The Trump administration announced Thursday it will dramatically slash spending on Obamacare promotion next year, cutting its advertising budget by 90 percent and tying grants for “navigator” groups to how many people they signed up last year.
President Obama set up the Navigator program to help people understand their options on web-based markets established by his signature overhaul, yet the Trump administration says the nearly 100 nonprofits, health centers and other in-person assistants are tapping federal coffers with little accountability.
The Health and Human Services Department said for 2018, grantees will be awarded an amount this fall that is directly tied their performance last year.
For instance, a group that achieved only 30 percent of its enrollment target during 2017 enrollment will receive only 30 percent of its expected funding.
As a result, spending on the program is expected to fall by roughly 40 percent — from about $63 million this year to $37 million.
The agency said they tied spending to performance because too many groups were falling short.
Less than a quarter of the assister groups achieved their own sign-up goals, and the 10 most expensive grantees spent twice as much as it would have cost to just pay their enrollees’ premiums, according to HHS.
“Judging effectiveness by the amount of money spent and not the results achieved is irresponsible and unhelpful to the American people,” said HHS spokeswoman Caitlin Oakley. “Under the Trump Administration, we’re committed to more responsible, effective government. Obamacare’s Navigator program has been ineffective.”
The agency said it will not, however, give a boost to any navigators who actually exceeded their goal, saying it was “not part of the methodology.”
Also, HHS will dramatically cut spending on radio spots, web ads and other materials that promote Obamacare’s exchanges, saying advertising dollars haven’t translated into results.
It says the Obama administration doubled advertising funding for 2017 — to $100 million from $50 million in 2016 — only to see a year-over-year decrease in sign-ups.
HHS will only spend $10 million for the coming year, bringing Obamacare in line with what the federal government spends on promoting Medicare Advantage and Medicare’s prescription-drug benefit program.
Democrats immediately accused the administration of trying to tank the Affordable Care Act even as it is tasked with implementing the program moving forward, after its GOP allies in Congress failed to repeal and replace it earlier this year.
“The Trump administration is deliberately attempting to sabotage our health care system. When the number of people with health insurance declines and costs skyrocket, the American people will know who’s to blame,” said Senate Minority Leader Charles E. Schumer, New York Democrat.
Former Obama administration officials also vented on Twitter, saying the navigator grants and promotional materials are generally funded by user fees that insurers pay, so the move was not designed to save taxpayer dollars.
The administration did say it will reinvest any savings into “program integrity measures” that would root out waste, fraud and abuse in the federal exchange known as HealthCare.gov.
Democrats also cried foul after the Trump administration yanked ads promoting the federal HealthCare.gov marketplace during the final week of enrollment in January, saying the program was set to best 2016 enrollment before President Obama ceded way to President Trump.
Mr. Trump’s critics also say he is artificially increasing premiums by wavering on critical insurer reimbursements and enforcement of the individual mandate that requires Americans to get covered or pay a tax.
The president himself has suggested that Republicans should let Obamacare “implode” on its own, though a bipartisan set of senators and governors are working on plans to stabilize the markets ahead of the enrollment period that begins Nov. 1.
HHS says it wants all Americans have access to affordable coverage but that it won’t spend excess dollars on an Obamacare program it views as deeply flawed, citing rising premiums and dwindling choices in the exchanges.
“A healthcare system that has caused premiums to double and left nearly half of our counties with only one coverage option is not working,” Ms. Oakley said. “The Trump Administration is determined to serve the American people instead of trying to sell them a bad deal.”
HHS said Mr. Trump’s own efforts to stabilize the program — such as cutting enrollment period in half and requiring payment of past premiums before consumer re-up in coverage — will put the individual market on firmer economic footing over the long run.
It also pointed to its decision to untether the enrollment process from HealthCare.gov, so consumers can use third-party websites to sign up instead of relying on the government portal.
HHS hasn’t said when the navigator groups will be awarded their performance-related grants for 2018 enrollment, though in previous years, the grants were announced in early September.
The grants were initially awarded in 2015 as part of a three-year deal that runs through Sept. 1, 2018, so this round of funding is the final year of CMS’s obligation.
Timothy Jost, a law professor at Washington and Lee University who closely tracks the Obamacare debate, said rewriting the rules partway through those agreements could be “problematic.”
He also said HHS shouldn’t Obamacare outreach to programs like Medicare, noting the former involves people who aren’t use to getting coverage or may not even speak English.
“It’s more sabotage,” he said.
• Tom Howell Jr. can be reached at thowell@washingtontimes.com.
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