It’s late August, and state officials who work in the Affordable Care Act (ACA) marketplace in Nevada and Oregon say they still have not been contacted by their federal partners about open enrollment, which is slated to begin November 1. This is the latest testimony in a string of recent reports that suggest the president meant what he said when ACA repeal efforts in Congress failed last month: “let Obamacare implode.”
Nevada’s ACA health insurance marketplace avoided one catastrophe this summer and is already working to dodge a second this fall. Fourteen counties in Nevada that were at risk of having zero insurers participate in the state-based marketplace, dubbed Nevada Health Link, were saved by Centene earlier this month. The insurance company reached out to Nevada Health Link and agreed to secure the market in time for open enrollment, said its executive director Heather Korbulic. That means over 8,000 people on the ACA in the state’s rural counties will continue to have health insurance. Unlike Centene, the federal government — whose responsibility it is to uphold the health law — has yet to reach out to Nevada Health Link.
“I’m looking up the face of a mountain now,” Korbulic told ThinkProgress.
The Centers for Medicare and Medicaid Services (CMS), a division within the Department of Health and Human Services (HHS), has not assured Korbulic that open enrollment will be like past periods. The window in which ACA enrollees can add or drop insurance begins in two months, and the agency has yet to meet with Nevada Health Link officials to discuss it.
Nevada isn’t alone. A state official at the Oregon Health Insurance Marketplace also told ThinkProgress that they have not heard from CMS regarding open enrollment period planning. ThinkProgress reached out to HHS on three separate occasions for comment, but did not hear back.
This failure on the part of HHS follows several reports that the Trump administration has been actively undermining current health law. In addition to shortening open enrollment in most states, the current administration has terminated contracts with two companies that help people sign up for coverage. Groups that partnered with the administration to promote open enrollment have also not been contacted by the administration, according to Talking Points Memo. And of course, the Trump administration has been using taxpayer money meant to promote enrollment in the ACA to instead create advertisements about its so-called “victims.”
The reports have left health activists and lawmakers alike questioning the federal agency’s efforts this open enrollment period. Last week, Congressional Democrats demanded detailed information from HHS Secretary Tom Price and CMS Administrator Seema Verma on their plans for marketing and outreach this November. The reason people are so worried is that at this time last year, HHS was actively reaching out to their state partners to discuss the enrollment period.
“I distinctly remember being in Washington, D.C. in July [2016].” said Korbulic. “And I remember thinking it’s annoying how many times they [HHS] are going to email our people.”
Former CMS officials corroborated mid-summer meetings between state exchanges and their federal partners. These meetings were not only meant to discuss open enrollment, but meant to strategize best practices for the the health care law more broadly and provide insight into new HHS regulations.
Elizabeth Cronen, Oregon Health Insurance Marketplace’s Communication and Legislative Manager, told ThinkProgress that Oregon state officials were emailed comprehensive information about federal outreach plans in October 2015 and 2016 for the subsequent enrollment periods. But another state official recalled getting detailed information about a millennial outreach campaign in June 2016:
Cronen says so far there’s been no correspondence between them or HHS on any open enrollment campaign. She maintained that the communication channel is always open.
Nevada and Oregon are state-based marketplaces that operate on the federal platform. That means states are responsible for performing all ACA marketplace functions for the individual and group marketplace, but they rely on the federal government to do its part. Because ACA customers sign up for insurance on healthcare.gov, the states don’t have access to enrollee-specific data. It’s not clear that HHS will reach out to people on the ACA to explain the plans available to them and encourage them to enroll again in the next period — and Nevada and Oregon don’t have the enrollees’ contact information, which means they can’t do the outreach themselves. This makes recruitment and retainment marketing challenging.
Nevada and Oregon are two of five states that operate this way. Arkansas, Kentucky, and New Mexico also are state-based exchanges that operate on the federal platform. ThinkProgress reached out to the three other states to see if they were facing similar challenges, but representatives declined to comment after repeated inquiries.
“I’ve submitted questions [to CMS] over and over again,” said Korbulic. “About marketing, strategy, supportive infrastructure, and how money is being spent.” She said she has yet to hear back and a meeting scheduled last week between the five state-based exchanges and CMS was cancelled, and has not been rescheduled.
Former Director of the State Exchange Group at CMS Mayra Alvarez, who facilitated meetings between the state-based exchanges and the federal government, said during her tenure, open and constant communication was critical to the success of the health law. “My relationship as director of state exchange group was to be an active partner with state-based marketplaces,” Alvarez told ThinkProgress. “To answer questions, identify how to support them, and to make sure we can do anything we can to provide enrollment opportunities for more Americans.”
The state-based exchanges work in conjunction with HHS for open enrollment marketing. States can use their own administrative fees and dedicate funds to state-specific ACA marketing and communication efforts. When the Trump administration halted federal spending last open enrollment period, Oregon officials spent additional money on advertising to encourage people to sign up. But again, it’s hard to reach out to people when you don’t have their contact information.
“We have concerns,” Cronen told ThinkProgress. “But Oregon has demonstrated in the end of open enrollment last year, we are ready to react and serve our customers.”
Last year, notices to enrollees about open enrollment and redetermination went out in September. Additionally, insurance companies send their own notices to people who sign up for their plans.
Since the ACA’s inception, comprehensive enrollee data has always been kept from states that didn’t setup their own website. The federal government periodically shows state-based exchanges enrollee trends. Efforts to transition the sensitive enrollee data to state-based exchanges began under the Obama administration, said one former CMS official. It’s unclear whether it’s being considered under the current administration.