Kaiser report: Support structure for enrollment in insurance exchanges is surprisingly strong

A recent report from the Kaiser Family Foundation details the many efforts to enroll people into health plans offered through state and federal health insurance marketplaces, offering a snapshot of a few successes and remaining challenges in fully implementing the ACA. It’s interesting to get a sense of the more mechanical implementation of healthcare reform […]

A recent report from the Kaiser Family Foundation details the many efforts to enroll people into health plans offered through state and federal health insurance marketplaces, offering a snapshot of a few successes and remaining challenges in fully implementing the ACA.

It’s interesting to get a sense of the more mechanical implementation of healthcare reform over the polarizing, unrelenting politics of the ACA, on full display this week.

Not surprisingly, given the intense political nature of states rights and the ACA, successes varied depending on if a state set up its own exchange or instead deferred to the feds. This could be further strained after Tuesday’s split court rulings on whether citizens of states that did not set up an exchange are eligible for federal subsidies.

“Assistance resources were not evenly distributed across states,” the report said. “In states with state-based marketplaces and consumer assistance partnership marketplaces, there were about twice as many assisters available per 10,000 uninsured, compared to states with a federally-facilitated marketplace.”

Accordingly, the number of people helped per 1,000 uninsured was also greater in state and partnerships, and state-run exchanges helped about twice as many uninsured compared to the federal marketplaces.

Interestingly, while all marketplaces were required to support consumer assistance with operating revenue, most assistance programs were funded by outside sources. In the first year, more than 70 percent of such programs were supported privately or covered by a federal safety net clinic program.

“Certified application counselors programs, which generally receive no marketplace funding, and programs sponsored by federal health centers funded by grants from the Health Resources and Services Administration together account for 71 percent of all assister programs and account for more than 60 percent of people who received help,” the report said.

Naturally, there were challenges in helping consumers who were not familiar with navigating the health insurance system – 64 percent of all assisting programs reported spending between one and two hours helping each consumer, on average, the report said. Website glitches didn’t help, either.

But the sheer volume of assisting organizations can perhaps be a sign of encouragement. Karen Pollitz, a senior fellow at the Kaiser Family Foundation, told the New York Times she was surprised by the amount, saying “The size of this infrastructure was something I wouldn’t have predicted when we began.”

With enrollment season just around the corner, that may bode well for states and organizations hoping to enroll all who are eligible, maybe even suggesting the battle is being won, or at least fought, as much on the ground as it is in the courts. That such mobilization occurred in the frenetic first-year run-up is not irrelevant, given how closely the country has been watching.

Assister programs that worked collaboratively reported positive results, though more than half of them “seldom or never coordinated with other programs,” according to the report.

All told, more than 4,400 assister programs, employing more than 28,000 full-time staff and volunteers, helped sign up about 10.6 million people for health plans throughout the first open enrollment period.

The types of assisting programs, and what sort of organization sponsored them, vary themselves, falling into the following categories:

  • Certified application counselors
  • Federally qualified health centers
  • In-person assisters
  • Navigators
  • Federal enrollment assistance program

Certified application counselors represented the bulk of such programs, at 45 percent, followed by FQHCs and in-person assisters each at 26 percent. Navigators and the federal program accounted for 2 percent and 1 percent, respectively.

Looking ahead to the next enrollment season, three-quarters of assister programs said they are “very likely” to continue providing marketplace assistance, and they will likely play a key role going into 2015. Indeed, if successful, it could create a whole new profession of assisters who “understand consumer needs and how ACA rules and coverage options apply to them,” the report notes.

It continues:

“The Congressional Budget Office has projected that 13 million people could enroll in marketplace health plans in 2015, 5 million more than signed up during the first open enrollment period. Increasing enrollment will first require maintaining coverage for current enrollees.”

Yet while things are perhaps looking up for exchange enrollment (depending on who you ask), it won’t be easy:

“Close to 40 percent of programs, though, said they could not help all who sought assistance, with 12 percent saying demand far outpaced capacity. During the final weeks of open enrollment almost half of assister programs had to turn away at least some consumers.”