I asked one director of a Missouri program, Catherine Edwards, why her organization opted to remain in the navigator program this year, despite seeing a 62 percent budget cut and the attendant layoffs and gutted social-media presence. Her organization, which otherwise focuses on senior citizens, could have simply sat out open enrollment.
“I tell you what,” she said. “Our case managers and outreach workers are dedicated to helping people in their community live better lives. If we could give people more access to health care, hopefully when they do age, they’ll age more healthily.”
After enrollment starts, navigators guide people through the process of signing up for health insurance, either through in-person appointments or on the phone.
Livbier Pearson, a navigator in Arizona, saw a smaller budget cut, but her team nevertheless worked Monday through Saturday, from 8:30 a.m. to 7 p.m. on some days. Her phones had 50 or so voicemails almost the entire six weeks, she said. She and several navigators said they ultimately couldn’t fit in everyone who needed in-person help.
Some people mistook Trump’s ending of the cost-sharing reductions as an end to the tax credits that individuals receive for buying health insurance. Meanwhile, because of a strange quirk in how the law works, the end of the cost-sharing reductions actually made the more generous “gold” plans cheaper this year than skimpier “silver” plans, in some parts of the country.
Leslie Bachurski, a director with the navigator group Consumer Health Coalition in Pittsburgh, had explained to her enrollees that the different metal-tiered plans are like rings—a gold ring is nicer than a silver ring. But she then struggled to explain why something better might cost less than something worse. She settled on, “just for this year, the gold ring is on sale!”
Several navigators said insurers had sent letters to customers quoting them wildly high prices for renewing their policies, potentially because they had overcompensated for the end of the cost-sharing reductions. For some, this created a chilling effect—a needless one, since the prices some of these individuals ultimately paid were much lower.
Sandy Dimick, the director of Get Covered Tennessee in Nashville, forwarded me a letter quoting a woman a monthly premium of $1,242. She said the woman actually paid nothing for her plan when she entered her information into Healthcare.gov. Another letter quoted $1,045 for a policy. That person got a silver plan whose actual premium was also $0, with a $20 deductible.
There was also confusion among people who fell into the Medicaid gap—a salary range, in states that didn’t expand Medicaid, in which people qualify for neither Medicaid nor tax credits to buy insurance. Navigators would try to problem-solve with them, Quenga said, asking if they could visit a low-income clinic or ask someone else to claim them as a dependent.