Health

Federal cuts limit Iowa's access to health insurance enrollment services

Bill Poulson of Cedar Rapids works with Outreach and Enrollment Specialist Ashley Loutsch to enroll in health insurance on the marketplace at the Eastern Iowa Women’s Health Center in Cedar Rapids on Thursday, December 14, 2017. (Cliff Jette/The Gazette)
Bill Poulson of Cedar Rapids works with Outreach and Enrollment Specialist Ashley Loutsch to enroll in health insurance on the marketplace at the Eastern Iowa Women’s Health Center in Cedar Rapids on Thursday, December 14, 2017. (Cliff Jette/The Gazette)
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For some health care providers and those who come to them for guidance in signing up for insurance through the Affordable Care Act marketplace, their options have narrowed even more.

The Trump administration announced this past Tuesday federal health officials would cut funding even further for navigators — professionals who help Americans sign up for insurance through the ACA marketplace — from $36.8 million to $10 million for the upcoming enrollment period, which starts in November.

In light of this cut — a second reduction in federal funding in less than a year — Iowa health care providers are left to pick up the slack or eliminate their programs all together.

“While I can’t speak specifically about navigator funding cuts proposed for next year, we are aware that the cuts last year resulted in several navigators ceasing to offer services”

- Chance McElhaney, Iowa Insurance Division spokesman.

That in turn means some Eastern Iowa consumers may not have access to enrollment services.

“Getting access to health care often is pretty intimidating for the average person,” said Henry Marquard, government and community affairs officer for Genesis Health System in Davenport. “It’s not just a hotline to call and troubleshoot, ‘Why won’t this button click?’ (Navigators) were being so proactively helpful.”

The Visiting Nurse Services of Iowa, a Des Moines-based medical and social service organization, will close out its navigator program at the end of August, officials said. VNS had received about $171,000 for 2018.

Nicole Kock, navigator services program coordinator and the only navigator on staff at VNS, confirmed its program will shut down the federal grant ends Aug. 30. Until then, Kock will be providing assistance only to those “who have a critical need or face significant barriers accessing health care coverage.”

Officials at Genesis Health System also believe “this will end the program for us,” Marquard said.

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Genesis saw its navigator funding plunge to $20,000, from the $269,000 the provider received each year from 2013-2015, reducing availability to just one navigator for both Iowa and Illinois. A position was eliminated at the beginning of this year.

Genesis employs non-federally funded consumer helpers, too, but it was unable to provide the number of these positions when interviewed this past week.

Other health care providers committed to using certified application counselors. Those counselors perform duties similar to navigators but have less extensive training and do not host public outreach events.

UnityPoint Health, for example, does not participate in the ACA navigator program and therefore won’t be affected by the cuts, according to Regional Marketing Director Laura Rainey. UnityPoint Health employs 60 certified application counselors — seven in Cedar Rapids — she said in an email.

In 2017, UnityPoint Health assisted 3,200 people during the open-enrollment period.

Missed targets?

This is the second round of cuts to the navigator program, a part of an effort by President Donald Trump to undermine the Obama-era law. Last August, aid to navigators was reduced by 41 percent, from $62.5 million.

“We are concerned that consumers who previously received assistance from navigators in previous years might not know how to access free, unbiased assistance — or may not be located in areas where they can easily access assistance”

- Joe Lock, president and chief executive officer of Eastern Iowa Health Center

Federal officials said navigators failed to meet their sign-up targets, while agents and brokers performed better in the marketplace.

“While I can’t speak specifically about navigator funding cuts proposed for next year, we are aware that the cuts last year resulted in several navigators ceasing to offer services,” said Chance McElhaney, Iowa Insurance Division spokesman.

“The ACA market in Iowa has collapsed irrespective of the good work that navigators do. Congress needs to fix the structural defects of the ACA or send the authority back to the states so we can.”

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Among these discontinued programs was at Planned Parenthood of the Heartland, whose funding was slashed by about 84 percent.

“We are concerned that consumers who previously received assistance from navigators in previous years might not know how to access free, unbiased assistance — or may not be located in areas where they can easily access assistance,” said Joe Lock, president and chief executive officer of Eastern Iowa Health Center, a federally qualified health clinic.

Federal officials also cut 90 percent of a related budget for outreach and advertising to foster ACA enrollment, and reduced the 2018 open-enrollment period last year by half.

But even with these cuts and the shortened enrollment period, Nicole Kock said the VNS navigator program saw an increase in the number of individuals signing up for insurance through the marketplace last year.

The VNS navigator program assisted 249 consumers during the six-week open enrollment period for 2018, 129 of whom enrolled in marketplace plans.

For open-enrollment period covering 2017 — which was six weeks longer than the 2018 period — the VNS navigator program assisted 302 people, and helped enroll 117 people in marketplace plans.

“We know people out there need health insurance, they want health insurance, they want it to be affordable for themselves and their families,” Kock said.

“They recognize the need and importance of that and they really just need an organization or an entity that is willing to and can provide that in-person assistance to sit down with them one-on-one, take the time to go through and educate them on health insurance literacy, how it works, how the plans can best benefit the families and their medical needs.

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“It’s a very important service and Iowans have proved to us, year after year, that’s it’s a want and it’s a need,” she said.

The Eastern Iowa Health Center’s Lock said his clinic employs certified application counselors to assist with health coverage enrollment. Last year, these professionals who were located at federally qualified health clinics across Iowa helped more than 1,700 individuals during the open enrollment period.

Last year’s cuts had no effect on the number of uninsured individuals seeking assistance at the Eastern Iowa Health Center, Lock added. He noted the numbers “were pretty flat” between enrollment periods 2017 and 2018.

Lock said he doesn’t expect a major change in the upcoming enrollment period.

“I would bet based on the way things turned out last year, hopefully the word will get out and people won’t fall through the cracks and they’ll still come to the Eastern Iowa Health Center for the help that they need,” he said.

Quad-City Times reporter Jack Cullen contributed to this article.

l Comments: (319) 368-8536; michaela.ramm@thegazette.com

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