Insurance commissioners weigh in on ACA outreach funding cut, individual mandate

Sen. Patty Murray, left, and Sen. Lamar Alexander, seen here during a previous Senate HELP committee hearing, conducted a hearing Wednesday to discuss ideas to stabilize the Affordable Care Act exchanges.

Still smarting over the Trump administration's decision to cut Affordable Care Act outreach funding, Democrats wasted little time addressing the issue Wednesday during the first of four hearings on stabilizing the ACA exchanges.

Last week, the Centers for Medicare & Medicaid Services announced that it would slash open enrollment advertising by 90% and reduce funding for the Navigator program by nearly 40%, arguing that money spent on those activities has been ineffective.

Sen. Elizabeth Warren, D-Mass., was perhaps the most colorful in her criticism of the move, saying the president is “actively working to sabotage” the healthcare system. “It’s petty and it’s going to hurt millions of people,” she said.

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For his part, Oklahoma Insurance Commissioner John Doak expressed doubt that the federal government’s help is really needed to help consumers understand their insurance options and enroll in the right plan. In his state, he said, insurance brokers and consultants do an adequate job of conducting outreach.

But Alaska Insurance Director Lori Wing-Heier pointed out that infrastructure doesn’t exist in rural states like Alaska, arguing that the federal government’s ACA outreach activities are critical to maximizing individual market participation. That’s especially true because ACA Navigators have the resources to communicate with the state’s population in their various native languages, she noted.

With the funding cut, “we are very concerned it will have a major impact on enrollment,” she said, adding, “this will be devastating to our population.”

Teresa Miller, Pennsylvania's acting health and human services secretary, concurred, saying she’s “very concerned” about the decrease in funding for ACA advertising and the Navigator program.

Commissioners take stances on individual mandate

Miller said she has also heard concern from insurers in Pennsylvania about whether the Trump administration will continue to enforce the law’s individual mandate, which assesses a tax penalty on those without insurance. 

“I think we’re going to see that uncertainty built into our rates going forward,” she said. 

But Sen. Bill Cassidy, M.D., R-La., argued that a state's engagement in implementing the law—not the individual mandate—makes the biggest difference when it comes to encouraging young, healthy individuals to enroll in coverage. (He also made a plug for the ACA replacement plan he's working on that would hand states more power over the individual markets.)

Tennessee Insurance Commissioner Julie McPeak agreed with Collins' point on the individual mandate, saying it has not been enough to compel lower-risk consumers in Tennessee to enter the individual market. She said she prefers the idea of a waiting period for those who have a gap in coverage as a means to compel people to stay insured.

For Doak’s part, he argued that offering more flexibility in benefit design—including allowing more low-cost catastrophic plans—would do a better job of encouraging young, healthy consumers to buy plans.