Last year, CMS spent more than $100 million on advertising the Affordable Care Act exchanges (ACA). Under President Donald Trump, it will only spend $10 million, while also cutting 41 percent from outreach activities meant to boost enrollment on the exchanges.
The announcement came on a phone call with reporters Thursday, with HHS officials arguing they’re seeing “diminishing returns” from ACA spending and feel most people are aware of the exchanges. They also used similar arguments as President Trump and the Republicans who supported ACA repeal in justifying the cuts.
“A healthcare system that has caused premiums to double and left nearly half of our counties with only one coverage option is not working,” said HHS spokeswoman Caitlin Oakley. “The Trump administration is determined to serve the American people instead of trying to sell them a bad deal.”
A story this week from the New York Times had quoted an administration official as saying, “I don’t think we can force people to sign up for the program,” adding that this official suggested agencies would only what the minimum amount necessary required to comply with the ACA.
The law does require a navigator program to help facilitate exchange enrollment, but Trump’s HHS is limiting those efforts, which the agency called “ineffective.” Navigators will receive a total of $37 million in funding, which the administration said would be appropriated based on effectiveness. If a navigator achieved 100 percent of their enrollment goal for 2017, for example, they would receive the same amount of funding for 2018. If they fell short of their targets, like enrolling 80 percent of its goal, it would only receive 80 percent of its 2017 funding for the coming enrollment period.
No grantees will be defunded entirely, HHS said, as every navigator will be guaranteed to receive at least $10,000 in funding. The cuts wouldn’t offer savings to taxpayers, as the navigator funds come from ACA user fees.
Part of HHS’ justification for this decision was the decline in enrollment for 2017, falling about 1.6 million enrollees short of projections. However, that drop off has been partially blamed on the Trump administration’s decision to cancel advertisements about the exchanges in the final weeks of open enrollment.
Additionally, HHS admitted it had not done any studies judging the effectiveness of the ads or measuring awareness of the exchanges among the public.
“We haven’t done a specific study related to the public awareness of the program,” an HHS official said to reporters. “I think most Americans are aware of the program at this point in time.”
The same officials also couldn’t comment on the agency’s specific plans to continue outreach to Spanish-speaking customers.
Groups which have run ACA outreach programs were quick to call the cuts “sabotage” on the part of the Trump administration, which had been actively supported efforts to repeal the ACA earlier this year. The new leadership at HHS and CMS had already limited chances for people to sign up for exchange coverage, finalizing an open enrollment period which will end on Dec. 15 instead until Jan. 31 as it had the past several years.
Customers may not be aware of those changes, tweeted former CMS communications director Lori Lodes, which is why outreach and advertising could be more important this year. She also criticized the reduced ad budget for including only digital media, email and text messages, not any television ads.