Trump continues to 'sabotage' Obamacare

The Trump administration is cutting grants to 'navigators' who steer people to health care

 President Barack Obama meets Donald Trump in the White House Oval Office before Trump's inauguration. (Pete Souza/White House)

President Barack Obama meets Donald Trump in the White House Oval Office before Trump's inauguration. (Pete Souza/White House)

By Ted Cox

Like a mechanic at a chop shop, President Trump is systematically dismantling the Affordable Care Act piece by piece until it just can't run anymore.

 The Trump administration's latest tactic to "sabotage" the national health system commonly called Obamacare is a proposal to dramatically cut grants to nonprofit "navigators" who steer people to medical plans.

Recruitment was considered key to spreading the costs under Obamacare, but the Trump administration has been consistent in trying to undermine enrollment efforts.

"It absolutely is an attempt to sabotage the ACA," said Dr. Elizabeth Calhoun, executive director of the Center for Population Health Sciences at the University of Arizona, who previously took part in a University of Illinois at Chicago study on Obamacare and those who steer people to coverage under the plan, known as "navigators."

It absolutely is an attempt to sabotage the ACA.
— Dr. Elizabeth Calhoun

According to The New York Times, the Trump administration announced Tuesday that it would cut grants to nonprofits for the annual Obamacare enrollment drive to $10 million this fall. That's after the administration cut those grants to $36 million last year in his first year in office after they had been set at $63 million in the last year of President Barack Obama's administration in 2016. That's a total cut of more than 80 percent from peak funding for the program.

The administration has maintained that professional insurance brokers have been doing an adequate job and that navigators serve relatively few people, and that's true up to a point, said Michele Thornton, who recently completed her doctorate at UIC with a dissertation on navigators.

"Brokers are doing the bulk of the work, and they should be," Thornton said. They're typically setting up employers with the best plans for their employees. "But what's important about navigators and why it's a bad thing their funding is being cut is because they're getting populations brokers don't typically work with."

Those nonprofit groups deal with those who previously fell between the cracks and weren't being insured at all, including rural and minority communities, as well as those for whom English is a second language. "That's where they really excel and make a difference," Thornton said, in getting individuals insured with the best possible deal, in part to spread the cost across the entire population. "That's really the point of Obamacare is to reduce those disparities in insurance rates," she added.

Brokers who concentrate on individuals and not companies are a dying breed, according to Cody Michael, director of client & broker services at Independent Health Agents. "There's not a ton of insurance-industry brokers in the individual care these days," Michael said. "We're one of the few agencies that focus on individual health insurance."

Independent Health Agents hasn't been receiving the grants, but it has benefited recently, Michael added, from the federal healthcare.gov site passing on references to individuals seeking coverage. The state Get Covered Illinois site, however, does not have a similar service. "It's really just an informational website," he said.

Thwarted in his attempts to repeal the popular Obamacare program in Congress, Trump has instead concentrated on undermining key aspects of the health system, such as the "individual mandate" to have coverage — removed in the tax bill passed and signed into law late last year.

Efforts to undermine Obamacare enrollment have been ongoing in the Trump administration, but last week it took action that could be far more damaging to people who already have their own coverage. The administration announced it was suspending billions of dollars in "risk adjustment" payments to insurers, which basically act as subsidies to insurers in exchange for covering patients they might previously have refused to cover for "pre-existing conditions" and other high-cost medical care.

Because of that, insurers will likely pass those costs on to consumers in the form of higher premiums. Medical experts warned of "turmoil" in the insurance markets. Even before that payment suspension was announced, the Kaiser Family Foundation found that premiums were likely to rise for coverage in 2019.

Get Covered Illinois, the state agency driving Obamacare enrollment, has faced reduced funding for years. The Chicago Tribune reported in 2015 that it had "eliminated most of its staff as operating money dwindled" in the first year of Gov. Bruce Rauner's term.

According to emails from a year ago obtained under the Freedom of Information Act by state Rep. Jeanne Ives in her challenge to Rauner's re-election in the Republican primary earlier this year, Rauner's wife, Diana, said the governor wanted to demonstrate more support for Obamacare but "he has been held back by fear of Trump backlash."