The Trump administration on Friday said that it would drastically cut annual spending on so-called navigator groups that help Americans enroll in Obamacare health insurance plans, from around $100 million to just $10 million.
The announcement was one of the first significant health policy actions by the Trump administration, a day after Robert F. Kennedy Jr. was sworn in as health secretary. It also indicated that President Trump was returning to a health policy playbook from his first-term, when he steadily reduced spending for the navigators program to $10 million.
Mr. Trump repeatedly sought to overturn the Affordable Care Act during his first term, but maintained a vague position on the 2010 law during his latest presidential campaign, with a majority of Americans approving of Obamacare. He threatened another repeal effort, then said he was open to replacing or changing the existing system.
The new spending cut showed that his administration planned to take early action to influence Obamacare enrollment, without immediately seeking action from Congress or the courts. Enrollment plateaued during Mr. Trump’s first term, when federal health officials made more administrative and technical changes like the one announced Friday.
A record number of Americans have enrolled in health insurance plans through the Obamacare marketplaces in recent years, primarily because large federal subsidies reduced the cost of the plans. Republicans have criticized the high cost of those subsidies, which are set to expire this year unless Congress renews them.
The Trump administration on Friday noted that health insurance navigators enrolled only 92,000 people on the Affordable Care Act’s marketplaces last year, or less than 1 percent of plan participants, amounting to more than $1,000 per enrollment. During Mr. Trump’s first term, with funding levels similar to the one announced Friday, navigators enrolled people at “a far more efficient $211 per enrollment,” the Centers for Medicare and Medicaid Services said in its announcement.
But health policy experts said on Friday that measuring the work of navigators by the number of people enrolled in the marketplaces could be misleading. Adrianna McIntyre, a health policy expert at the Harvard T.H. Chan School of Public Health, noted in a post on X that navigators had also enrolled nearly 300,000 people in Medicaid, the joint federal-state health insurance program for the poor, and had referred more than 100,000 people to other insurance providers.
“They are primarily there to help people navigate a complex, often byzantine, eligibility and enrollment system,” said Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms. “And they’re supposed to be working with the most complex cases. And so as a result, they’re not going to be a huge source of enrollment volume.”
Ms. Corlette said that appointments between navigators and enrollees often last hours, in part because of the complexity of the lives of the people enrolling. Many rural Americans and immigrants rely on the help, she added. People without easy access to computers or proper employment documents can struggle without them.
“It might be that they’re a seasonal worker, or a gig economy worker,” she said. “They’re not able to document their income that easily, or they have to prove their eligibility because they move a lot.”
Researchers have found that navigator groups tend to be well known in local communities because of how long they have operated in them. The groups also tend to operate at a larger scale than other organizations that help people enroll in health insurance plans, such as federally funded health clinics.
Cuts to the navigator program during Mr. Trump’s first term decreased health insurance coverage among lower-income Americans, Hispanic adults and people who spoke a language other than English at home, researchers found.
Federal officials on Friday predicted that the decrease in navigator funding would generate savings because the program was funded by so-called user fees, when insurance companies are charged for the rights to sell plans in the marketplaces. Because those fees factor into the premiums that health insurers charge, the Trump administration argued, less navigator funding could result in lower premiums for Americans buying health plans.
Ms. Corlette said that it could be difficult to test that theory, in part because premiums could skyrocket later this year if the government’s large subsidies for health plans are not extended.
