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.
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.
Guest post from Maryanne Tomazic, Raising Women’s Voices
The national survey of 3,105 women took place in late 2013, before the end of the first open enrollment period of the new health insurance marketplaces. It showed that low income women and women of color experience high rates of being uninsured. While many women have enrolled in plans via the marketplaces (NY State of Health enrolled 189,888 women into qualified health plans as of the end of April!), others still cannot afford the cost of the qualified health plans. Still others live in states that, unlike NY, have not expanded Medicaid.
The survey also showed that cost is often a barrier to accessing health care services. Most women reported delaying or forgoing care because of cost: Two thirds of uninsured women, 35% of women with Medicaid, and 16% of women with private insurance. Other barriers to healthcare included being unable to take time off of work, not being able to get child care, and lack of transportation.
These survey results show that even though the Affordable Care Act has expanded and continues to expand coverage options and make insurance more affordable, steps are still needed to make sure women are able to get and use the care they need.
For the full report, click here.
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.