The Trump administration’s critics have long argued it is purposefully sabotaging the Affordable Care Act (ACA). Now they have a report from a federal watchdog agency to back that up.
Notably, the Department of Health and Human Services (HHS) chose not to create a numeric target for enrollment in 2018 for the federal exchange, according to a report released by the Government Accountability Office. Federal internal control standards direct agencies to establish and monitor specific performance metrics so they can work toward their objectives, the watchdog agency noted.
Without this target, HHS may not be able to meet “its current objective of improving Americans’ access to health care, including by stabilizing the market and implementing policies that increase the mix of younger and healthier consumers purchasing plans through the individual market.”
HHS has set numeric targets for enrollment in the past to monitor progress throughout the enrollment period, as well as to focus its resources on consumers most likely to enroll, GAO said. Yet HHS did not concur with GAO’s recommendation that the agency establish numeric enrollment targets going forward.
In its response, HHS said it focused this past year on improving the consumer experience instead. For instance, it reduced downtime on Healthcare.gov and increased the site’s functionality by adding new tools. It also reduced the amount of time consumers contacting the call center spent on hold.
RELATED: Healthcare.gov is moving to the cloud; 2018 downtime was less than expected
HHS also said enrollment targets do not account for external factors, such as economic issues.
However, GAO maintained its conclusion that numeric targets are critical to the exchanges’ success. The report also noted that HHS didn't measure key aspects of consumer engagement it identified in 2017.
Changes to outreach funding may have also contributed to the 7% decrease in enrollment on the exchanges between 2016 and 2018, GAO wrote.
The Department of Health and Human Services (HHS) cut funding for navigator organizations from $63 million in 2017 to $37 million in 2018, a 42% reduction, “due to a shift in administration priorities,” GAO said.
In July, HHS cut funding even further, down to $10 million, for the 2018 enrollment period.
RELATED: Trump administration cuts funding for ACA enrollment efforts again
GAO said HHS allocated 2018 funding based on “unreliable” metrics. The 2018 approach considered only one aspect of prior navigator performance, and funding amounts were not based on consistent, complete or fully accurate data.
Stakeholders interviewed for the report also attributed the enrollment decline to the dramatic reduction in funds for advertising. HHS cut 90% of funding for all advertising, including 100% of funding for television, radio and mail ads. The agency said it wanted to focus on “low-cost, high-performing” forms of advertising instead.
However, stakeholders said advertisements are important for increasing new enrollment, especially among consumers who are younger and healthier—and that group is harder to reach.
At the same time, consumers may have been discouraged from enrolling after hearing negative messages about the ACA from top administration officials, several stakeholders said.
The 23 stakeholders GAO interviewed for the report represented six state insurance departments, five research and consumer advocacy organizations, four navigator organizations, three issuers, three trade associations and two state-based exchanges.