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Affordable Care Act navigator

Former Genesis Health System navigator Jennifer Busch, center, helps Maquoketa, Iowa-area residents re-enroll for health insurance through the Affordable Care Act in 2016 at a temporary enrollment site in the Jackson County Regional Health Center. Genesis eliminated Busch's position in January because of a lack of federal funds. President Donald Trump has cut funding for the navigators two years in a row.

Enrollment for health insurance in the Affordable Care Act marketplace begins soon, and eastern Iowa/western Illinois consumers likely will not have access to enrollment services previously supported by the federal government.

The Trump administration announced this week it will slash grants to organizations that answer questions and help people sign up for the Obama-era program.

Funding for these experts, called “navigators,” will be cut from $36.8 million last fall to $10 million for the six-week enrollment period that begins Nov. 1, marking the second major reduction in two years. The government provided $62.5 million to insurance counselors in late 2016.

“We’re presuming this will end the program for us,” said Henry Marquard, government and community affairs officer for Genesis Health System in Davenport. “In our opinion, that’s a really unfortunate thing, because those navigators were really an excellent resource for our patients.”

'Not just a hotline'

From 2013-2015, Genesis received $269,000 each year for two navigators, who directly enrolled and provided assistance to about 2,000 Iowa and Illinois residents. In year two, for example, they enrolled 1,406 individuals and aided 671 others by setting up accounts, advising on plans and locating providers — a complicated process, Marquard said.

“Getting access to health care often is pretty intimidating for the average person,” he said. “It’s not just a hotline to call and troubleshoot, ‘Why won’t this button click?’ They (navigators) were being so proactively helpful.”

In 2016, funding for Genesis dropped to $200,000, and navigators enrolled 958 individuals and helped 989 others. From 2013-2016, about 60 percent of the people enrolled by Genesis’ helpers signed up for private insurance in the marketplace; the remaining 40 percent, people with low incomes, signed up for Medicaid, Marquard said.

In turn, "We saw a tremendous reduction in the amount of charity care and unreimbursed care we've had to provide," he said.

Then there was one

Last year, the enrollment period was slashed in half, and Genesis saw its navigator funding plunge to $20,000, reducing availability to just one navigator for both states.

Navigator Jennifer Busch enrolled more than 145 people and helped more than 90 others, exceeding her goals set by the Centers for Medicare and Medicaid Services, Marquard said.

However, Genesis did not meet its advertising goal for marketing the program. Budgeted promotional dollars, separate from the grant, were instead used to supplement Busch’s income, Marquard said. The position was eliminated at the beginning of this year.

Federal officials also will cut 90 percent of a related budget for advertising and other outreach activities to foster Affordable Care Act enrollment. They said navigators failed to meet their sign-up targets, while agents and brokers performed better in the marketplace.

Applications for navigator funding are due Aug. 9, and Genesis does not have a plan to submit a request, given the start-up expense. Awards are expected to be announced Sept. 12.

“We are currently moving forward as if we don’t have that program,” Marquard said. “If we get a grant that allows us to change that, we’ll certainly do so, but seeing that the administration just axed funding by more than one third, it seems unlikely.”

Additional programs cut

Planned Parenthood of the Heartland, which had operated a navigator program in 78 counties in Iowa, announced last September it was shutting it down.

A third navigator program in Iowa, run by Visiting Nurse Services of Iowa, a Des Moines-based medical and social service organization, is closing out its navigator program at the end of August, officials said.

Nicole Kock, navigator services program coordinator and the only navigator on staff at Visiting Nurse Services, confirmed the program will close once its federal grant of $171,304 runs out Aug. 30. Until then, Kock will only be providing assistance to those “who have a critical need or face significant barriers accessing health care coverage.”

But even with these cuts and the shortened enrollment period, the agency  navigator program saw an increase in the number of individuals signing up for insurance through the marketplace last year.

The agency's navigator program assisted 249 consumers, 129 of whom enrolled in marketplace plans, during last year's six-week enrollment period. Throughout the 12-week enrollment period in 2016, the navigator program, which received $180,891, assisted 302 consumers and helped enroll 117 people in marketplace plans. 

“We know people out there need health insurance, they want health insurance, they want it to be affordable for themselves and their families,” Kock said. “They recognize the need and importance of that and they really just need an organization or an entity that is willing to and can provide that in-person assistance to sit down with them one-on-one, take the time to go through and educate them on health insurance literacy, how it works, how the plans can best benefit the families and their medical needs.

“It’s a very important service and Iowans have proved to us, year after year, that’s it’s a want and it’s a need,” she said.

Other enrollment services

Despite the cuts, there still will be help available. Certified counselors who are not federally funded have been working to help enroll people since the marketplace first took applicants in the fall of 2013.

UnityPoint Health’s team of nine counselors helped 2,258 people in the Quad-City area navigate the enrollment process in 2017, interim regional marketing director Brian Boesen said.

Genesis employs non-federally funded consumer helpers, too, but the number of these positions was not available Thursday. 

Community Health Care Inc., which has facilities in Davenport, Rock Island, Moline and East Moline, also helps with enrollment. It is not in the federally funded navigator program, either, so it will continue to operate as usual, said CEO Tom Bowman.

Mateo Tiry-Ortiz, outreach and enrollment coordinator for Community Health Care, spends a lot of time helping people during the enrollment period, but that is just one part of his job.

“More people are getting comfortable with navigating the system,” Bowman said. “It may not be as crucial of a position as it once was.”

(Gazette reporter Michaela Ramm contributed to this report.)

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Jack Cullen covers health and the outdoors for the Quad-City Times.