Federally funded Navigators are disproportionately located in rural states where they are tasked with helping people who, for various reasons, may not be well served by other enrollment resources, such as brokers. Navigators do not receive commissions from insurance companies and tend to assist individuals with lower incomes. Compared to insurance brokers, Navigators are far more likely to help consumers enroll in Medicaid, work within their communities to reach people without coverage, and assist individuals in circumstances that make enrollment challenging (e.g., no home internet).
What Does the Research Tell Us About the Value of Outreach and Enrollment Assistance?
Research over the past decade has shown that outreach, education, and enrollment assistance boost take-up of comprehensive coverage. The U.S. Department of Health and Human Services attributed higher enrollment numbers in 2023 in part to Navigator activities, a conclusion that aligns with early research that found strong associations between consumer interactions with Navigators and increased numbers of applications and successful enrollments. Outreach has consistently been shown to reduce the number of Americans uninsured and increase marketplace enrollment, and interventions that successfully encourage individuals to obtain coverage have been linked to reduced mortality.
Studies have identified the negative effects of the first Trump administration’s cuts to outreach and marketing funding, including increases in the uninsured rate and decreases in marketplace enrollment among certain populations. One rationale for the initial funding cuts was that privately funded advertisements and insurance brokers would compensate for the loss in federally funded outreach and assistance. Subsequent research concluded that the Trump administration’s hollowing out of the Navigator program and outreach efforts in 2017–2018 did not spur an increase in private advertising and that federally funded advertising was more successful at driving marketplace enrollment than privately funded ads.
Justification for the Cuts Doesn’t Add Up
The ACA established a “user fee” that participating insurers pay to the federal government to fund marketplace activities, such as the call center, technical support and operation of the HealthCare.gov website, enrollment assistance, and the Navigator program. The administration asserts that eliminating Navigator funding will allow it to reduce that user fee, generating savings that will be passed on to enrollees in the form of lower premiums, and ultimately, the broader public, by reducing federal spending on premium tax credits. These claims deserve skepticism.
Previous cuts to the Navigator program under the Trump administration did not result in lower user fees. In fact, these fees were at their lowest under the Biden administration, which undercut the first Trump administration’s rates while simultaneously ensuring robust Navigator funding.
Navigator funding accounts for only a small fraction of user fee dollars — less than 5 percent in 2023 and a much smaller portion of overall federal spending. Even draconian cuts are unlikely to translate into noticeable premium savings and any effects on federal expenditures will be even more attenuated. Indeed, cutting Navigator funding may have the unintended effect of raising premiums. Actuaries have identified outreach and assistance programs as a factor that contributes to individual market enrollment growth, which improves the overall risk pool and helps constrain rising premiums.
Policies That Deprioritize Health Coverage
The U.S. House of Representatives recently voted for a budget resolution that could potentially strip $880 billion from the Medicaid program, while the congressional majority has shown little interest in preserving the enhanced premium tax credit for the roughly 20 million Americans who use the marketplaces. As consumers face more obstacles to obtaining coverage, Navigators will be essential in helping people understand their options. The administration’s severe cuts to the program may cause these community-based organizations to face budgetary shortfalls and potentially layoffs, making consumer help harder to come by when it’s needed most.
