Information Gaps and Health Insurance Enrollment: Evidence from the Affordable Care Act Navigator Programs

Abstract

We studied the impact of Affordable Care Act navigator programs on health insurance coverage, using the 80% cut in program funding under the Trump administration as a natural experiment. Our study design exploited county-level differences in the navigator program prior to funding cuts. We did not find that cuts to the navigator 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% (point estimate -1.3%, 95% CI -2.7% to 0.1%), or total coverage declines of up to 1.8 percentage points (point estimate -0.8 percentage points or -1.2%, 95% CI -1.8 to 0.2). Cuts to the navigator program significantly decreased marketplace coverage among low-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% 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 marketplace coverage.

Note:
Funding Information: Research reported in this paper was supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health, the Office of The Director, National Institutes of Health (OD) and the National Cancer Institute (NCI) under Award Number K12HD101368. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Conflict of Interests: None to declare.

Keywords: health insurance, health policy, information, navigator

JEL Classification: I13, I18, I14