Why don’t more uninsured enroll in health care?

Despite Arizona’s strong economic growth, we rank among the worst states for the number of adults and children with health insurance.

The statistics don’t demonstrate the adverse effects of going without health coverage. Uninsured people are more likely to forgo necessary medical services, are at higher risk for preventable hospitalizations, less likely to receive follow-up care and experience significantly higher mortality rates than the insured.

But it’s not just the individuals without insurance who are affected. Many of them end up in the ER for concerns that could be addressed by a family doctor, draining valuable resources from hospitals already overwhelmed by staff shortages and supply chain problems.

Everyone’s care suffers as a result and these costs ultimately get passed to others through higher premiums and higher taxes.

To help resolve some of these issues, Congress passed the Affordable Care Act in 2010, which created Health Exchanges like the one used by Arizonans at healthcare.gov.

The ACA was designed to expand access to affordable coverage for people who qualify, including those without coverage from an employer. It also extended subsidies or premium discounts to many Americans and expanded Medicaid eligibility in some states. Over the past decade, these efforts have reduced the number of uninsured Americans by 50%.

While 155,000 individuals signed up for coverage through the exchange this year, there are still approximately 800,000 uninsured Arizonans. So why don’t more Arizonans enroll?

We can start to answer this question by thinking about who is most at risk to be uninsured. Many traditionally underserved groups have high uninsured rates, including Hispanic, Black and low-income individuals. This is noteworthy since over 60% of uninsured Arizonans are Hispanic. This population is less likely than others to receive coverage via an employer, despite being in the workforce at higher rates than non-Hispanic individuals.

Fear, misinformation, language barriers and confusion about immigration status also prevent many eligible legal immigrants from enrolling in coverage.

Yet regardless of income, race or ethnicity, too many Arizonans wrongly assume that they won’t be able to afford coverage, too few coverage options exist or think the exchange is complicated and confusing to use. We need to correct these misperceptions, increase affordability and restore trust via consumer education and support.

The private sector has a significant role to play. The more insurers participate in the Affordable Care Act, the more consumers enjoy greater choice and competitive pricing.

Because of this, Banner|Aetna made the decision to join the exchange this year, becoming 1 of 8 carriers in Arizona in 2022, a significant increase from years prior. In addition to better competitive pricing, having more insurers also means that there are more resources dedicated to awareness building and enrollment support — areas of emphasis for us as well.

The federal government has also stepped up in consumer support, providing an additional $80 million, including $2.3 million in Arizona, to fund Navigators through the American Rescue Plan Act.

Navigators are experts who can answer coverage and subsidy questions and assist consumers with plan enrollment. Most importantly, they are completely independent from insurers. Many of the Navigators are bilingual, particularly in Spanish. (Visit CoverAZ.org to learn more.)

The government has also expanded subsidies, or premium discounts. As a result, Arizonans who purchased ACA coverage in 2021 saved an average of 39% on monthly premiums and out-ofpocket costs.

In fact, approximately 40% of uninsured Arizonans now qualify for no-cost or lower-cost coverage.

Plus, many do not realize that financial help may be available to lower their out-of-pocket costs (for things like copays and deductibles) in lower-income households, another significant factor in health care affordability.

Misperceptions extend to the uninsured, as well. These individuals are often hard-working people at small businesses or part-time workers. They are the teacher’s aide at a local preschool, the florist running her own business and the graphic designer managing gig work.

They are also among the thousands of construction workers meeting Arizona’s burgeoning needs as the country’s third fastest-growing state. These are our friends and neighbors, which is why all Arizonans have a vested interest in spreading the word about these changes that are making health coverage more affordable.

Tom Grote

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