A person holds a sign directing people to an insurance company where they can sign up for the Affordable Care Act, also known as Obamacare.
A group that is supposed to help Native Americans sign up for Affordable Care Act coverage in South Dakota received $200,000 in federal funds to support its efforts — and managed to sign up just one person in an Obamacare plan, the Trump administration said Wednesday.
The group, the Great Plains Tribal Chairmen’s Health Board, had better luck in North Dakota — where it assisted 67 people in shopping for and enrolling in an Obamacare plan that went into effect in 2017.
But in that state, the board received another $154,000 in federal cash for its efforts.
That works out to nearly $2,300 per enrollee in North Dakota.
In both Dakotas, the group’s work cost taxpayers $5,200 per enrollee, according to data from the federal Centers for Medicare and Medicaid Services.
At the start of 2017 plan last fall, the tribal board — which has not responded to a request for comment from CNBC — had hoped to sign up 5,900 people in Obamacare plans sold by private insurers.
The organization was not alone among Obamacare navigators in falling woefully short of its goals — or in getting a lot of federal money while doing so.
CMS said that besides tribal chairmen’s board,16 other Obamacare navigators each had enrolled fewer than 100 people for 2017 plans — at an average cost of almost $5,000 per enrollee.
And the 10 navigators that received the most federal funds got a total of $2.77 million to sign up just 314 people in Obamacare plans, according to CMS.
Nationally, “Navigators received $62.5 million in federal grants to enroll 81,426 people — just 0.7 percent of total enrollees” in Obamacare plans, CMS said.
And 78 percent of navigators failed to reach their enrollment goals “while spending $50 million,” CMS said.
A former top health official with the Obama administration questioned the veracity of CMS’ data, the context in which it was presented, and the agency’s motivation for releasing the information in the midst of the on-going enrollment season.
But the Trump administration — which is actively hostile to Obamacare — cited the apparently poor performance of most navigators as it released a list of navigator grant recipients and the money they will be getting this enrollment season.
In 34 states served by the federal Obamacare exchange HealthCare.gov, navigators will get a total of just $36 million — 42 percent less than the funding for the prior year — according to the CMS.
CMS released another document that detailed the enrollment goals for each navigator that received federal funding for 2017 plans, and how those groups actually performed. That report card affected how much navigators will be getting this season.
The tribal chairmen’s board is one group that is getting a lot less money — a total of just $20,000 for its work in the Dakotas.
“The value of a program should be judged by its results and not by the amount of money spent,” said Caitlin Oakley, a spokeswoman for the U.S. Health and Human Services Department, the parent of CMS.
“Last year, the navigator program helped less than 1 percent of enrollees sign up for Obamacare at a cost of nearly $63 million,” Oakley said.
“Our aim is to provide Americans with a seamless enrollment experience, and not spend money for the sake of maintaining the status quo,” she said.
Lori Lodes, a former spokeswoman for CMS in the Obama administration, said there are several reasons to doubt that the navigator program is performing as poorly as the Trump administration suggests.
“This doesn’t paint a full picture,” Lodes said of CMS’ data.
Lodes said that navigators, in addition to helping people sign up in Obamacare plans, are responsible for steering people to other health coverage programs they might be qualified for. Enrollment in those other programs are not reflected in data released by CMS on Wednesday.
Lodes said those other programs include Medicare, which serves primarily older Americans, and Medicaid, which serves mainly poor people. They also include the Indian Health Service, which provides coverage to Native Americans, including people served by the Great Plains Tribal Chairmen’s Health Board.
Lodes, who now helps run the Obamacare advocacy Get America Covered, also said that during her tenure at CMS, agency officials knew the enrollment data in Obamacare plans related to navigator assistance was “extremely flawed.”
Lodes said some navigators were never conditioned to enter their identification numbers when helping people to sign up, meaning their contribution to the enrollment would not be known.
She also said navigators were instructed not to enter their ID numbers unless they had assisted a customer from the beginning to the end of their enrollment process.
“It’s not fulsome data,” Lodes said. “Because it doesn’t capture all types of enrollment and it doesn’t capture all of the people that have been helped by that navigator.”
Lodes said she strongly suspects that the Trump administration is releasing the navigator data as part of an ongoing effort to sabotage Obamacare, whose enrollment season started Nov. 1.
“I don’t understand how they would be releasing such misleading data three weeks before the enrollment deadline if they were not trying to hurt enrollment or morale” among navigators, Lodes said.
“It’s sticking a finger into a lot of hard-working Americans’ eyes,” she said. “For the government that runs this government program to question navigators’ motivation and their work is disappointing.”
Officials also said Wednesday that enrollment on the federal Obamacare marketplace hit nearly 2.3 million people in the first three weeks of sign-up season for individual health plans. That number is about 64 percent higher than in 2016.
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