Who got covered…and why?

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Guest post by Jessie Kavanagh, Master’s Student in Public Health, Hunter College

 

 

 

 

People with more knowledge about the ACA and health insurance were more likely to enroll in the Marketplaces, according to a new Enroll America survey.  The July 2014 report, “Voices from the Newly Enrolled and Still Uninsured,” produced by Enroll America and PerryUndem Research/Communications, offers insights into why Americans decided whether or not to enroll through the newly created Marketplaces during the first open enrollment period. In particular, a large knowledge gap between insured and uninsured adults points to the need for more outreach and education on our health care system and ACA provisions.

The researchers surveyed adults across the US aged 18-64, and the report analyses are based on two sample groups: 671 enrolled adults and 853 uninsured adults.

Below are highlights of the survey findings:

Uninsured individuals need more information about financial assistance.

  • Only 26% of uninsured people knew that financial assistance/subsidies were available through the Marketplace.
  • Over half of the uninsured respondents assumed that insurance was too expensive and therefore decided against enrolling.
  • 1 in 3 uninsured people began the enrollment process, but did not end up enrolling for various reasons such as concerns about cost.

Uninsured Americans need more information about ACA provisions and the healthcare system in general.

  •  Almost half of uninsured adults don’t understand the term “premium.”
  • Only a quarter of the uninsured knew that preventive care is now free under the ACA.

More outreach and education is needed to reach Latinos and young adults in particular.

  •  20% of Latinos said the Marketplace was too confusing as compared to only 9% of whites.
  • Latinos and young adults were the most likely of the uninsured to not know about the open enrollment deadline and individual mandate.
  • More than half of young adult respondents did not know they might be able to stay on their parent’s insurance until they turned 26.

Nearly half of uninsured respondents said they would “definitely,” or “probably” enroll next year if they are still uninsured. However, 42% were unsure. This shows how important it is to create more and better ways to reach and educate uninsured populations to ensure that no one goes without care.

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Guest post: Jessie Kavanagh, Health Policy Intern at Community Service Society of New York

Last week, a 3-judge panel of the U.S. Court of Appeals for the District of Columbia ruled 2-1 that states using the federally-facilitated marketplace (healthcare.gov) cannot offer government subsidies to their residents. The same day, a 4th U.S. Circuit Court of Appeals in Virginia unanimously came to the opposite conclusion– that the states using the federal marketplace should be able to offer subsidies.

What to make of this conflict? Regardless of the disagreement, the bottom line for New Yorkers is simple: the decisions have no immediate impact on New Yorkers’ eligibility for the ACA tax credits and subsidies.

The main issue in these cases concerns the language in the ACA regarding the subsidies. The language states that subsidies are only available “through an exchange [aka marketplace] established by the state.” The U.S. Court of Appeals for the DC Circuit argued that this language means subsidies should be available only to people who enroll through a state-based marketplace. However, the 4th Circuit Court said that the law was ambiguous, and that the IRS was entitled to its interpretation that the federal marketplace acts as a state’s marketplace, and therefore all states can offer subsidies to their residents.

Ultimately, the ACA was written with the intent to make insurance more affordable for all Americans. And, it seems to be working. In New York, 3 out of 4 enrollees in commercial Qualified Health Plans during open enrollment- or 274,247 New Yorkers – were eligible for tax credits that made insurance more affordable.

 

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Navigator Leon McIntosh helps New Yorker Anna enroll

We all know finding the right health insurance plan can be complicated and overwhelming – even with the launch of the insurance marketplaces offering one-stop shopping under the ACA. One of the most exciting features of the ACA is the establishment of assister programs to help people enroll (e.g. Navigators and Certified Application Counselors). A new survey from Kaiser Family Foundation shows just how effective these groups were during the first open enrollment period.

According to the survey, administered to directors of assister programs around the country:

28,000 assisters helped 10.6 million people apply for coverage and financial assistance.

States with State-based Marketplaces, like New York, had a much higher ratio of assisters to uninsured and helped two times as many people relative to the uninsured population when compared to states with a Federally-facilitated Marketplace. Our own NY State of Health‘s recent enrollment report shows that 643 Navigators and nearly 4,000 Certified Application Counselors helped over 413,000 New Yorkers enroll in coverage. That’s nearly half of enrollees.

Most consumers who sought help applying for coverage were uninsured and had limited health insurance literacy.

The vast majority of programs reported that consumers seeking help had a limited understanding of the ACA and struggled with basic health insurance terms, like “deductible.” As a result, assistance took time – between one to two hours in most cases.

Nearly all assister programs have been “re-contacted” by consumers with post-enrollment problems, including questions about how coverage works.

Questions from consumers don’t stop at enrollment. However, assister programs are not trained on post-enrollment issues, and in many cases don’t have funding that allows them to provide this type of assistance. Instead, the ACA established Consumer Assistance Programs (CAPs) to provide these services, but these programs haven’t received federal funding since 2012. Luckily, New York legislators recently approved $2.5 million in the 2014-2015 budget for the State’s CAP, Community Health Advocates (CHA). Thanks to the funding, CHA will be able to provide more robust hotline and in-person services through community-based organizations in the coming months.

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Guest post:
Bob Cohen, Policy Director, Citizen Action of New York/Public Policy and Education Fund;
Theo Oshiro, Deputy Director, Make the Road New York

New York took a big leap forward in enrolling nearly a million New Yorkers in health coverage during the first open enrollment period under the ACA that ended in March, but we still have a lot to do to ensure that all New Yorkers, including traditionally excluded communities, fully benefit from the federal law. This is the simple message of a new “white paper” released in June by two HCFANY partners, the Public Policy and Education Fund and Make the Road New York, in conjunction with the Alliance for a Just Society, a national network for research, policy and organizing.

The report, Addressing Health Disparities Through the Marketplace: An Action Agenda for New York State of Health,” applauds NY State of Health for a number of steps it has already taken, like easing enrollment in emergency Medicaid. The white paper establishes a broad agenda with 11 recommendations for further actions by NYSOH and the Legislature. For example, the report recommends a greater focus on outreach aimed at reaching diverse communities through steps like stronger targeting of ethnic media and reexamining current restrictions on navigators on contacting New Yorkers in their homes. It suggests that public numerical targets be set for enrollment of groups like immigrants and people of color, that NYSOH move forward aggressively with translating its website into languages other than English, stronger enforcement of requirements that health plans develop clear strategies to address health disparities, and the establishment of  a stakeholder task force focused on the reduction of disparities.