Lee Nathans, like insurance brokers in many states, expects tobe crazy busy for the next several weeks, fielding calls from“people who are not going to be happy.”

Open enrollment for Affordable Care Act coverage started Nov. 1,and the approximately 10 million people who buy their own health insurance are only nowgetting a look at what’s being offered. It’s daunting.

“There will be a lot of people who will need to use a broker,”said Nathans, of Columbus, Ohio.

The enrollment period is also shorter than in previous years,ending Dec. 15.

In many places, there are fewer health insurance carriersoffering coverage — and those that remain have sharply raisedprices and changed their networks of doctors and hospitals.

More perplexing for people sifting through these options is thefact that this year there’s less on-the-ground assistance to help decode thosecomplexities because of Trump administration funding cuts.

All that means brokers are coping with what may be the mostchallenging sign-up period since the ACA marketplaces, also knownas exchanges, debuted in 2014.

When the ACA became law, some thought the days of brokers werenumbered.

The ACA’s rules and online state and federal exchanges weresupposed to make comparing plans and purchasing health insuranceeasier.

But for many consumers — particularly those who have neverbought insurance before — having help is vital.

“Yes, health insurance is complicated,” said Lisa Hamler-Fugitt,executive director for the Ohio Association of Foodbanks, whichprovided such help for the past four years through federalgrant-funded navigator programs in the state. Navigators aretrained individuals or groups that guide consumers and smallbusinesses through the process, for free.

“[Customers] didn’t turn to us just during open enrollment, butalso when they had questions about how to use their plan, aboutdeductibles and copayments.”

This year is different.

The Trump administration, criticizing the navigator effortnationwide, slashed funding. The Ohio program learned it would get a 71 percent cut andreluctantly closed its doors for this enrollment season.

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Kaiser Health News, a nonprofit health newsroom whosestories appear in news outlets nationwide, is an editoriallyindependent part of the Kaiser Family Foundation.

There were also cuts to other states, which varied, but averaged40 percent nationally. In Tennessee, for example, navigatorfunding was reduced by 16 percent, while in Indiana it fell 82percent.

The Department of Health and Human Services appears to beturning to brokers to fill this gap. It announced in late Octoberthat the federal online marketplace, healthcare.gov, has a newresource under its “Find Local Help” tab. Consumers can enter theircontact information in the “Help On Demand” feature — and get a call back from a statelicensed broker.

It isn’t known how many brokers signed up to participate, butagent John Dodd thinks it’s a good idea.

“This move of working more with brokers will help make up someof the difference [from losing the navigator program], althoughanytime you remove help, that’s not a positive step,” said Dodd,president-elect of the Ohio Association of Health Underwriters andowner of his own agency in Westerville.

But growing pressure on brokers — from smaller commissions toincreased complexity of the health offerings — means they may beharder to find.

Last year, several big Blue Cross Blue Shield insurers cut orreduced their commissions, citing it as a cost-cutting move,following a similar action in 2015 by UnitedHealthcare. Somebrokers then began charging a fee to help people enroll, whileothers stopped entirely.

When insurers pay commissions, the amounts are included inpremiums and can be between 2 and 5 percent, depending on thecarrier.

This year, “I’m still going to help my clients, but I’m notdoing direct enrollments,” said Nathans. He will refer customerswho need this assistance to a colleague.

There are reasons why the enrollment process is a heavylift.

Licensed insurance broker John Jaggi of Forsyth, Ill., said heand his daughter, Anne Petri, also a broker, often spend the first35 minutes of appointments just helping clients figure out the mathto determine if they can get a premium subsidy. People who qualifyearn less than 400 percent of the federal poverty level ($48,240for an individual) and don’t have other coverage.

By that point, clients are exhausted and don’t even want to talkabout the details of the plan, Jaggi said. And he’s paid “almostnothing” for his efforts.

Still, Jaggi and Petri plan to continue helping individuals withthis year’s enrollment.

A Trump administration decision in October likely has createdeven more demand for these services. President Donald Trump saidthen that he was stopping federal “cost-sharingreduction” payments to insurers. These payments were used tooffset the costs of coverage for certain low-income policyholdersby reducing their deductibles and copayments.

Even without the federal assistance, insurers are still requiredto provide these cost reductions. To make up for them, insurersboosted premiums, particularly in middle-level “silver” plans.Because the cost of these plans is also the benchmark used to setthe tax-credit subsidy many people receive to help pay theirpremiums, eligible consumers will likely receive more federalassistance this year and have more affordable options from which tochoose.

In other words, people who receive the tax credits are notlikely to feel a financial pinch. People who don’t, though, willlikely take a hit.

“You have to feel bad for them,” said Petri. “How can theyafford another $100 to $200 a month in premium?”

The individual market has always been volatile, but brokers saythe situation is bad this year.

Dodd, the Westerville, Ohio-based broker, said he hopes Congressacts to stabilize the market. And soon.

Without that, “2019 could be Armageddon, off-the-charts bad,” hesaid.

Kaiser Health News, a nonprofit health newsroom whosestories appear in news outlets nationwide, is an editoriallyindependent part of the Kaiser Family Foundation.