The Washington Post

The Trump Administration Removed A Training Guide For Latino Outreach From An ACA Website

The Washington Post — December 10, 2018

By Paulina Firozi
The Washington Post / The Health 202

Just over a month before this year's open enrollment period began for 2019 Obamacare plans, the Trump administration removed an online resource intended to help members of the Latino community enroll for health coverage.

The Centers for Medicare and Medicaid Services removed a presentation called "Marketplace Outreach: Best Practices for Outreach to Latino Communities" from one of its Web pages sometime in late September, according to a report released last week from the Sunlight Foundation, a nonpartisan government watchdog group. The presentation, an 18-slide PDF file, was intended to provide training for groups like navigators — a group formed under the obama administration to promote health-plan selection — on better engaging with Latino communities and on challenges the community faces in enrollment.

Critics are pointing to this latest move as another in the list of actions the Trump administration has taken to undermine the Affordable Care Act and to weaken the Latino and immigrant communities' access to public programs like health care.

A CMS spokesman told me the removal was part of routine "updates and maintenance of CMS.gov, which sometimes includes the revision and removal of content that is not current or underutilized."

"This ongoing process is managed and implemented by agency career staff and is not influenced or directed by political leadership," the spokesman said. "In this instance, the slide presentation contained outdated information and the page was archived in September of this year."

Jodi Ray, who oversees a navigator program as director of Florida Covering Kids & Families at the University of South Florida, said resources like the one removed are critical to her group's efforts.

"If you pull credible resources, make it less accessible, it does make our job more difficult," Ray told me.

"Being that Florida is so demographically and geographically diverse, we use those resources in a way to make sure we aren't using a one-size-fits all approach," she said. "You have to know your community, the population, the culture of who you're trying to reach. If we're not providing the resources to be able to do that effectively, we're going to lose that population that needs this more than anyone."

Here is one page of the 18-slide presentation that was taken down: (Internet Archive's Wayback Machine screenshot via Sunlight Foundation's Web Integrity Project)

To that point, data from the Kaiser Family Foundation in January notes members of the Latino community face challenges in health-care access and coverage and are at a much higher risk of being uninsured compared to white Americans.

Ray also lamented the change as yet another move to reduce resources after the administration already slashed federal spending on advertising and outreach to promote the ACA, including dramatically reducing funds for navigator grants.

The removal of a training guide on the CMS website also preceded an open enrollment period for 2019 Obamacare plans that has so far seen lagging numbers.

In The Health 202 on Friday, I wrote that experts have pointed to a lack of awareness about enrollment and reduced marketing efforts as some of the biggest factors contributing to the slow sign-up rates thus far. But Ray noted we won't know until after this year's open enrollment if any of the administration's actions really had an impact on a particular population.

Steven T. Lopez, associate director of the Health Policy Project at UnidosUS, a leading Latino civil rights organization, called the removal of the CMS guidance part of a "consistent effort to undermine the law for our community in particular and to make coverage out of reach for so many."

"This type of resource conducted in a culturally relevant and linguistically appropriate way has proven effective in enrolling the Latino community and other underserved communities," Lopez said in an interview. He said it was important to "build upon gains" that have resulted for the Latino population following the implementation of the ACA, "not reverse them."

Rachel Bergman, director of the Sunlight Foundation's Web Integrity Project and author of the report, called the removal a "piece of the puzzle of limited marketing, limited outreach under this administration."

Bergman also challenged CMS's explanation that the material was out of date. She said one bullet point on the presentation referring to the ACA's individual mandate, which was repealed as part of the GOP tax overhaul last year, was the only thing that stood out to her as "out of date."

In response to a question about whether the agency planned to update outdated content on its site, a spokesman told me: "CMS will continue to review and update website information as necessary to ensure all Americans have the resources to select a health plan that best fits their individual needs."

The Sunlight report also pointed out that around the same time the change was made, the Trump administration announced a proposal to change the "public charge" rule, which could make it harder for legal immigrants to gain citizenship if they have used public welfare programs.

My colleague Colby Itkowitz reported in The Health 202 earlier this year the "mere suggestion of the expanded policy has already had a 'real chilling effect' on immigrants using health-care services."

In an interview about open enrollment in New Jersey last week, Raymond Castro, director of health policy at progressive group New Jersey Policy Perspective, told me there was concern about whether the public charge proposal could impact enrollment. He said the proposal "does not include subsidies in the ACA exchange, but a lot of people don't know that."

Maura Collinsgru, health-care program director for New Jersey Citizen Action, a longtime ACA advocate, said the administration's actions "go to promoting an agenda this administration seems to have to discourage inclusion, the full inclusion of Latinos and immigrants in all aspects of our economy and our communities."

She added, "to target health care within some of those changes I think is an egregious act."

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