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Trump Era Cuts to N.H. Health Care Navigators Have Lasting Impact On Current Special Enrollment Period

Health Insurance Sign
The Biden Administration extended the sign-up window for those who buy their own health insurance through the Affordable Care Act. The extended window expires on August 15.

During the COVID-19 pandemic, Pat Lynch of Henniker lost her job as a caretaker for someone with Down Syndrome. She also lost her health insurance. She’s been delivering groceries as a gig worker and saving up cash for her physical.

But advocates in New Hampshire say that people like Lynch often don’t know their health insurance options. For some, affordable health care is newly within reach — if they can access it.

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In the past, Lynch searched for plans through the Affordable Care Act, but she says she couldn’t afford any of them. But this year, Congress increased the subsidies for which most people can qualify.

About 15 percent of Granite Staters have selected a plan for ten dollars or less a month. Because of the pandemic, the Biden Administration extended the sign-up window for those who buy their own health insurance through the Affordable Care Act. Over 8,000 additional New Hampshire residents have been able to purchase health insurance. The extended window expires on August 15.

Lynch says she didn’t know that cheaper care was available. She wants to find health insurance but has struggled to complete the process. She says she’ll consider reaching out to the state’s navigator.

She might end up reaching out to Jeremy Smith, a health care navigator for New Hampshire and the state’s program director. His job is to help people like Lynch enroll in the Affordable Care Act, and spread the word that insurance is available. He would help Lynch with everything from getting her username and password sorted out to guiding her through selecting an appropriate plan.

He says what Lynch experienced, feeling initially turned off by Affordable Care Act options and unaware of new price changes, is something he sees frequently, especially this year when prices have gone down so significantly.

And a lot of health care advocates like Smith are struggling to connect the consumers who may not know how to sign up with cheaper health insurance options

But the Trump administration substantially cut funding for roles like Smith’s. And Smith is not even based here, he’s over 700 miles away in West Virginia. His team of six serves four states. Before the cuts, New Hampshire alone had 10 in-state navigators.

But when funding was slashed in 2018, some of the state’s former navigators say the proposed budget was too meager to function. No local organizations even applied for funding in 2018, so New Hampshire didn’t have any navigators that year. In 2019, First Choice Services, which Smith works for, secured a remote grant award.

Lucy Hodder teaches health law and policy at the University of New Hampshire Franklin Pierce School of Law. She says although Smith has done everything he can to help, he just can’t be everywhere.

Many of the state’s health centers and providers have also been working in tandem with Smith, but they're mostly limited to those who are already coming in for care.

And there are other advocates who know the system but have been pushed out of the work. Tika Acharya used to head a team of multilingual navigators focused on helping refugees and immigrants, populations he says are underserved.

Compared to the general adult population, immigrants, both undocumented and legal citizens are uninsured at much higher rates. Barriers to care include language, costs, difficulty navigating the enrollment process, fear, and confusion about eligibility policies. Undocumented immigrants are not eligible for Affordable Care Act coverage.

But between funding cuts to navigator services and the organization's other work, Acharya left the position.

Now, he runs AS Insurance Agency, a brokerage based in Manchester. Many of his current clients are new Americans. He tries to continue some of the work he did as a navigator but doesn’t have the resources to do community outreach. He’s only able to help the people that come to him, he says.

More direct outreach could be available soon. The pool of funding available for New Hampshire navigators has increased tenfold from Smith’s 2020 operating budget.

Jeremy Smith says there are a million dollars of funding available for New Hampshire navigators. And he, along with several New Hampshire providers, applied for some of it.

The plan, Smith says, is that he’ll continue to provide virtual enrollment assistance and a hotline, and N.H.- based navigators will work with people in person and do outreach. Smith will find out if they got the funding at the end of the month before the 2022 ACA enrollment period starts on November 1.

N.H. Navigators can be reached at 603-931-3858

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