Enrollment assisters an essential piece of ACA’s success, survey shows

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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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We already knew that nearly a million New Yorkers had enrolled through NY State of Health during the first open enrollment period from October 1 to March 31. But now we know more than ever about who they were, where they live, and how they enrolled. That’s thanks to the new enrollment report released yesterday by NY State of Health, the official health plan marketplace, which includes eagerly awaited demographics data such as age, race and ethnicity of enrollees.

HCFANY issued a press release, highlighting key findings from the data, such as the importance of in-person assistors in helping New Yorkers obtain health insurance. Nearly 50% of insurance applications were completed with help of in-person assistors, including Navigators, Certified Application Counselors, and brokers. In-person assistance was particularly critical for low-income New Yorkers: more than half (59%) of the Medicaid enrollees used in-person assistance to complete their application.

For the first time, the report offers a glimpse into the race and ethnicity, as well as preferred language, of New York enrollees. Though the data is incomplete – about one in four enrollees chose not to respond to the application on race – it nonetheless will help direct future outreach and enrollment efforts across the state. About 37% of enrollees who answered the question reported their race as Black/African American, Asian/Pacific Islander, or “other” non-white race. About 20% of Medicaid enrollees chose a language other than English, but no enrollees reported their preferred language as Korean, Russian, or French Creole, pointing to potential gaps in these communities. As useful as this data is, it only provides a statewide picture – there is still a need for race, ethnicity and preferred language by county in order to target outreach to the communities that need it most.

Financial assistance was key to the high enrollment numbers in Qualified Health Plans (private health insurance). Nearly 3/4 of enrollees got private health plans with financial assistance in the form of Advanced Premium Tax Credits (APTC) or a combination of both APTC and cost-sharing reductions. An average New Yorker who was eligible for financial assistance saved $215 per month in premium.

And, while some enrollees (about 13%) clearly benefited from the Medicaid expansion that made them newly eligible for public insurance, a whopping 93% of Medicaid enrollees were newly insured overall. That means many of those who enrolled in Medicaid were previously eligible but, for whatever reason, had been unable to enroll. New York clearly did something right in building it’s health insurance marketplace – the single, streamlined web application our State officials built is working. And, boy, did New Yorkers come.

 

Final Numbers for first open enrollment period

Yesterday, HHS announced that over eight million Americans enrolled in health insurance between October 1, 2013 and March 31, 2014. That’s over a million more than the original goal for that period (seven million) and over two million more than the revised goal. As recently as the middle of March, some media outlets predicted that enrollments would fall short of this goal. But, enrollments surged during the last month of open enrollment, with the administration reporting that nearly 3.8 million people selected a Marketplace plan in the final month.

Note, too, that both the federal government and New York’s own Marketplace, NY State of Health, issued a 15-day extension period for those who ran into barriers completing their applications during this time. So, the final count of “open enrollment” sign-ups will be even higher. In New York alone, nearly 100,000 people enrolled between April 1 and April 15.

We’re looking forward to the next report of detailed demographics data from NY State of Health, something like the December Enrollment Report they released in early January. In the meantime, the HHS report gives us a taste:

  • New York ranks 4th in the nation in terms of sheer number of Marketplace enrollments, with 370,451 enrollments in private Qualified Health Plans (QHPs). We’re behind only California, Florida, and Texas.
  • Just over half of enrollees were women.
  • About 1/3 of enrollees were young adults between 18 and 34.
  • Over half of enrollees selected a Silver-level plan and over 80% selected a Silver plan or above. 
  • Nearly 3 out of 4 enrollees received financial assistance (e.g. tax credits).
  • States also reported the difference between March 2014 enrollment and Pre-ACA Average Medicaid and CHIP (children’s health insurance) enrollment (July-September 2013). In New York, about 343,835 additional New Yorkers enrolled in Medicaid or our Child Health Plus program during the first open enrollment period.

The federal report also includes enrollment by race/ethnicity for the federal marketplace. We don’t have this data for New York…yet. Hopefully, the next NY State of Health enrollment report will include it.

 

 

Much of the ACA enrollment outreach to young adult “invincibles” has been on the lighter side. Take, for example, the recent Valentine’s Day campaign around national youth enrollment day that featured various celebrities making quips about love and insurance (see the ad featuring Amy Poehler in our February post).  And, months back, we highlighted Colorado’s GotInsurance campaign, which markets health insurance to young adults using “bros,” yoga, and roller derby.

President Obama’s latest education effort has taken an especially comedic turn. The President was a guest on Zach Galifianakis’ Funny or Die web series, “Between Two Ferns,” which is known for its parody of low-budget interview shows and hilariously awkwardly interviews. The video has already gone viral and is trending on twitter. Besides being good for a laugh, the interview turns out to be a decent platform for marketing healthcare.gov and the new insurance options under the ACA, particularly to young adults. Earlier this afternoon, White House Senior Communications Advisor Tara McGuinness tweeted that FunnyorDie.com was the #1 source of referrals to healthcare.gov.

Whether because of the targeted outreach efforts or simply the increased affordability of insurance in the state and federal marketplaces, the rates of uninsured young adults are falling along with those of older adults. According to a recent Gallop poll, the uninsured rate for adults aged 26-34 – likely the primary audience for “Between Two Ferns” - dropped 1.6% points between the end of last year and the first two months of this year. The drop in uninsured was smaller – 0.5% – among 18-25 year-olds, but this group experienced a much more dramatic dip in its uninsurance rate a few years ago. The uninsured rate for these young adults dropped by over 4% in early 2011, when they became eligible to stay on a parent’s insurance plan until age 26. Still, the rates of uninsured young adults remain significantly higher than older populations. Targeted outreach is likely to pick up during these last few weeks of open enrollment.

In the meantime, we have President Obama going out on a limb to pitch the merits of health insurance – of which there are many! – with an unexpected partner in Galifianakis. President Obama’s plug starts at about the halfway point, and one of the best interchanges is at 4:15:

Pres. Obama: “The point is, a lot of young people, they think they’re invincible.”

Galifianakis: “Did you say invisible, because…”

Pres. Obama: “No, no – not invisible. Invincible. Meaning that they don’t think they can get hurt.”

Galifianakis: “I’m just saying that nobody could be invisible…if you had said invisible.”

 

Good point.