Private Sector Outreach Did Not Make Up For Navigator Program Funding Cuts

When federal funding for the Navigator program was reduced significantly, private companies did not make up for the lack of outreach, according to a study published in JAMA Network Open.

“Many individuals eligible for coverage in the Patient Protection and Affordable Care Act (ACA) marketplace remain unenrolled because of information barriers. Whether the private sector or the public sector should conduct outreach to address these barriers is a topic of active debate,” the researchers explained.

The Trump administration cut federal funding for Affordable Care Act marketplace outreach, eliminating television advertising funding, cutting Navigator program grants by around 40 percent, and decreasing marketing funding by 90 percent. Following these cuts, coverage rates dropped for low-income groups, adults under the age of 45, individuals who identify as Hispanic, and individuals with low proficiency in English.

“For insurers seeking to raise profits by enrolling more people in marketplace coverage, advertising may be a substitute for public funding of the navigator program, albeit an imperfect one,” the researchers proposed.

The study used open enrollment data and counties’ Navigator data from 2015 through 2019 as well as health insurance advertising data from the most comprehensive data set available in order to assess whether private payers boosted advertising payments following the federal spending cuts for Affordable Care Act marketplace advertising.

The sample size was 2,435 counties, of which 1,333 had local navigator programs and 1,102 did not.

Counties that had local Navigator programs tended to boast fewer private Medicare advertisements. These counties also had bigger populations and higher uninsurance rates.

In 2015 before the federal government cut back on funding for open enrollment outreach, counties that had local Navigator programs aired over 1,650 television advertisements. The counties with Navigator programs and those without such programs had similar numbers of advertisement airings, both overall and for non-Medicare and non-Medicaid coverage.

In counties with lower exposure to Navigator program cuts, the mean number of private sponsor airings was 2,241. In higher exposure counties, the mean was 2,283.

The mean number of private sponsor non-Medicare, non-Medicaid airings in counties with low exposure was 1,551. In higher exposure counties, the mean was 1,655.

When comparing the mean number of private airings with a Medicare focus, low exposure counties had 633 mean airings, while higher exposure counties had 556 mean airings.

Counties that were more likely to experience the effects of the funding cuts were not more likely to see a spike in private or state sponsorship of airings during open enrollment.

These results are significant because advertising can influence enrollees’ confidence in their own knowledge about the Affordable Care Act marketplace when making health plan selections during open enrollment, the researchers argued. Additionally, there are potential health equity implications for eliminating the Navigator program and reducing outreach capabilities.

“Our findings are consistent with prior evidence suggesting that private sector actors target outreach to individuals who are likely to be profitable, whereas public sector actors often use other criteria to prioritize outreach activities,” the researchers stated.

When the Biden administration took office in 2021, patient navigators called for the new president to improve financial support for Affordable Care Act marketplace enrollment outreach.

The Biden administration reinstated funding for the Navigator program, boosting funding levels to a historic $80 million in 2021.

Navigators have also been valuable for connecting Medicaid and Medicare beneficiaries with resource related to social determinants of health needs. From February 2022 to May 2022, the social determinants of health navigator program resolved 85,000 beneficiaries’ social determinants of health needs.