Consumer Group Provides Top Ten List For Increasing Coverage In Future Enrollment Periods

Now that the Patient Protection and Affordable Care Act’s (ACA) first open enrollment period has ended, many are weighing in on how to improve the process. One group, the national consumer organization Families USA, has released ten recommendations for strengthening outreach and enrollment efforts to increase health coverage in future enrollment periods.

The organization urged the Department of Health and Human Services (HHS) and state health insurance marketplaces to move quickly to implement these changes well before the next enrollment period, which starts on November 15.

The ten recommendations include increasing funding and resources for enrollment navigators and assisters; aligning enrollment periods with tax-filing seasons; streamlining Medicaid enrollment for people participating in other means-tested programs; and building a larger, better-coordinated, public-private sector education campaign around the availability of tax credit subsidies.

“Our recommendations build on the laudatory success of the first enrollment period,” said Ron Pollack, Families USA’s executive director. “If they are acted on well before the start of the next enrollment period, the momentum from that success will be sustained and significantly strengthened.”

Legislation not required. Collectively, the ten recommendations would significantly improve future enrollment efforts, do not require the enactment of new legislation, and can be implemented by HHS and/or state marketplaces, according to Families USA. Seven of the recommendations affect the enrollment process itself, while three improve coverage affordability—the key factor when people decide whether to enroll in health insurance.

The ten proposals in the Families USA report include the following:

1. Increase the number of, and resources for, enrollment navigators and assisters. Surveys show high demand for help during the enrollment process. The report criticized the uneven distribution of navigator resources, with combined funding this year for 34 states in federally managed marketplaces equal to $67 million, while California alone had funding of $40 million.

2. Build a substantial, sustained public education campaign coordinated between the public and private sectors about the availability of tax credit subsidies that make insurance premiums affordable. The report cited survey research showing that seven in ten uninsured adults (69 percent) do not know about this financial assistance, a problem that is especially acute in communities of color.

3. Coordinate ACA enrollment with the tax-filing season. This would enable professional tax preparers to play a much larger role in enrollment efforts, and it would help people understand the tax consequences if they do not enroll in health insurance.

4. Streamline Medicaid enrollment for people participating in other means-tested programs. Since people who participate in programs like SNAP (the Supplemental Nutrition Assistance Program, formerly food stamps) have already submitted income and other data to government agencies, their applications should be “fast tracked.” Arkansas, California, Illinois, Oregon, and West Virginia have successfully used this strategy to increase Medicaid enrollment.

5. Provide applications that can be completed in multiple languages, not just English and Spanish. Making the application available in additional languages would help people complete it independently, thus reducing the burden on call center staff and in-person enrollment assisters.

6. Strengthen coordination among the marketplaces and Medicaid to prevent applications from being lost or unduly delayed. HHS should ensure that Medicaid eligibility assessments are transferred to state agencies within 24 hours, and state agencies should process these applications quickly. Individuals applying through marketplaces should be notified when their application is transferred and informed about how to check its status.

7. Fix the roadblocks that prevent people from completing their applications. This includes establishing alternative avenues for verifying identity when a consumer creates an account with, requiring employers to provide an employer coverage tool to all employees who have an offer of health insurance so they have the information needed to complete their applications, and providing clear mechanisms for resolving enrollment problems.

8. Ban health plans from continuing to impose premium surcharges that make insurance unaffordable for people who use tobacco. Although insurers can no longer charge higher premiums based on health status or gender, in most states, they can still charge people up to 50 percent more for insurance if they use tobacco. Some states have banned this practice or lowered the surcharge that is permitted.

9. Ensure that marketplaces offer low-deductible silver plans. HHS should develop models of low-deductible plans and/or plans that include routine care for people before they meet the deductible, especially for bronze and silver plans. HHS should encourage states to make such plans more widely available.

10. Exclude health plans that set unacceptably high premiums. Since keeping premiums affordable is crucial to improving enrollment, HHS and state marketplaces should exclude plans with unreasonable premiums.

“These recommendations can make a huge difference in reaching the tens of millions of Americans who are still uninsured. Since this is a key goal of the ACA, we hope that the improvements we suggest are implemented quickly and effectively,” said Rachel Klein, Families USA’s enrollment program director.

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