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Funding Cuts Have Impacted Navigation Of Affordable Care Act Marketplace

By Jill Sheridan, IPB News | Published on in Business, Government, Health
Employees from the Jane Pauley Community Health Center at an open enrollment visit. (Jill Sheridan/IPB News)
Employees from the Jane Pauley Community Health Center at an open enrollment visit. (Jill Sheridan/IPB News)

It’s open enrollment season for the health insurance marketplace established by the Affordable Care Act, or ACA. But many people who need to sign up may not know it.

The current administration has made a number of moves to diminish the law including cuts to marketing and outreach. Funding for navigators to help people get signed up was also slashed, but in many organizations across Indiana, the job is not lost.

U.S. Rep. Andre Carson (D-Indianapolis) was in town recently. He hosted an event at the Jane Pauley Community Health Center to promote Open Enrollment, a time when Hoosiers can sign up for health insurance or make coverage changes through the ACA.

“As we approach 10 years since the passage of the Affordable Care Act,” says Carson. “It’s a great time to reflect on the successes and the millions of Americans who have received health care because of it.”

About 150,000 Hoosiers get insurance through the marketplace, down from a peak of more than 218,000 in 2015.

After a failed effort to repeal the law, the Trump administration attempted to dismantle it with other moves, including severe cuts to the advertising budget. That means Hoosiers may not even know about open enrollment or have help signing up.

“Well, not not only has the funding for advertising been cut, but also average health care premiums have increased by over $2,300,” says Carson. “And I think that is an unfair burden that is placed on American families, especially Hoosiers.”

Prices are up a bit, especially for Hoosiers who don’t qualify for premium subsidy discounts offered through the ACA. But most will.

Darlene Lopez retired this past summer. Too young for Medicare, she wasn’t sure where to turn for health insurance. The unemployment office couldn’t help her. Social Security told her to call 211 where they provided her a list of places that may help, including the Jane Pauley Community Health Center.

“Amazingly through God’s grace, I walked through the door and Sherriece was standing there,” says Lopez. “And she’s helped me so much with the process the whole painful process. She took me step by step by step to get me where I’m at today.”

Sherriece Harris is a navigator. She says Lopez is not alone in not knowing and not understanding her options.

“A lot of people are they’re unaware of what’s out there. People are scared of the marketplace because they’re hearing that the prices are not affordable,” says Harris. “But actually with Miss Lopez it was affordable for her and actually for it, you know, 2020 it even went down even more for her.”

Organizations like community health centers and hospitals have retained and even brought more navigators. Despite a more than 80 percent cut in federal funding for the positions since 2016.

Covering Kids and Families of Indiana, a nonprofit that helps people with health coverage, staffs navigators. Mark Fairchild is the group’s policy director and says the position is vital.

“They know the ins and outs, they know the process,” says Fairchild. “They’ve seen 100 of these applications, whereas for a consumer, it’s probably their first one and it looks very daunting, and they walk you through that process step by step.”

This year all 92 counties will be able to pick from plans provided by at least two companies. But there is a lot of variety in the plan options.

There was also a federal push to increase short-term or so called “junk” plans that don’t have to comply with ACA standards including covering pre-existing conditions. People can get confused easily says Fairchild.

“As much as I’m in this line of work, I don’t always understand my insurance, right? There’s a lot of jargon a lot of legal terminology. A lot of things you could do wrong to be denied coverage, even if you perfectly well qualify for it,” says Fairchild.

Many states have adopted measures to strengthen the ACA. Indiana is one of the states that has done the least to preserve the health law.

But Fairchild says despite the cuts, repeal of the individual mandate and other moves to weaken the ACA, the marketplace has proven resilient.

“A lot of what the Affordable Care Act really sought out to do which was to get people covered and get them used to the benefits of coverage has stuck around,” says Fairchild.

Getting people used to having insurance and the peace of mind that comes with it. Darlene Lopez says she isn’t the only one that needs help signing up for insurance.

“I’m not alone in this, you know other people retire, people lose their jobs,” says Lopez.

Open enrollment for the marketplace ends Dec. 15.

Contact Jill at jsheridan@wfyi.org or follow her on Twitter at @JillASheridan.