees.

Meanwhile, spending for navigators, people usually aligned with community organizations who get the word out about the ACA, also took a hit. HHS reduced spending for that by 42%, from $37 million compared to the $63 million it spent in 2017.

Of course, the fate of the ACA has been a political battle since Trump won the White House. Republicans failed to kill the law outright and Trump has made it clear that he’d still like to do away with it. Democrats say that the president is doing just that with piecemeal measures.

The GAO is nonpartisan and takes a measured approach. It notes that HHS defended the advertising cuts by arguing it targeted “its reduced funding toward low-cost forms of paid advertising” that would be more effective in reaching specific populations.

HHS cited the $1.2 million it spent on two digital advertising videos aimed at younger enrollees, “and $2.7 million on search advertising, in which Internet search engines displayed a link to healthcare.gov when individuals used relevant search terms.”

About the cuts to navigator programs, HHS said that it’s steering potential enrollees toward insurance agents and brokers, who are employed by health plans and other private companies. Navigators are paid by HHS.

HHS said it narrowed its focus when determining how navigator organizations should be paid toward the number of people who are actually signed up. The agency compared the numbers that navigator organizations actually enrolled with the organization’s stated goals. Funding for 2018 was decreased accordingly.

“Based on this change in approach, HHS offered 81 of its 98 navigator organizations less funding for 2018, with decreases ranging from less than 1% to 98% of 2017 funding levels,” the report stated.

The GAO said the data HHS used for this new approach were problematic for many reasons, and HHS even said as much. Navigators were not consistently entering their identification numbers into applications. That remained a problem during the 2018 enrollment period, the GAO said. For example, in many instances the place on the application where the navigator should have entered an identification number had already been occupied by a broker’s number.

“HHS’s narrower approach to awarding funding; lack of reliable, complete data on the extent to which navigator organizations enrolled individuals in exchange plans; and lack of clear guidance to navigator organizations on how to set goals could hamper the agency’s ability to use the program to meet its objectives,” the report stated.

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