Local Officials Anticipate Challenges in Expanding Coverage Under the ACA

Officials behind previous local and state efforts to enroll uninsured individuals in health coverage say that such individuals often are reluctant to purchase coverage and that outreach efforts take longer than expected, which could foreshadow similar struggles for the health insurance exchanges under the Affordable Care Act, Kaiser Health News/Washington Post reports.

Examples of Previous Coverage Efforts

In 2006, Palm Beach County, Fla., launched a program -- called Vita Health -- that offered subsidized coverage for low-income residents who could not afford private insurance but were ineligible for Medicaid.

Although enrollees could purchase health plans for $52 per month -- well below the cost of private coverage -- the program signed up fewer than 500 people, about one-third less than was anticipated.

A similar effort to provide low-cost coverage for small employers in Florida -- called JaxCare -- also experienced low enrollment.

ACA Provisions

Unlike local and state programs, the new health insurance marketplaces under the ACA will have several advantages, including that they are available to anyone needing coverage and will offer subsidies to individuals with annual incomes below 400% of the federal poverty level.

In addition, the ACA requires U.S. residents to have insurance coverage, imposing an initial penalty of $95 or 1% of income in 2014 and $395 or 2% of income in 2015.

Officials' Concerns

However, officials involved in past efforts warn that the penalties might not be enough to overcome the challenge of convincing young, healthy adults to enroll in the exchanges, which is necessary to hold down premiums.

Paul Gionfriddo -- a consultant who previously led an alliance for the uninsured in Florida -- said, "A lot of people who are uninsured and can afford it don't buy it because they aren't sick."

Further, experts note that outreach often takes longer than expected, warning that such efforts need to occur through trusted individuals in the community, rather than just television and radio advertising.

Additional Complications

Complicating the Obama administration's and states' efforts to enroll individuals in the exchanges is the fact that few U.S. residents understand the ACA's provisions and requirements, including that they might be eligible for insurance subsidies, according to several polls.

Meanwhile, the administration -- which is running or helping to run exchanges in 33 states -- has yet to release details on its marketing campaign, according to KHN/Post (Galewitz, Kaiser Health News/Washington Post, 3/30).