Thus far unable to get repeal and replace legislation through the U.S. Congress, President Donald Trump is using his executive powers to try to cripple the federal exchanges ? cutting the open enrollment time period in half, forgoing advertising and decreasing funding to navigator programs.
But Eastern Iowa health care providers are doing their best to fill in some of those gaps.
Navigators ? a job created under the Affordable Care Act ? help people sign up for insurance through the exchange for Medicaid, insurance for the poor and needy. They host educational events and target hard-to-reach populations, including the uninsured and underinsured.
But groups around the country, including in Iowa, have reported severe funding cuts, hampering their programs.
The U.S. Department of Health and Human Services announced a 41 percent cut overall to the outreach program in September, arguing the program so far has been unsuccessful. Last year HHS gave out $62.5 million nationally to navigators, who in turn helped sign up less than one percent of total ACA marketplace enrollees.
But navigators believe those are unfair figures because a large portion of the people they also help ? those eligible for Medicaid ? were not counted in those numbers.
In Iowa, three groups obtained HHS funding to create navigator programs ? Planned Parenthood of the Heartland, Genesis Health Care in the Quad Cities and the Visiting Nurses Association.
The Visiting Nurses Association, which has three full-time navigators covering 22 counties in Central Iowa, did see their funding reduced, but the organization is able to continue services, representatives said.
That isn?t the case for Planned Parenthood, whose navigator funding was slashed by about 84 percent and ultimately decided to end the program.
?We are having to make some really hard choices, and this one is particularly devastating,? said Rachel Lopez, spokeswoman of Planned Parenthood of the Heartland, whose navigator program covered 78 Iowa counties including those in Eastern Iowa. ?People don?t realize this isn?t just about signing people up for the ACA or Medicaid ? it?s about helping people to navigate a very, very complex system.?
Many of these individuals do not have access to computers or are computer literate, Lopez said, and the organization?s six navigators helped people access health care year-round.
Organizations providing navigator services apply for federal grant dollars each year to fund the programs. In the most recent 2016 grant cycle, Planned Parenthood had 278 events around the state that reached more than 10,000 people.
?Because the navigator program has to be certified at a federal level to provide these services, only navigator funds can fund navigators,? Lopez said. ?We can?t just absorb that cost and pay it out of our pocket.
?We had to either accept what was offered, which was impossible, or had to refuse the grant entirely and cut the program.?
There are many health care providers that offer enrollment assistance through Certified Application Counselors, including UnityPoint Health, Mercy Medical Center and Eastern Iowa Health Center. These individuals perform similar duties to navigators ? helping individuals sign up for insurance plans ? but have less extensive training than navigators and don?t hold public outreach events.
Navigators also must give unbiased advice and comply with conflict-of-interest standards.
Joe Lock, president and chief executive officer of Eastern Iowa Health Center, a federally qualified health clinic, said the provider has 10 application counselors spread out through its pediatrics, family medicine and women?s health clinics that can schedule up to 21 appointments each week. He?s expecting to see an influx of patients who need sign up help, he said, as navigator programs have seen funding cuts.
?We work hard to meet patients where they are and when they need it,? Lock said.
The Community Health Free Clinic in Cedar Rapids also recognized a possible increase in demand ? so the organization hired one of the navigators cut from Planned Parenthood.
Karen Wielert, who worked as a Planned Parenthood navigator for four years, said the funding cut came as a shock. She?s now at the free clinic two days a week and is working to formalize a similar position in Johnson County. But she knows her time there is limited with funding most likely running out by December.
But that isn?t what?s concerning her right now, she said. She really wants to be there for people to get through this open-enrollment season, which is bringing plenty of challenges on its own.
Iowa currently has only one insurer ? Minnesota-based Medica ? selling plans statewide on the individual market while the back and forth on the federal level has left people with whiplash.
?I know there are a lot of families who have relied on me,? she said. ?Even to just get through open enrollment, I don?t want to feel like I?m abandoning all those people I?ve worked with.
?There?s already so much uncertainty and confusion.?
The open-enrollment period this year will run from Nov. 1 through Dec. 15.