Affordable Care Act Navigator Program Boosted Insurance Enrollment in Underserved Communities

The ACA Navigator Program is a federally funded program that provides free one-on-one assistance to help people understand their health insurance options and purchase health insurance, including Medicaid coverage or coverage through marketplaces. established under the ACA.

This year, the program received nearly $100 million, according to the Centers for Medicare & Medicaid Services, a record amount of government funding. However, under the Trump administration, the federal government cut the amount of funding by about 80%.

To measure the impact of navigation program funding, a research team led by Rebecca Myerson, assistant professor of population health sciences, UW School of Medicine and Public Health, compared changes in coverage outcomes in the counties that were more or less exposed to the cuts.

When funding was cut from 2017 to 2019, enrollment in health insurance coverage — and market coverage in particular — declined among low-income adults, according to one of the papers produced by the team. of Myerson.

Cuts to the navigation program have also significantly reduced insurance coverage for adults under 45, Hispanic adults and adults who speak a language other than English at home.

In the counties surveyed, the estimated declines mean that about 109,000 people who prefer to use a language other than English have lost their health insurance coverage due to cuts to the navigation program, Myerson said.

The researchers analyzed Centers for Medicare & Medicaid Services records for market coverage and American Community Survey records for total coverage. The survey analysis was limited to US citizens only to avoid the potential confounding impact of other competing policies that may have reduced coverage among noncitizens.

“Our research showed that the navigation program had an impact on coverage among the same underserved communities that many navigation programs said in their grant proposals they would target,” Myerson said. “The navigation program was essential in helping these consumers obtain health insurance.”

The browser paper was published in the American Journal of Health Economics.

When the ACA was enacted in 2010, it set up assistance programs in every state to provide individuals with free, unbiased help so they could better understand their health insurance options, including information about the financial aid they were eligible for and advice on how to enroll. The ACA required that support services be offered by at least one community group and one consumer-focused nonprofit group in each state. The Browser Program is the support program that works in states that do not establish a state-run exchange or partner with the federal government to operate an exchange.

Timing and extent of budget cuts

Money for the navigation program is provided by grants from the Centers for Medicare & Medicaid Services. In the two years before Donald Trump assumed the presidency, the program received $60 million and $63 million, respectively, but in 2017, the first year of the Trump administration, funding was cut to $37 million. dollars and, in 2018, to 10 million dollars.

Of the 40 programs operating in the United States, a 2017 survey found that 89% expected to lay off staff due to funding cuts, while others planned to cut staff time on complex cases. or reduce the amount of services provided in languages ​​other than English. , according to a report by the Kaiser Family Foundation.

The private sector has not filled the void

After identifying the impacts on coverage for underserved populations, Myerson and his team wanted to understand whether the private sector insurance industry would increase advertising activity.

The researchers looked at the number of TV ads purchased to entice new consumers to buy from the market or other non-Medicare, non-Medicaid health insurance.

The results were published in the journal Open JAMA Network.

Using TV advertising data from open enrollment periods from 2015 to 2019, the team analyzed changes in advertising associated with reductions from 2017 to 2019 in navigation programs in counties with higher exposure or lower at discounts.

Myerson and colleagues found no increase in the amount of private sector television advertising in the affected counties, meaning they detected no additional evidence of advertising spending to compensate for the reduction in the shipping program in those counties. counties, she said.

The conclusions were cited by the Centers for Medicare & Medicaid Services in their decision not to allow Georgia to eliminate the Market and Navigate program and rely solely on private sector outreach in 2023.

“These studies demonstrate the effectiveness of the navigation program, but more importantly, the studies taken together show that people were falling through the cracks,” Myerson said. “The lack of a compensating increase in advertising in the private sector is consistent with previous data suggesting that the private insurance industry may have different priorities or target different populations than government programs.”

Now that federal funding for the navigation program has been restored, these documents can help policymakers understand the potential impact of this investment on equity in access to coverage, she said.

“In an environment where health insurance options can be complex and confusion can arise during the enrollment process, tools like the Navigation Program are essential to ensure everyone has the chance to be covered,” Myerson said.