« May 2018 Issue

12 Million Enrollees: Significant Barriers Required Creative Approaches to Health Coverage Enrollment

Leading up to the fifth open enrollment period (OE5) for the Affordable Care Act (ACA) marketplace, the mood among the enrollment community was grim, at best. Due to the Trump administration’s significant rollback in funding for advertising and consumer assistance, a condensed enrollment period, and ongoing ACA repeal efforts, public opinion polls previewed a dire situation. The 34 states on the federal marketplace were at the center of the crisis, since they had less flexibility and resources to manage the fallout than states like California, Colorado and Massachusetts that manage their own state-based marketplaces.

While there was wall-to-wall media coverage of the politically driven attacks on Americans’ health care in the months prior to open enrollment, little of that attention focused on open enrollment. In the months leading up to OE5, only 1 in 3 people surveyed knew open enrollment began on November 1, 2017. Another 1 in 3 thought the Congress had already repealed the ACA in its entirety. Yet, nearly 12 million Americans enrolled in an ACA marketplace plan in 2017, down only 3 percent from last year, in half the time!

“It was a challenging year for us, but we more than made it through,” said Dara Taylor, director of consumer assistance at Community Catalyst. “Thankfully, the enrollment community was prepared in light of the repeated ACA sabotage efforts orchestrated by members of Congress and the Trump administration.”

Limited public knowledge about the availability of coverage required new and innovative approaches to open enrollment this past year. In addition to targeting consumers in states with the highest rates of the uninsured, Community Catalyst’s Outreach, Enrollment and Education team prioritized sharing materials designed to attract more young adults, immigrants, people of color and LGBTQ individuals to shop on the health insurance marketplace.

With generous support from the Robert Wood Johnson Foundation, and in partnership with federal, state and community-level organizations, Community Catalyst and its partners created a broad suite of consumer-facing enrollment materials to educate health care consumers around the nation.

"Community Catalyst made this year's open enrollment much easier than it could have been, given the shortened timeframe and consumer confusion,” said Katie Keith, steering committee member with Out2Enroll, an enrollment organization for the LGBTQ community. “At Out2Enroll, we were able to leverage all the great materials from Community Catalyst in a way that helped us spend much more time focusing on reaching uninsured LGBTQ people and supporting our partners."

The funding from RWJF enabled Community Catalyst to create materials in Chinese, Korean, Marshallese, Tongan, Vietnamese and Spanish, helping to reach communities overlooked in previous years. With Community Catalyst’s ongoing commitment to health equity, it was a priority to ramp up outreach to underserved communities, especially as the Trump administration pares back efforts aimed at reducing health disparities.

This strategy required a multi-pronged approach that incorporated In the Loop, a collaboration between Community Catalyst and the National Health Law Program (NHeLP) that provides an online platform for nearly 5,000 members of the enrollment community and the Expanding Coverage project, a Missouri-based program to boost the number of insured people in the state. Digital partnerships to boost social media efforts through Twitter chats and theme weeks, as well as in-person trainings and calls, complemented these efforts.

Unfortunately, despite the relative success of the recent enrollment period, ACA sabotage attempts continue to take their toll. A recent Kaiser Family Foundation poll found that 58 percent of ACA marketplace enrollees said they were “very” or “somewhat worried” that there will be no insurers selling plans in their area next year, and over 80 percent worry that premiums will make the cost of insurance unattainable for them or their families.

Regardless of these difficult circumstances, Community Catalyst’s Outreach, Education and Enrollment team is optimistic that the lessons it took away from last year offer a roadmap for combatting the confusion and chaos the Trump administration has sown. Organizations large and small discovered new ways to reach consumers in late 2017 and early 2018, building on the partnerships they developed in previous years. Additionally, with advertising and in-person assistance scaled back, the enrollment community placed more emphasis on online and digital advertising, creating compelling content that could be shared through social media. OE5 also reinforced that success in enrolling millions of people in health coverage requires meeting them where they are – developing materials in the languages people speak in their homes, expanding partnerships into underserved communities, and pushing back against pessimistic or inaccurate narratives in the media.

“This year showed us the power of collective action around a shared mission, especially amid a difficult environment,” added Taylor. “We will have our work cut out for us ahead of next year’s enrollment period, which is just six months away. Continued attacks on health care compel us to be even more creative and strategic, but I’m confident we can do it together.”

Stephen Eisele, Communications Manager