Amid mounting speculation about how it will handle the upcoming open enrollment period, the Trump administration said Thursday that it will drastically slash funding for outreach and advertising to promote Affordable Care Act exchange sign-ups.
The Centers for Medicare & Medicaid Services said it will spend $10 million on promotional activities during the upcoming open enrollment period. Comparatively, CMS spent $100 million in 2016 for the 2017 open enrollment period, and a little more than $50 million the year prior.
The agency will also change how the ACA’s navigator program is funded. Navigators received $62.5 million in federal grants in 2016, but will receive $36.8 million this year—a 39% funding cut. They’ll also receive funding based on their ability to meet their enrollment goals during the previous year.
CMS said the new policy will “ensure accountability within the navigator program and avoid rewarding grantees that have failed to meet their performance measures.”
To Tim Jost, a Washington and Lee University law professor and expert on the ACA, the funding cuts are concerning.
“It is very likely to result in fewer people being aware of the need to enroll in marketplace coverage for 2018, in particular in light of the shortened open enrollment period,” Jost wrote in an email. “People with health problems are more likely to find out about coverage on their own, while young and healthy people are less likely to find it. This is very likely to result in deterioration of the risk pool.”
And Andy Slavitt, the CMS administrator under the Obama administration, had a similar take. "A 90% funding cut will mean a dramatic cut to enrollment next year, which means a worsening risk pool, higher government outlays, less competition and higher premiums paid by American families," he said via email.
The National Health Law Program, which advocates for low-income and underserved individuals, was also critical of the move.
“With today’s action, the administration is tying navigators’ hands behind their backs by piling on funding cuts to an already shortened enrollment period,” Jane Perkins, the group’s legal director, said in a statement.
Yet the Trump administration argues that it’s simply making the outreach programs more efficient.
“Judging effectiveness by the amount of money spent and not the results achieved is irresponsible and unhelpful to the American people,” Department of Health and Human Services Press Secretary Caitlin Oakley said in a statement.
“Under the Trump administration,” she added, “we’re committed to more responsible, effective government.”
In addition to the changes in funding, CMS said it will focus its outreach and advertising efforts on educating consumers about the new dates of the open enrollment period. This year’s open enrollment will last from Nov. 1 to Dec. 15, meaning it will be narrowed from three months to 45 days.
The agency also noted that outreach will be conducted through digital media, email and text messages, and will be “targeted based on specific demographic and geographic data.”
Editor's note: This article has been updated to include comment from Andy Slavitt.