ACA navigator program funding for 2020 remains $10 million

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Trine K. Tsouderos HRI Regulatory Center Leader, PwC US May 31, 2019

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The federal government is giving $10 million to Affordable Care Act (ACA) navigators—individuals, organizations and companies that help consumers choose plans in the 34 states that use HealthCare.gov—in anticipation of the upcoming ACA open enrollment season later this year, according to a recent announcement from CMS. The federal money is significantly lower than the funding high of $63 million in 2017. For 2019, funding dropped to $10 million, where it will remain for the coming year.

HRI insight analysis: The navigator program, established under the ACA, was intended to help consumers understand the new ACA marketplaces and their plan choices, which were, and are, complex. Under the Obama administration, HHS offered more robust funding for the program.

Under the Trump administration, HHS says it is emphasizing the customer experience of HealthCare.gov, according to a 2018 report by the GAO examining factors contributing to a decrease in enrollment through HealthCare.gov during open enrollment for 2018 coverage. HHS, in its response to the GAO’s findings, stated that despite the decrease in enrollment, customer satisfaction reached “an all-time high, averaging 90 percent.”

Insurers selling plans in the states affected by the funding plateau for navigators may find a modest increase in the number of consumers confused about their options, or unaware of open enrollment altogether. Reduced federal funding for advertising could compound that effect, along with an increase in the variety and number of coverage options, such as association health plans and short-term, limited duration insurance.

Contact us

Trine K. Tsouderos

HRI Regulatory Center Leader, PwC US

Tel: +1 (312) 241 3824

Alexander Gaffney

Senior Manager, Health Research Institute, PwC US

Tel: +1 (202) 836 1604

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