Enrollment for Affordable Care Act plans opened in November, giving people who don’t get insurance through an employer a chance to sign up for coverage for next year.
This year’s enrollment comes as enhanced federal tax subsidies — expanded during the pandemic — are set to expire for the first time since 2021. A recent analysis estimates that without those subsidies, average annual premiums for subsidized enrollees could more than double, rising 114% from $888 in 2025 to $1,904 in 2026.
At the same time, funding for health insurance navigators — the trained workers who guide people through the enrollment process — has been repeatedly reduced.
Earlier this year, the Trump administration cut navigator funding by 90%, dropping federal support for states on the federal marketplace from $100 million to $10 million. During Trump’s first term, the program was cut by 84%. The Biden administration later restored about $40 million through the Inflation Reduction Act.
As consumers face rising premiums, the shortage of navigators is already being felt in Missouri.
Treva Warrick, a navigator administrator with SeniorAge Area Agency on Aging in southwest Missouri, said her organization is seeing more calls this year because several health groups have stopped participating in the navigator program due to low funding.
“We’re getting more calls than we have in the past, especially from areas where navigators are not available anymore,” Warrick said. “We’re still putting in the same amount of time — we’re just not getting compensated through the navigator grant for the amount of time that we are putting in.”
Warrick said her agency is operating this enrollment season without any full-time navigator staff, leaving little capacity for outreach or educational events. At least one Missouri organization has exited the program entirely, she said.
The Centers for Medicare & Medicaid Services has defended the cuts, arguing the program has not delivered enough value. The agency noted that in 2024, only about 1% of ACA enrollees signed up through navigators and said the reduction would save an estimated $360 million over four years.
But experts say focusing only on enrollment numbers misses the broader role navigators play. They help consumers compare plans, check eligibility for subsidies, enroll in Medicaid and understand documents that private insurance agents often don’t handle.
“Historically, navigators have been a very important public outreach tool for people who are systemically marginalized,” said David Anderson, an assistant professor of health services policy and management at the University of South Carolina. “If navigators aren’t there to reach populations that are both hard to reach and not profitable for insurers or brokers, those groups may simply be overlooked by profit-driven entities.”
A 2022 study by researchers at the University of Wisconsin found that previous navigator cuts did not significantly reduce overall marketplace enrollment. But they did lead to notable declines among certain groups — including lower-income adults, adults under 45, Hispanic adults and people who speak a language other than English at home.
As ACA enrollment continues through mid-January, navigator groups warn that shrinking staff and rising consumer needs could leave more people without the help they need — and potentially without coverage.
