Healthcare.gov collects user fees from insurers. Insurers in states that delegate all authority to the federal market place pay 3.5% of premium to Healthcare.gov. Insurers in states that use Healthcare.gov as a front-end but perform significant backend functions pay 3.0% of premium to Healthcare.gov in 2019 and they paid 2% of premium in 2018.
Healthcare.gov is supposed to use these fees to fund operations. It pays for the server racks. It pays for the Help Desk. It pays for file loads. It pays for advertising. It pays for outreach. The fees are designed to make the system work well.
However over the past two years, advertising has been slashed. Navigator funding is a figment of the imagination now. Open Enrollment is half the time it used to be. On-Exchange enrollment has barely moved down since 2017 even as average premiums have increased significantly due to the termination of Cost Sharing Reduction (CSR) payments which is then looped into silver premiums and general medical trend. The total premium going through Healthcare.gov has increased significantly without a concurrent increase in opeational expenses or outreach.
So where is that money going?
House Democrats want to find out:
House Dems want to know what the Trump administration is doing with all its https://t.co/dhlLq11UsV user fees, now that it’s not using them for outreach and enrollment assistance. https://t.co/RycvAc9ruC
— Margot Sanger-Katz (@sangerkatz) January 10, 2019
We know that more revenue should be hitting the federal accounts for Healthcare.gov user fees. We know that outreach expenses have been slashed. So where is the money that is not being visibly spent compared to 2017? Is it just sitting in an account? Or did someone get a no bid PR contract to talk down the ACA? Where is the moola?