Rachel Grob says a review of available data suggests Affordable Care Act (ACA) marketplace assisters successfully helped enroll millions of consumers in health care plans in the first two open-enrollment periods, and play a vital role by supporting consumers seeking coverage under the ACA.
Grob collaborated with Mark Schlesinger, a professor at the Yale University School of Public Health, to assess variation and innovation in assistance programs designed to help consumers make health insurance choices under the ACA. They analyzed reports and articles that evaluated various aspects of open enrollment in 2013-2014 and 2014-2015, as well as quantitative data gathered from 843 programs by the Kaiser Family Foundation Survey of Health Insurance Marketplace Assister Programs. The study was published this week in Health Affairs.
By 2014-2015, 16.8 million people had enrolled into a health insurance plans through state-based marketplaces. To facilitate this large volume of enrollees, up to 4,700 programs employed more than 20,000 full-time-equivalent staff and volunteers to assist people during the two open-enrollment periods. Grob said consumers who received in-person assistance were more than twice as likely to successfully enroll compared to those who tried to enroll online without any assistance. She said several factors accounted for the success of the marketplace assister model.
“Assister programs play a vital role in supporting consumers particularly when assisters maintain ongoing relationships with consumers,” said Grob. “Our synthesis of the evidence from the first two years of open enrollment also highlights that assister programs are successful when assisters come from, and are situated from within, communities that they serve; when local programs are well coordinated; and when post enrollment issues can be addressed.” In brief, according to Grob, “evidence from the field suggests that enrolling cannot be separated from educating and engaging—and that assisters are positioned to do this work.”
The data showed that typical new clients helped by assisters needed two to four hours of help. Fifty-seven percent of assister programs reported that at least half of their clients required more than one session. In addition, marketplace assisters found themselves heavily involved in post-enrollment work because many consumers did not understand coverage provisions.
After the first enrollment period, 39 percent of assister programs said they needed additional training to learn how to better select among insurance plans. That dropped to 29 percent in the second year of open enrollment but remained a significant issue.
The study suggests that marketplace assisters face some tough challenges ahead.
Seventy-two percent of those newly-eligible for coverage hadn’t enrolled after the first enrollment period and 64 percent after the second. Grob says many of these consumers don’t have a full understanding of the ACA, which means substantial outreach and education will be needed to reach and enroll them.
“Assisters have a complicated and important job to do,” said Grob. “If assister programs are to be treated as a lasting instead of a transitional part of health reform, investment in and development of the assister workforce will be important.”
Grob said the use of multi-year grants instead of one-year grants would stabilize employment of marketplace assisters and help build the programmatic context necessary for this important work. An alternate option would be to earmark a guaranteed portion of marketplace revenues to fund assistance programs. Practice norms, team building, collaboration and continuing education are also important for giving assisters and assister programs support and stability as they continue to help consumers get and use insurance coverage.