CHARLOTTE, N.C. -- Despite all the efforts in Congress to repeal the health law this summer and fall, the Affordable Care Act is still the law of the land. People can start signing up for health insurance for 2018 starting Nov. 1. But the landscape for that law has changed a lot.
Take navigators. Those are specially trained people who help consumers sign up for coverage. The federal government cut navigator funding by 41 percent. But that's not an across-the-board cut. Some groups and states are dealing with far deeper cuts, while others will have dollars close to what they had last year.
South Carolina and North Carolina are cases in point. South Carolina's navigator funding is about two-thirds less than the state had last year, while most of North Carolina's funding is intact.
The Trump administration has said that it is rewarding groups that did a good job and cutting off those that didn't. But the strategy may have the effect of hobbling navigators who have the most daunting job signing up people.
"We are between the rock and the hard place," said Shelli Quenga, who runs programs at the nonprofit Palmetto Project, South Carolina's largest navigator group. "We know that people in rural areas don't have as much internet access. The people who need help are probably in the rural areas, but we can't afford (to send navigators there)."
Instead, Quenga said, she will have to be strategic about where she plans to place navigators.
"It is based on those areas that are a) more densely populated and b) had a higher level of ACA enrollment for 2017," she explained.
That means about two-thirds of the state's counties will not have any navigators. Quenga said she is still planning to help people in those areas by using screen-sharing technology to walk people through sign-ups. People can always call the federal call center for help, but that's not ideal, she said.
Quenga said her employees really take the time to work through complicated cases. For example, she said, "lots of people have family members sleeping on their couch. Do you count that person as a tax dependent or not?"
The answer is complicated. How much someone gets financial aid is based on his or her taxable income, which changes with the number of dependents, she said. "Choosing whether to include that person as a dependent can have big consequences in terms of your financial assistance," she said. "The call center is not set up to run those scenarios for you."