After funding cuts, N.H. insurance navigators short on time, resources

Monitor staff
Published: 11/5/2017 12:05:11 AM

A year ago, Bhagirath Khatiwada had four health insurance navigators on the payroll. His organization, the Manchester-based Building Community in New Hampshire (BCNH), helps sign Granite Staters up for insurance plans on the individual market; the trained navigators play a vital role.

But then came a leadership change in the White House – and in health care policy broadly. After the Trump administration made sweeping cuts to outreach and assistance programs for the Affordable Care Act, Khatiwada’s organization saw a 60 percent cut in grant funding.

This year, BCNH is down to two navigators – all of its subcontractors have been let go. And with the open enrollment window cut from 12 to six weeks – from Nov. 1 to Dec. 15 – those still working to help people enroll have much less time to do it.

Khatiwada, the BCNH program director, says despite a strong outreach program to get through to consumers, his organization is bracing for fewer sign-ups.

“We assumed that a lot of people would be left out, because despite we being aggressive, people are not – the consumers are not so aggressive to enroll into the health insurance,” he said.

It’s a prognosis shared by many. Five days after the Obamacare markets opened for consumers to renew plans or enter new ones, the tighter funding and reduced sign-up period are creating a squeeze on the organizations tasked with sign-ups.

“They’re definitely feeling crunched for time,” said Eireann Aspell, outreach coordinator for the New Hampshire Insurance Department.

But beyond the structural difficulties is a bigger obstacle: confusion. After months of headlines about attempts to repeal the Affordable Care Act in Washington – and recent reports of a White House decision to stop paying federal “cost sharing reduction” subsidies – many consumers are uncertain what their options are, Aspell said.

Richard Silverberg, CEO of HealthFirst Family Care Center operating in Franklin and Laconia, said his organization – which has also faced outreach funding cuts – agreed that uncertainty is rife.

“A lot of the clients are confused, and they think that they’re not going to get a subsidy,” he said. HealthFirst has been sending its clients postcards to try to clear some areas up.

Part of the problem, Aspell said, arises from customers registering concerns that, while reasonable, are unfounded.

Some who receive advanced premium tax credits to cut down worry about whether the estimated 52 percent average premium increases in New Hampshire’s individual market will affect their monthly payments. (They won’t.)

Others who get cost sharing reductions to bring down deductibles and other costs fear that President Donald Trump’s decision to cut CSR payments to insurance companies mean they won’t get their own subsidies. (It doesn’t.)

Then there are the less-obvious problems to which Aspell said consumers should pay attention.

For instance: Due to a decision by some insurers to change their coverage networks – including Harvard Pilgrim, which pulled out its state-wide network – some people’s plans may no longer cover their hospitals.

Others may have plans that have shot up in price while different, cheaper options are available.

And for those in higher income brackets who aren’t insulated with subsidies, the new premium hikes may now be prohibitive; those people need to be especially careful and should consider options off the market, Aspell said.

For Aspell, the solution is the same for all: research. And for the department, outreach is more important this year than ever.

“We are doing more than we’ve done in years past,” she said, citing weekly press releases and social media posts.

Khatiwada, for his part, said he knows that the tighter deadline means they will likely sign up fewer than they did last year – 500 overall. But he said BCNH will seek to maximize what it already has.

Results so far are encouraging; about 25 people per day signed up in the first few days.

“We are hopeful, but lets see how it goes,” Khatiwada said.

(Ethan DeWitt can be reached at, or on Twitter at

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