The Whys, Whats, and Hows of Convincing Specific Populations To Enroll in Exchanges

In California, recent data on Affordable Care Act exchange enrollment showed that the state is ahead of its enrollment goals. As of Feb. 15, about 829,000 California residents had enrolled in health coverage through Covered California. The state had projected signing up about 500,000 to 700,000 individuals in private coverage by March 31.

However, enrollment has been slow among Latinos, who, according to some estimates, make up more than half of the state’s uninsured population. As a result, the exchange plans to add about 4,000 Spanish-speaking enrollment counselors and insurance agents, as well as promote in-person enrollment efforts. Covered California also will spend about $8.2 million on Spanish-language advertisements for the exchange, according to Covered California Executive Director Peter Lee.

Most recently, some counties in the state have introduced specific initiatives to reach the Latino population. For example, the Monterey County Department of Social Services and county Health Department are working in conjunction with agencies in Santa Cruz and San Benito counties to enroll Latino consumers in health coverage through the exchange. The campaign will focus on face-to-face enrollment efforts at different locations, such as community forums, farmers markets, public libraries and schools.

Population-Specific Efforts Around the Nation

California is not the only place where population-specific enrollment outreach is taking place.

  • In Minnesota, MNsure officials have launched a series of videos featuring prominent members of the state’s minority communities discussing the importance of health coverage.
  • In Missouri, where 172,000 Latinos might be eligible for coverage through the ACA, HHS has partnered with local Latino groups, churches, schools and other organizations to encourage enrollment in the exchanges.
  • In Texas, where Latinos make up two-thirds of the six million uninsured state residents, advocates are relying on promotoras, or health counselors who provide information about coverage options to Spanish-speaking communities.

On the national front, White House senior adviser Valerie Jarrett last week announced a “final coordinated push” to enroll African-Americans in coverage through the exchanges. According to Jarrett, African-Americans have a “disproportionately low rate of coverage”; about 6.8 million of them are uninsured. She added that enrolling African-Americans in the exchanges is the administration’s “top priority.”

Why Enrollment Advocates are Targeting Specific Populations

According to HHS Secretary Kathleen Sebelius, “Objective A” of the ACA is to “extend affordable coverage to the uninsured.” In theory, it would seem as if enrollment advocates would simply target the 47 million or so U.S. residents who are uninsured. However, in practice, it’s not as simple as that.  

Proponents of the ACA also note that for the exchanges to be successful — i.e., for coverage in the exchanges to remain affordable — the mix of enrollees needs to be right, and that means there needs to be a certain percentage of young adults.

Meanwhile, targeting minority populations for exchange enrollment is simply a numbers game. Data show that minority populations make up huge swaths of the uninsured in the U.S. For example, according to the Kaiser Family Foundation, about one-third of Hispanics and more than one-fifth of African-Americans are uninsured, compared with 13% of non-Hispanic whites. California provides an even starker example: More than half of the state’s uninsured population is Latino.

In addition, Latinos typically pose a lower financial risk because they typically are younger and healthier than other uninsured residents, which means enrolling Latinos helps foster the right balance for the exchanges.

Specific Populations, Unique Challenges

Reaching out to specific populations has presented its fair share of challenges already, enrollment advocates say. One of the biggest challenges has been a lack of education.

Sinsi Hernández-Cancio, the health equity director at Families USA, noted that many Latinos “might need someone to explain insurance because they’ve never had coverage before.”

Linda Leu — the California Research and Policy Director for Young Invincibles, which works to enroll young adults in the exchanges — agrees. She said her group has spent a lot of time working to educate young adults, many of whom just assume they can’t afford coverage.

“We’ve seen a large awareness gap,” Leu said, noting that many young adults don’t know that they qualify for Medicaid or subsidies to help them purchase coverage through the exchanges.

Hernández-Cancio said there also have been more traditional obstacles to getting Latinos to enroll, such as language barriers, concerns about their own or a family members’ immigration status and “simply not enough navigators” to help.

Further, Hernández-Cancio said another challenge — at least in reaching out to Latinos — is not knowing whether their efforts are fruitful. While the federal government’s data break down enrollment by age and gender, there hasn’t been any official breakdown of minority enrollment yet. “What we know is anecdotal,” Hernández-Cancio said.

Non-Traditional Success

The enrollment advocates who spoke to California Healthline said the efforts that they felt were most successful could be considered non-traditional.

For example, Hernández-Cancio noted that her organization has helped educate potential enrollees through “enrollment summits,” which are taking place all over the country. Hernández-Cancio says the success can be attributed to the fact that the summits are well-advertised in the community, and because “there are a lot of computers and a lot of navigators.” She also says it helps to get people in one place and add the educational component.

Leu said her group has a number of non-traditional outreach efforts, such as partnering with a local radio station for a music festival or sponsoring comedy shows, at which volunteers dispersed information about exchange enrollment.

However, Leu said that for her group, the most successful efforts have been the “on-the-ground outreach in communities,” such as peer-outreach counselors, who speak to young adults one-on-one at college campuses and similar venues.

March 31 Is Not the End

Enrollment advocates were emphatic that just because the open enrollment period ends on March 31 doesn’t mean people can’t still enroll in coverage.

For one thing, enrollment in Medicaid is year-round, so low-income residents in states that have expanded Medicaid have more opportunity to get coverage. Hernández-Cancio said her group will work hard to encourage other states to expand their Medicaid programs.

Leu noted that young adults likely will have other opportunities beyond the first open-enrollment period to enroll in coverage. Leu said, “Young adults are at the prime age for life events” that qualify them to enroll in exchange coverage outside of typical open enrollment, such as marriages, college graduation or moving to another state.

Meanwhile, Hernández-Cancio noted that enrollment advocates’ work doesn’t end when the open-enrollment period ends. She said that her group and others will need to keep educating people about the benefits of health coverage and how to use the insurance they signed up for, as well as look at ways to improve the enrollment process and ensure there are enough navigators.

And enrollment advocates are already eyeing Nov. 15, 2014, when the next open-enrollment period begins.

Around the nation

Here’s a quick review at what else is making news on the road to reform.

So much for that “horror story”: The Washington Post‘s “The Plum Line” examines how some stories about the negative effects of the ACA “fall apart under scrutiny.” Meanwhile, Mother Jones‘ Kevin Drum examines whether any of the stories about ACA woes are true.

The Arkansas situation: Although Arkansas’ alternative Medicaid expansion was seen as a model for other states, continued funding for the plan is at risk. The Atlantic looks at what that means for other states.

The Obamacare insurer: CNBC examines Oscar Insurance, a health insurer that could be confused with a “tech start-up” and might be a new breed of company designed for the “age of Obamacare.” 

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