It's your last week to sign up for health insurance via the Affordable Care Act, and nonprofit organizations are intensifying their efforts to get people signed up.

Earlier this year, President Trump's administration cut the program's marketing budget by 90 percent and reduced the open enrollment period from 12 weeks down to six. (Enrollment kicked off November 1 and ends December 15.)

Organizations known as "navigators," which receive federal grant money, have been helping people sign up for health care since ACA insurance marketplaces opened in 2013. Though many of these grants have also been cut, United Way of Metro Chicago continues to assist people with the process. Ahead of the deadline, we spoke with United Ways' Inna Rubin, manager of health access initiatives, to discuss the challenges of getting people insured during a tumultuous period for health care policy.

The current administration has been outspoken about its opposition to the Affordable Care Act. Has that made your job more difficult?

Primarily, there's been a lot of confusion. People are coming to our navigators, asking whether they still have insurance. They want to know whether the ACA still exists. We've seen many people who don't know when the deadline is, let alone knowing that they need to re-enroll. 

Despite this confusion, it’s been reported that there was an initial spike in enrollment. Why do you think that is?

We see news reports about the number of enrollments compared to last year, but you can't really make that comparison; we only have six weeks this year, versus the 12 weeks from last year. At this time last year we were at the midway point of the enrollment period. As of December 2, we're at an estimated 120,000 people enrolled in Illinois and we have until the December 15 deadline. Last year, when we had seven days to go, we had over 350,000 people enrolled.

Why was the enrollment period cut down from the 90-day enrollment period of previous years to 45 days this year?

It was a rule change proposed by the Centers for Medicare & Medicaid Services (CMS) earlier this year. They proposed it, and opened it up to public comment; United Way was one of the thousands of organizations that submitted a comment opposing the rule change, outlining that the change would be harmful. Then a few months later, the CMS moved forward with the final rule changes. 

How has that affected navigators who are trying to enroll people in the program?

It's been hard, honestly. It's been stressful for them and all of us. What people often don't know is, clients with coverage return to those same navigators every year. Plans and networks change every year. Your doctor may have been in your plan this year, but that doesn't mean the plan will be available next year. So people still need help year in, year out. Navigators serve as a point of contact in their community, and they are a necessary resource. All the people they helped in 90 days, they have to help in 45 days.

Navigator grants have also been cut.

At United Way of Metro Chicago, our navigator funding wasn’t affected, but we know a lot of organizations who have lost that funding. There's still the same amount of people who need help, but fewer people to help them. We've seen roughly a 25 percent reduction in the enrollment assistance workforce, and that's just in the Chicago area. Statewide it's much worse, especially in downstate Illinois where they received the biggest funding cut. 

How do organizations like United Way work around not having the same level of support as in previous years?

We have done everything we can to make sure every person in every community has access to health coverage because that's what it takes to build a strong community. We are making every effort on social media, with our donor networks, and with our partner agencies in our communities, to get the word out about the deadline. We also had a press event with Senator Dick Durbin and several representatives from the state before open enrollment began. 

The cuts to navigator grants, the lack of marketing, and not having the 90-day enrollment period has created the perfect storm of confusion and uncertainty. We know tens of thousands of people are going to lose their health coverage, and health care services next year. But we are doing everything we can to get the word out.