TAMMYE NASH | Managing Editor
Nash@DallasVoice.com
Since it took effect in 2013, more than 38 million people have gotten health care coverage under the coverage provisions of President Obama’s Affordable Health Care Act. That has cut the country’s uninsured rate from 14.5 percent to about 8 percent.
By last year, some 44 million people were enrolled in health coverage through the ACA’s Marketplace and its Medicaid expansion.
That has been due, in no small part, to the work of ACA navigators — individuals and organizations who have been trained and are certified to provide consumers with free, unbiased assistance in understanding health insurance options, in completing eligibility forms and enrolling in coverage. Under the 2022 federal grants to provide ACA navigators, some 59 navigator organizations received nearly $100 million, funding that could support adding to over 1,500 existing Navigators.
In the 2025 Plan Year — the 2024 grants — some $100 million in grant money funded 44 navigator organizations. In Texas, those navigators have been especially important since Texas’ GOP leadership has chosen to opt out of Medicaid expansion, leaving many low-income residents of the state to fall into a coverage gap — they don’t qualify for Medicaid and don’t make enough money to pay for insurance in the marketplace.
But thanks to the Trump administrations hostility toward the Affordable Care Act and his ongoing efforts to dismantle it, the $100 million in ACA navigator grants is being cut some 90 percent to just $10 million nationwide. Trump’s administration claims the cuts are being made because the program is inefficient and costly; his critics say the cuts are a politically motivated strategy, growing from Trump’s animosity toward Obama and his successes, that will drastically impact individuals’ ability to get health insurance coverage.
In the Dallas/Fort Worth Metroplex, Prism Health North Texas has used ACA grant dollars to fund a team of eight full-time ACA navigators, led by Ismael Cruz. That team contributed to the more than 4 million people who enrolled in ACA coverage last year, according to Prism Health press release. “Without Medicaid expansion in Texas, the ACA has been a safety net for thousands of people we serve,” the press release noted.
But come Monday, Sept. 1, that safety net will be shredded; the Prism Health team will drop from eight full-time navigators to just two part-time workers. The loss will be drastic, and the impact will be felt quickly, Prism Health officials say.
The ACA navigators at Prism Health didn’t just help individuals find their way around the ACA Marketplace and access coverage, Cruz said. The Prism Health navigator team members also focused on public education and outreach.
The Prism Health team helped consumers determine their eligibility for Medicaid. They helped folks faced with changing incomes adjust their coverage as needed. They helped those not eligible for the ACA Marketplace, and they helped with billing questions and complaints.
“All of these activities — these are services we won’t be able to provide” starting Sept. 1, Cruz said. “With the current administration cutting gender-affirming health care services, it’s made these [ACA navigator funding cuts] even more dangerous. With fewer navigators available, it’s going to be harder for transgender people and everyone else to find the care they need.”
In a Prism Health press release, Cruz said, “New patients that are unfamiliar with the system will have nowhere to turn for trusted, personalized guidance. People will miss enrollment deadlines, and they will ultimately lose access to the care that they need.
“When the ACA grant goes away, the confusion crisis will be dire.”
But, he stressed, Prism Health will still work to make sure every person gets the health care they need.
“The North Texas community is going to be facing some drastic cuts, but we are here to support our patients,” Cruz said. “One of the main concerns right now is that people need the education we provided. We will be referring patients to financial navigators for that.”
Prism Health will also be focusing on its efforts through its Financial Navigation services, led by Phil Matthews, a program already in place to help make sure patients understand payment options before they arrive for care. They do that by verifying insurance, checking eligibility for the agency’s sliding fee scale or Ryan White funding and connecting patients to programs that help cover medication costs, birth control and women’s health.
That program, Cruz said, will help fill in the gaps left in the wake of the ACA navigators losses. Both he and Matthews pledged to do everything possible to help consumers get the help they need.
“While the loss of funding will present real challenges, we are doing everything we can to minimize the disruption in care,” Cruz said. “We remain committed to ensuring that no patient is left behind during this transition.”
PHNTX will “keep providing care through a sliding fee scale, working with community groups to help patients get medical care, housing and food, and guiding them to programs that can make a real difference in their lives,” the press release said.
“We are not turning people away,” Cruz insisted. “No one should avoid health care because they are worried about costs. We will help people, and people can continue to call the ACA program here” at 214-910-5065. ■
Prism Health North Texas is also accepting donations through a link on its website, PHNTx.org, to help fund programs.