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New Government Accountability Office Report Criticizes Trump Administration’s 2018 Affordable Care Act Enrollment Efforts

Aug 23, 2018
Press Release
Report Blasts HHS for Lack of Enrollment Goals & Faulty Navigator Funding Formula Attributes Lower Enrollment and Higher Costs to Sabotage and Consumer Confusion

Top House and Senate Democratic health leaders released a new Government Accountability Office (GAO) report today that exposes the deficiencies in the Trump Administration’s management of the 2018 Affordable Care Act’s (ACA) open enrollment period.

The report attributes the decline in enrollment to increased costs caused in part by the Trump Administration’s cancellation of Cost-Sharing Reduction (CSR) payments, consumer confusion about the status of the ACA following repeated efforts by Republicans to repeal the law, and drastic cuts to the outreach and advertising budget.

The GAO report was requested by House Energy and Commerce Ranking Member Frank Pallone, Jr. (D-NJ), Senate Health, Education, Labor, and Pensions (HELP) Ranking Member Patty Murray (D-WA), Senate Finance Ranking Member Ron Wyden (D-OR), and Senate Aging Ranking Member Bob Casey (D-PA).

“This independent and nonpartisan GAO report confirms that the Trump Administration’s sabotage of our health care system is driving up costs for consumers and leaving more Americans without health insurance,” Pallone, Murray, Wyden and Casey said. “It’s not surprising that consumers were confused about the status of the ACA at the end of last year, which made the extreme cuts to consumer outreach and advertising that much more egregious.”

In its report, GAO also criticizes the U.S. Department of Health and Human Services (HHS) for not developing enrollment goals for 2018, and for using a funding process for Navigators based on performance data that was unreliable. In looking ahead to the 2019 open enrollment period, GAO recommended that HHS set overall numeric enrollment totals, ensure that the data it uses to determine funding awards for Navigators is accurate, and focus on enhancing the consumer experience for the program.

“This report should serve as a wakeup call to the Trump Administration that it needs to change course when it comes to educating and notifying millions of Americans about their health care options for 2019,” the four Democratic health leaders continued.       

The report makes several key findings including:

  • Health insurance plan affordability played the largest role in 2018 enrollment. Premiums across all plans increased by 30 percent, which was more than expected.  One driver of premium increases was the Trump Administration’s elimination of the federal CSR payments in late 2017, which resulted in larger premium increases for silver tier plans (the most popular plan type on healthcare.gov); (page 14)
  • Most stakeholders interviewed by GAO reported that consumer confusion about the ACA and its status likely played a major role in detracting from 2018 healthcare.gov enrollment. Some stakeholders attributed consumer confusion to efforts to repeal the ACA and others attributed confusion to the Trump Administration’s negative statements about the ACA; (page 18)
  • Stakeholders also reported that reductions in HHS outreach and advertising likely detracted from 2018 enrollment. (page 18) Despite Trump Administration claims that television advertising was too expensive and not optimal for attracting young enrollees, a 2017 HHS study found paid television advertising was one of the most effective forms for enrolling new and returning individuals; (page 21)
  • HHS’s poor management of the Navigator program – including its approach to awarding funding, lack of reliable data, and the lack of clear guidance to Navigators on how to set their goals – could hamper the agency’s ability to use the program to meet its objectives; (Page 27) As a result, Navigators cutback on outreach efforts – particularly in rural areas – due to the Trump Administration’s funding cuts. Navigators collectively reported conducting 68 percent fewer outreach events during the 2018 open enrollment as compared to 2017 open enrollment; (Page 26)
  • HHS did not set any numeric targets for 2018 open enrollment as it had in prior years. Without developing numeric targets, HHS’s ability to use its resources effectively to improve Americans’ access to health care is hampered. (Page 26)

As part of the report, GAO spoke to 23 stakeholders representing a broad range of perspectives including four navigators, three issuers, and six insurance departments.

Read the GAO Report HERE.

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