The Trump administration needs to up its game on how it handles health coverage under the Affordable Care Act, according to a new report from the Government Accountability Office.

According to The Hill, the GAO took action at the behest of Representative Frank Pallone, D-NJ, and Senators Patty Murray, D-WA, Ron Wyden, D-OR and Bob Casey, D-PA, who asked the GAO to “examine outreach and enrollment for the exchanges using healthcare.gov.” The action was a result of the changes that the Department of Health and Human Services made to its 2018 outreach that, says GAO, “prompt[ed] concerns that fewer could enroll, potentially harming the exchanges' stability.”

The report examined three different issues: 2018 open enrollment outcomes and factors that may have affected those outcomes; HHS's outreach efforts for 2018; and HHS's 2018 enrollment goals.

Not only did HHS spend 90 percent less on 2018 advertising ($10 million, compared with $100 million for 2017), its officials told GAO that “the agency's approach for 2018 was to focus on low-cost, high-performing forms of advertising.”

HHS also cut funding for navigator organizations by 42 percent, spending just $37 million in 2018 compared with 2017's $63 million, because of “a shift in administration priorities.” In addition, the GAO pointed out that HHS “allocated the funding using data that it acknowledged were not reliable in December 2016. The lack of quality data,” GAO said, “may affect HHS's ability to effectively manage the navigator program.”

HHS also chose not to set any numeric targets related to 2018 total healthcare.gov enrollment, telling GAO that they chose instead to focus on “enhancing the consumer experience for the open enrollment period.”

However, GAO wrote, “Setting numeric targets would allow HHS to monitor and evaluate its overall performance, a key aspect of federal internal controls. Further, while HHS reported meeting its goal of enhancing the consumer experience, such as by improving healthcare.gov availability, it did not measure aspects of the consumer experience it had identified as key in 2017, such as successful outreach events. Absent a more complete assessment, HHS may not be able to fully assess its progress toward its goal of enhancing the consumer experience and may miss opportunities to improve other aspects of the consumer experience.”

Noting that enrollment for 2018 was down 5 percent, to 8.7 million consumers in 39 states, from the 9.2 million enrolled in 2017, GAO said that the drop “continued a decline in enrollment from a peak of 9.6 million in 2016.” Affordability played a large role, it said, in both attracting and detracting from enrollment.

GAO made three recommendations to HHS in its report: that it ensure the data it uses for determining navigator organization awards are accurate, that it set numeric enrollment targets and that it assess other aspects of the consumer experience. While HHS did agree with two recommendations, GAO said the agency disagreed with the need to set numeric targets—which GAO stressed as important.

The members of Congress who requested the report, according to The Hill, “said its conclusions are proof the administration purposely set ObamaCare up for failure.” It quoted their joint statement, in which they said, “This independent and nonpartisan GAO report confirms that the Trump Administration's sabotage of our health care system is driving up costs for consumers and leaving more Americans without health insurance.”

Instant Insights /

GAO report urges Trump administration to do better on ACA

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