If you buy insurance on your own and have been paying attention to the Affordable Care Act, you've probably heard that open enrollment for 2018 plans has just started and the government is spending a lot less money this year to get the word out.
That's true in the 39 states that rely on HealthCare.gov. But circumstances are different in some of the 11 states plus the District of Columbia that run their own ACA websites and marketplaces.
They're in charge of their own marketing and enrollment assistance programs, so are somewhat immune from Trump administration actions — and inaction — that critics have warned will undermine 2018 individual market enrollment.
"We're in a very different position than the federal government," says Allison O'Toole, who runs Minnesota's exchange, MNsure. "I see a lot of action coming out of Washington designed to destabilize the market and to hinder enrollment. I have the exact opposite goal in Minnesota."
In its first year of managing the sign-ups, the Trump administration slashed the marketing budget most states rely on for the federally run insurance exchange by 90 percent. The open enrollment period is shorter and HealthCare.gov, the federal website, will curb its hours on all Sundays during the sign-up period, except the last one.
A recent analysis by the chief marketing officer of HealthCare.gov under President Obama estimates that the marketing cuts alone may reduce next year's enrollment by at least 1.1 million people.
In contrast, MNsure is planning another all-out annual enrollment push with TV ads and on social media. It will also pay other organizations to help spread the word; for example, MNSure gave $500,000 to Portico Healthnet, a nonprofit health care navigator group, for outreach efforts.
The money helps a lot.
"Portico Healthnet was able to staff up — so we have more navigators on staff now to prepare ourselves to meet the needs of the open enrollment demand," says Meghan Kimmel, president of the organization, which is based in St. Paul. "We are anywhere we can be where we can talk with people about access to coverage."
The picture is very different in states like Mississippi, which relies on HealthCare.gov, the federal exchange. Open enrollment in these states is shaping up to be much different under President Trump than it was under President Obama.
"We're still enrolling," says Ginni Tran, who works as an ACA navigator at Mercy Housing & Human Development in Gulfport, Miss., "but we're not aggressively outreaching and educating" because there isn't enough money.
Tran's office helps Gulf Coast seafood industry workers find health plans on HealthCare.gov. Cuts to federal enrollment assistance translated to a 70 percent smaller budget for Mercy's open enrollment activities.
Mississippi's uninsured rate has fallen to 12 percent, but remains tied for third worst in the United States. Gov. Phil Bryant has staunchly opposed the Affordable Care Act and did not expand Medicaid.
Kimmel and others says what's happening in states using HealthCare.gov underscores the value of Minnesota having its own exchange.
At least one longtime MNsure critic, however, remains unpersuaded. State Rep. Greg Davids, a Republican, dismissed the notion that cutting back on the open enrollment period and slashing the promotional budget will discourage enrollment. He favors having the state turn to HealthCare.gov, instead.
"We need to get rid of MNsure," Davids says. "They're an unnecessary duplicate layer of government that hasn't worked."
This story is part of NPR's reporting partnership with Minnesota Public Radio and Kaiser Health News.
DAVID GREENE, HOST:
Open enrollment starts today for anyone looking to get health insurance through the Affordable Care Act's individual market. But this process is going to look very different for people in states that have their own exchanges versus states where residents are sent to the federal HealthCare.gov marketplace. Mark Zdechlik for Minnesota Public Radio reports.
MARK ZDECHLIK, BYLINE: Minnesota's exchange is called MNsure. As President Trump bashes the Affordable Care Act and slashes open enrollment funding for the federal HealthCare.gov exchange, MNsure is enthusiastically promoting the ACA, just as it did under President Obama.
ALLISON O'TOOLE: We're in a very different position than the federal government.
ZDECHLIK: That's MNsure CEO Allison O'Toole.
O'TOOLE: I see a lot of the actions coming out of Washington designed to destabilize the market and to hinder enrollment. I have the exact opposite goal in Minnesota.
ZDECHLIK: So as the Trump administration cuts HealthCare.gov advertising by 90 percent and does away with TV ads, Minnesota is promoting open enrollment as much as it can, and MNsure is running TV ads like this.
(SOUNDBITE OF AD)
UNIDENTIFIED WOMAN: We're the only place whose sole reason is to help all Minnesotans find the right plan they can afford.
ZDECHLIK: MNsure is also planning a big social media push - Twitter, Facebook. They want to reach everybody from millennials to older Minnesotans. MNsure is also spending millions to help other organizations enroll Minnesotans in individual market plans. In the HealthCare.gov states, feds slashed much of the funding for what are called navigators. But St. Paul-based Portico Healthnet got a half-million dollars from MNsure to help people sign up. Meghan Kimmel runs the nonprofit.
MEGHAN KIMMEL: Portico Healthnet was able to staff up, so we have more navigators on staff now to prepare ourselves to meet the needs of the open enrollment demand. We are anywhere that we can be where we can talk with people about access to coverage.
ZDECHLIK: About a thousand miles due south of St. Paul, Ginni Tran says she helps a lot of people who work in the seafood industry get health insurance in southern Mississippi.
GINNI TRAN: So shrimper - harvesting oysters, crabs...
ZDECHLIK: Tran works for Mercy Housing and Human Development in Gulfport. Unlike Minnesota, Mississippi does not have its own exchange, so people there sign up and qualify for tax credits through the federal HealthCare.gov site. And under President Trump, it's an altogether different proposition than it was under President Obama.
TRAN: We're still enrolling, but we're not aggressively outreaching and educating.
ZDECHLIK: ...Because, Tran says, they just don't have enough money anymore. Trump administration cuts translated to a 70 percent funding decrease for Mercy's open enrollment efforts.
TRAN: We were actually going to make another of our employee, our co-worker, to become certified, but with the cutback, we won't be able do that.
ZDECHLIK: And the Trump administration slashed HealthCare.gov's open enrollment period from three months to a month and a half. In contrast, Minnesota's open enrollment period goes for 2 1/2 months. Most other state exchanges also have longer open enrollment periods than does HealthCare.gov. For NPR News, I'm Mark Zdechlik in St. Paul.
(SOUNDBITE OF PORT BLUE SONG, "OVER ATLANTIC CITY") Transcript provided by NPR, Copyright NPR.