ACA Health Plan Enrollment Brisk Despite Federal Cuts

In Alabama, about 200,000 people have insurance through the Affordable Care Act. But this year, people have half as much time before the Dec. 15 deadline to sign up for a health plan through the ACA, known as “Obamacare.” The Trump administration also slashed the budget to advertise the healthcare.gov website.

But in a tiny office in Birmingham, Enroll Alabama “Navigator” Agee Baldwin steers Elisa Lewis through choosing a health plan.

“You’ve got the same E.R. copay on both of those plans, right?” he asks. “Well, one primary doctor copay is $10 on your 94 plan.”

The plans are complicated – the process is sort of like getting your taxes done – but Enroll Alabama offers free help for people applying for individual health plans.

Lewis asks whether the plan on the computer screen would allow her to keep the doctors she has now. With a few quick keystrokes, Agee calls up the Blue Cross Blue Shield provider directory.

Lewis has come to see Baldwin every year since the federal health insurance marketplace opened. She just recently found out she has a heart condition.

Dan Carsen, WBHM
Agee Baldwin helps Elisa Lewis compare health plans on Healthcare.gov.

“I wouldn’t go anywhere else,” she says. “We get my insurance coverage together, something that I can afford. And without it, I don’t know where I’d be – probably wouldn’t be here. No really … I just thank God that I have this.”

President Trump has made deep cuts in the grants that pay for health care navigators like Baldwin and slashed the budget to advertise healthcare.gov by 90 percent. And that worries Baldwin. He says in rural Alabama especially, people need affordable health care. But many don’t have Internet access, so researching and signing up for health plans is a challenge.

“I know there are people out there who can benefit from this,” says Baldwin. “But there’s this systematic subversion of accurate information that’s taking place.”

Many predict fewer people will sign up this year than in past years. But at Enroll Alabama, staffers and volunteers are swamped. Project Coordinator Sonja Smith says the group’s overall federal funding, unlike with many other enrollment programs around the country, has been steady. She also says Alabama never got much healthcare.gov marketing funding to begin with, but there may be an upside to the national cuts:

“Ironically, although the marketing funds, the marketing dollars have been cut, that has garnered a lot of interest and a lot of earned media. So that kind of offsets whatever they were trying to do.”

David Becker is a UAB associate professor and director of the university’s doctoral program in healthcare organization and policy. He says first there were three attempts in Congress to repeal and replace the Affordable Care Act.

“Then we have the change in the length of the enrollment window. And that all stands alongside these significant cuts in advertising [and] reducing funding for the Navigators. And so the public might be a little bit uncertain about what’s happening with the ACA.”

But, he says, in reality, not much will change in 2018.

“Despite all of the media coverage you’ve seen of efforts to repeal and replace the Affordable Care Act, [the] marketplace is still working the same in this coming year as it’s worked in years past.”

Even so, he worries people who really need health insurance will miss the Dec.15 enrollment deadline.

In his conversation with WBHM, UAB’s Dr. David Becker shared more thoughts on the U.S. healthcare system.

The Importance of Advertising Health Plans

“It’s just like for advertising for Coca-Cola and Pepsi, reminding you how much you like consuming those products and how important they are to you. Without advertising, the concern is that people won’t take care of business and make sure that they sign up during that window. I think there’s always that tendency that people always put off to tomorrow what they could do today, and that procrastination with the new deadline is something that I certainly worry about, that some people just miss the boat and inadvertently fail to reenroll or enroll in coverage that they need.”

But Why Keep Spending Money on That?

“There’s also this risk that we think, ‘oh everyone knows, right? The ACA has been in place for a few years. Do we need to keep spending money on advertising? Do we need to keep spending money on these navigators to help facilitate plan choice?’ And of course the reality is that different people will be purchasing coverage in the individual market five years from now versus today; they’ll be different people in the market that need that help and the assistance and selecting plans. And, advertising doesn’t just go away once people are aware of a product. That information is still relevant today. Just like Coke, Pepsi, Ford Motor Company, they all continue to advertise even though we’re well aware of the products that they sell. And so I think again the purpose of advertising advertising is to remind consumers and to reinforce why something like health insurance is important. And my concern is not seeing that on the airwaves … I think it’s important to get these messages out as much as possible.”