Obamacare's first open enrollment season under the Trump administration is expected to be a flop — and even the law's most ardent supporters are worried there's little they can do to change that.

With less than a month before sign-up begins, the federal government has gutted outreach and marketing, slashed funding to outside enrollment groups and left state officials in the dark on key details.


The enrollment window is only half as long as in previous years. HealthCare.gov — the main sign-up site for more than half the country — will be shut down for 12 hours nearly every Sunday. Regional health officials have been told not to participate in sign-up events sponsored by outside groups. And in the White House and Congress, Republican leaders continue to insist the entire market is on the brink of collapse.

While the Trump administration failed to repeal Obamacare, it's doing everything it can to whack it administratively — pulling resources, while pursuing strategies that are likely to depress sign-ups for the law's fifth open enrollment. As a result, even supporters acknowledge that Obamacare enrollment will likely drop for a second straight year as more young and healthy people jump ship, putting even more stress on fragile markets and driving a fresh round of partisan bickering over who's to blame.

"They're trying to sabotage the markets," said Sen. Claire McCaskill (D-Mo.), warning that Republicans are fully responsible for the law's fate. "It's now all them. It is all them. One hundred percent."

Republicans insist that if enrollment tanks, it will be because of rising premiums and dwindling choices.

"A much bigger driver than a government agency trying to get you to enroll is what's going on in the market itself," said Alaska Sen. Dan Sullivan. "Our market has been the poster child of the disaster."

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The Centers for Medicare & Medicaid Services defended the reductions as a bid to reduce wasteful spending, contending most people are already aware of open enrollment and don't need as much help. Officials have said they cut funds to navigator groups that failed to meet their enrollment targets last year. Navigators dispute that, however, saying that agency didn't account for people they helped enroll in Medicaid, advised to automatically re-enroll in Obamacare, or helped to start applications but who finished at home.

A CMS spokesperson also emphasized that individuals will still have a range of options to help them sign up this year, including local insurance agents and brokers and certified application counselors.

The impact of the cuts will be felt most acutely in the 28 mostly red states that rely solely on the federal government to run open enrollment. The Trump administration's 90 percent cut to its advertising budget means individuals won't see television ads urging them to visit HealthCare.gov. Its decision to eliminate 40 percent of federal grant money to enrollment assistance groups means far fewer on-the-ground resources, especially compared with states like California and Massachusetts that continue to pour resources into state outreach.

Concern about the cuts has already spurred a counter-offensive led by former Obama administration officials Lori Lodes and Josh Peck, who oversaw outreach and education for HealthCare.gov. Their new nonprofit — called Get America Covered — is planning to do some of the outreach that federal health officials won't, enlisting celebrities and pushing out information aimed at getting people covered.

Several Senate Democrats have talked with Get America Covered about turning their own political networks into a makeshift campaign to drive people to HealthCare.gov.

"If the administration is going to try to undermine open enrollment, we're going to have to build a massive operation outside of Washington," said Sen. Chris Murphy (D-Conn.), who met Tuesday with the group. "I'm going to be helpful in any way that I legally can be, including pushing the message out and helping raise money for it."

On Friday, 13 former regional CMS directors wrote to acting Health and Human Services Secretary Don Wright objecting to the agency's decision not to allow regional directors to participate in sign-up events around the country.

"To continue down the current path would undermine the will of Congress in passing the ACA — which remains the law of the land — and unnecessarily damage the marketplace," they wrote.

Obamacare's supporters admit there's little chance of matching the federal government's vast reach or resources. The Obama administration used every imaginable option to spur sign-ups over the last few years. Even then, enrollment had begun to plateau at about 10 million — less than half the level originally projected by the CBO.

With half the enrollment time and millions less to spend, those closely involved with the enrollment effort say they'll struggle to build on that number — especially coming off a bruising repeal fight marked by President Donald Trump's claims the law is already dead.

"The recent repeal efforts have created a great deal of political noise," said Jessie Menkens, who oversees outreach efforts for the Alaska Primary Care Association, which lost about 25 percent of its federal funding this year. "It has caused a lot of confusion and it has caused a sense of unease."

Congressional Republicans, though, say that Obamacare was already in a free fall before the Trump administration took office. They note that nearly half the counties in the country have just a single insurer selling plans, and premiums have skyrocketed in many places.

"I think Obamacare is sabotaging enrollment because the costs are so high, the choices are so limited," said Sen. John Barrasso (R-Wyo.).

Those problems, while real, are unlikely to cause the markets to implode. That's because there's a core group of millions of enrollees who receive generous subsidies tied to their incomes. So even if premiums jump, many of those customers won't see their monthly bills increase, making them unlikely to drop coverage.

Beyond those people, though, the lack of advertising and outreach is likely to put a big dent in Obamacare's sign-ups.

"My fear, of course, is that people will lose coverage because they didn't do what they needed to do to re-up," said Margarita Labarta, CEO of Florida’s Meridian Behavioral Healthcare, which saw its federal grant cut from $550,000 in 2017 to just over $40,000 now. That wasn't even enough to fund one full-time worker, she said, so the group turned down the money.

Just one group is now doing outreach work in the 17-county, predominantly rural area where Meridian works, she said.

In Louisiana, funding for the main statewide navigator group was cut 72 percent. The hit forced Navigators for a Healthy Louisiana to lay off 14 people and make very tough choices. It reassigned its remaining five navigators to the communities where they've seen the highest enrollment, leaving broad swaths of the state without anywhere to turn for in-person help.

"North Louisiana — the entire upper part of the boot — is without navigator services," said Brian Burton, the group's state director. "It leaves more people needing assistance and fewer people to assist them."

It also remains unclear what will happen once HealthCare.gov opens for business. Randy Pate, who heads the CMS office that oversees Obamacare implementation, told staffers last week that the agency is making it easier to find the sign-up site, and for people to enroll through insurers and brokers.

But at the same time, it's planning to shut down HealthCare.gov for 12 hours on five of the six Sundays during open enrollment — a popular time for people with weekday jobs to sign up. The open enrollment period itself has been compressed from 12 weeks to six, from Nov. 1 to Dec. 15.

"What we're doing is focusing on those things we can control," said Cheryl Gardner, the CEO of New Mexico's health exchange, which manages its own marketplace but relies on the HealthCare.gov website. "These [outages] are pretty long and right in the middle of open enrollment, which is really inconvenient."

State officials have also complained that CMS is keeping them in the dark on how it plans to manage the expected crush of people trying to access the website. A CMS spokesperson said that call center staffing will be consistent with prior years and that they'll use waiting rooms and a callback service to ensure everyone who wants to enroll by the deadline can do so. But the agency has not said how many call center employees will be dedicated to open enrollment, or whether it has a contingency plan should HealthCare.gov suffer technical problems, said Heather Korbulic, the head of Nevada's state health exchange.

That all adds up to big questions about how enrollment under the Trump administration will actually work.

"The good thing is that the bar is so low and they're doing so little, that anything people do on the outside is going to have an impact," Lodes said. "But nothing can replace the government."