During open enrollment for 2018 coverage, the Trump administration allowed consumers to bypass the federal HealthCare.gov platform and buy an ACA-approved plan directly from a broker or an insurer's website.
It also introduced a tool called "Help on Demand" that connected shoppers to licensed agents able to help with application and enrollment questions. The CMS also began recognizing high-performing brokers and agents in 2018. On the flip side, the Trump administration slashed federal funding to ACA navigators, who receive grants to assist consumers during open enrollment. Some navigator groups were forced to cut staff or cancel outreach events because of the smaller budgets.
The administration has supported privatizing health insurance enrollment. But navigator funding cuts, along with dwindling broker participation have helped reduce ACA enrollment. Nearly 11.8 million people signed up for 2018 coverage, down from 12.2 million in 2017. So far 1.1 million people have dropped their 2018 plans as of mid-March, the CMS said Monday.
Still, the CMS said that though there are fewer agents and brokers participating, they are still supporting about 42% of HealthCare.gov customers.
Brokers help consumers navigate coverage options and also tend to advocate for their customers if claims get denied. They've historically signed up about half of all exchange enrollees. Before the ACA, insurance companies would pay brokers commissions based on monthly premiums for plans sold on the individual market. But insurers—many of which lost money on their individual insurance plans, but are now on track to make a profit—have increasingly chosen to stop paying those fees for all or certain types of health plans, saying its necessary for them to stay financially viable.
The CMS in December 2016 issued guidance instructing health plans to be consistent in how they pay commissions across all exchange plans, effective January 2018. But brokers say nothing has changed since the guidance came out. Groups representing agents and brokers have long complained that the CMS was unwilling to enforce commission payments for fear of discouraging insurer participation.
"Without a viable compensation structure for agents and brokers, it may be difficult for CMS to improve or stabilize agent and broker retention and achieve significant enrollment gains, leaving consumers with diminished access to insurance specialists willing to help them in their local communities," the agency said in its report.
The CMS also said it would continue to streamline the HealthCare.gov platform for 2019 and give brokers and agents new tools to help them assist customers with eligibility determinations and plan selections while reducing the need to use the federal website or call center.
