Information Gaps and Health Insurance Enrollment

We studied the impact of Affordable Care Act navigator programs on health insurance coverage, using the 80 percent cut in program funding under the Trump administration as a natural experiment. Our study design exploited county-level differences in the program prior to funding cuts. We did not find that cuts to the program significantly decreased rates of marketplace coverage or any health insurance coverage by 2019; however, our estimates could not rule out marketplace coverage declines of up to 2.7 percent (point estimate -1.3 percent, 95 percent CI: 2.7 percent to 0.1 percent), or total coverage declines of up to 1.8 percentage points (point estimate -0.8 percentage points or -1.2 percent, 95 percent CI: -1.8 to 0.2). Cuts to the navigator program significantly decreased marketplace coverage and total coverage among lower-income adults, and significantly decreased total coverage among adults under age 45, Hispanic adults, and adults who speak a language other than English at home. We found no significant impact of the cuts on Medicaid enrollment (95 percent CI: -1.9 percentage points to 0.5 percentage points); most uninsured people in the states we studied lived in locations that had not implemented Medicaid eligibility expansions. These findings suggest that before the funding cuts, navigators were helping underserved consumers obtain coverage.