For the past three years, the US Health and Human Services Department has partnered with a health advocacy group in Mississippi on an education tour before Obamacare enrollment started. They would meet around the states with groups that sign people up for coverage — state officials, health centers, insurance brokers, and the like — to prepare for open enrollment. Up until Monday, Roy Mitchell, executive director of the Mississippi Health Advocacy Program, thought these events were going forward in the coming weeks as planned. He had even asked HHS just last week for biographies of the officials they’d be sending. But then two days ago, he received a short message from an agency official, which Mitchell shared with Vox: HHS wouldn’t be doing any Obamacare marketplace events in the South this year. No further explanation was provided. “HHS bailing out was the last straw for us,” Mitchell told me by phone Wednesday. “It’s clearly sabotage.” The department did not immediately respond to a request for comment. HHS’s abrupt withdrawal from the events is part of a bigger story. The Trump administration has already cut this year’s open enrollment period in half. It slashed spending on advertising by 90 percent. Funding for the navigators program, which went to groups that helped people sign up for insurance, was reduced by 40 percent and then allowed to lapse entirely. With Obamacare facing an uncertain future on so many fronts — over its repeal, over the payment of key subsidies, over the enforcement of the individual mandate — HHS has added the apparent undermining of open enrollment to the plate. A key part of the law is the outreach and education that happens every fall, encouraging young and healthy people to enroll and letting Americans know what assistance is available to them. The Trump administration is cutting back sharply on these efforts — an act people like Mitchell have labeled “sabotage.” The Mississippi Health Advocacy Program, which Mitchell said did not receive any federal funding to put on the events, has put on seminars tailored to Obamacare navigators, insurance brokers, state officials, and community health centers — the various entities that would help people enroll in coverage — for three years. They were a chance to coordinate the various groups that work on enrollment and to educate them about what changes were coming to the marketplace that year. These meetings were also, Mitchell said, the only time the full apparatus of people and groups helping Mississippians sign up for Obamacare coverage would get together. “This was the last vestige of coordination in Mississippi,” he said. “That’s what this was.” This year, HHS officials had repeatedly told Mitchell that the pre-enrollment events would go forward as they had before, he said. A senior official made that commitment a few months ago. As recently as last week, Mitchell’s group had been in contact with the agency, gathering biographies for the HHS officials who were supposed to attend, he said. “They reaffirmed their commitment to partner with us this year,” Mitchell told me. “We justifiably relied on their representation.” The advocacy program had booked venues, promoted the events, and started registering attendees. Five events were planned, in the delta, on the Mississippi coast, in Jackson. Between 200 and 300 people had already registered to come. But then on Monday, Mitchell received an email from an HHS official in Atlanta, announcing in a blanket statement that HHS would not be participating in any such Obamacare outreach events this year. “We were told a few days ago that we will not be supporting marketplace efforts by being out in the regions this year,” the official said in the email, which Mitchell shared with me. Mitchell told me he was so caught off guard that he didn’t quite believe the announcement applied to his group’s planned events. “I just thought, ‘Well, surely, it’s kind of a broad statement they made, maybe; perhaps they’re still planning on coming,’” he said. But when one of his staff members checked with HHS, they affirmed that the agency wouldn’t be participating in the advocacy program’s efforts. Mitchell’s group is still regrouping, and the events could still go ahead. But they will not be the same without HHS, which had been a willing partner during the Obama administration, Mitchell said. The agency’s presence helped convince navigators and insurance agents to show up, and federal officials would have the best information available on Obamacare open enrollment. “It’s an attempt to show good faith,” he told me. “The people that attended these meetings in the past always remarked that it’s amazing to see health advocates side by side with insurance carriers and HHS and the state. That was a pretty big draw.” Mitchell’s frustration was clear. Mississippi hasn’t expanded Medicaid under Obamacare, which has limited its coverage gains through the law, but nonetheless nearly 90,000 people in the state signed up for coverage in 2017. There is solid empirical evidence that less outreach will lead to fewer people enrolling in insurance. “We’re kind of a shoestring operation. I feel like I am sole-handedly holding up the ACA in the state,” Mitchell said. “I’m not the Wizard of Oz. I’m not printing money.” It is part of a pattern, on official and unofficial fronts, of the Trump administration undercutting Obamacare, the federal law that despite repeated attempts to repeal it remains on the books and helps millions of Americans get health insurance. There have been the overt actions: shortening the open enrollment to six weeks, slashing the funding for TV advertising and navigators, sowing doubt about whether Obamacare’s individual mandate would be enforced. But then there have been less obvious tactics that still undermine the law. Talking Points Memo reported recently that HHS had abandoned an outreach partnership with Hispanic groups that the Obama administration had started. Dropping out of the events in Mississippi is in a similar vein. “HHS is a big draw in terms of these meetings. I think it was highly beneficial to hear the policy directly from HHS,” Mitchell said. “Certainly we can go forward, but frankly it was an attempt at collaboration.” But it seems that collaboration is now over.
Utne Altwire: healthcare