Oba­macare con­sumers re­lied heav­ily on en­roll­ment helpers to sign up for cov­er­age

Modern Healthcare - - NEWS - By Paul Demko

More than 28,000 out­reach work­ers helped about 10.6 mil­lion Amer­i­cans learn about health in­sur­ance op­tions dur­ing the 2014 Oba­macare open en­roll­ment pe­riod, ac­cord­ing to an anal­y­sis by the Kaiser Fam­ily Foun­da­tion. Each worker as­sisted an aver­age of nearly 400 in­di­vid­u­als.

“I was per­son­ally struck by the ex­tent of the con­sumer as­sis­tance in­fra­struc­ture that’s been built,” said Karen Pol­litz, a se­nior fel­low at the Kaiser Fam­ily Foun­da­tion and an au­thor of the re­port. “I thought that was im­pres­sive.”

There was a sig­nif­i­cant dis­par­ity, how­ever, in out­reach ef­forts in states run­ning their own ex­change ver­sus those that re­lied on the federal ex­change. In the 16 states and the District of Columbia that de­cided to op­er­ate their own ex­changes, 325 people re­ceived as­sis­tance for ev­ery 1,000 unin­sured in­di­vid­u­als. In con­trast, only 162 in­di­vid­u­als per 1,000 unin­sured people re­ceived as­sis­tance in the 29 states that re­lied on the federal mar­ket­place. The re­main­ing five states, which part­nered with the feds, fell in the mid­dle: 276 in­di­vid­u­als re­ceived as­sis­tance per 1,000 unin­sured.

The dif­fer­ences largely re­flect that there were more nav­i­ga­tors and other en­roll­ment as­sis­ters on the ground in states run­ning their own ex­changes, which re­ceived much more federal fund­ing for as­sis­tance pro­grams.

States with their own mar­ket­places had 8.7 as­sis­ters per 10,000 unin­sured—or nearly dou­ble the num­ber of work­ers in­volved in out­reach ef­forts in states that re­lied on the federal ex­change, ac­cord­ing to the Kaiser study.

More than 80% of the out­reach pro­grams Kaiser sur­veyed re­ported that most con­sumers who sought help did not un­der­stand the health- care re­form law or were con­fused by the choices avail­able.

In ad­di­tion, nearly three-quar­ters of in­di­vid­u­als who re­quested as­sis­tance strug­gled to un­der­stand ba­sic in­sur­ance con­cepts such as de­ductibles or provider net­works.

Sixty-four per­cent of the as­sis­tance pro­grams said they spent an aver­age of one to two hours with each con­sumer.

Of the 4,400 as­sis­ter pro­grams, 70% were sup­ported ei­ther by fed­er­ally qual­i­fied com­mu­nity health cen­ters or pri­vate fund­ing.

Nearly 90% of out­reach pro­grams re­ported that most of their clients were pre­vi­ously unin­sured. In ad­di­tion, nine out of 10 as­sis­ter pro­grams in­di­cated that they had al­ready seen clients re­turn­ing to dis­cuss fur­ther ques­tions or prob­lems with their new in­sur­ance cov­er­age, such as not re­ceiv­ing in­sur­ance cards.

Sixty-four per­cent of the as­sis­tance pro­grams said they spent an aver­age of one to two hours with each con­sumer.

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