Health Insurance Marketplace Assister Programs ‘Impressive'
By Christine Kern, contributing writer
A Kaiser study examines the role and effectiveness of ACA Assister Programs.
More than 4,400 Assister Programs, employing more than 28,000 full-time-equivalent staff and volunteers, helped an estimated 10.6 million people during the first ACA Open Enrollment period, according to an analysis conducted by the Kaiser Family Foundation. That means each worker assisted an average of nearly 400 individuals in learning about insurance coverage.
“I was personally struck, and a little bit surprised, at 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, according to Modern Healthcare. “I thought that was impressive.”
The report did find a significant disparity, however, among outreach efforts between states that opted to run their own insurance marketplaces and those that defaulted to the federal exchange. In states with State-based Marketplaces (SBM) and Consumer Assistance Partnership Marketplaces (FPM), there were about twice as many Assisters available per 10,000 uninsured, compared to states with a Federally-facilitated Marketplace (FFM).
The number of people helped per 1,000 uninsured was also greater in State and Partnership Marketplaces. SBMs helped about twice as many people relative to the uninsured population compared to FFMs, while FPMs helped about 1.5 times as many relative to the uninsured population. Some people who were helped enrolled in new QHPs, and some in Medicaid and CHIP. Others who sought help didn’t enroll in coverage, for example, if they were ineligible for both Medicaid and premium tax credits.
In the 16 states and the District of Columbia that operated their own exchanges, 325 people received assistance for every 1,000 uninsured individuals. By contrast, only 162 individuals per 1,000 uninsured received assistance in the 29 states that relied on the federal marketplace.
The remaining five states, which partnered with the federal government in running their exchanges, fell in the middle: 276 individuals received assistance per 1,000 uninsured.
More than 80 percent of the outreach programs surveyed by Kaiser reported that most consumers who sought help didn’t understand the Patient Protection and Affordable Care Act or were confused by the coverage choices available to them. In addition, they reported that almost 75 percent of those who requested assistance have problems comprehending basic insurance concepts such as deductibles or provider networks.
The report demonstrated that most outreach clients – nearly 90 percent – were previously uninsured. In addition, nine out of 10 assister programs indicated that they had already seen clients return to discuss questions or problems with their new insurance coverage. Those issues included not receiving insurance cards or having claims denied.
Perhaps not surprisingly, the study also found that 64 percent of Assister Programs reported spending between one and two hours helping each consumer, on average. Explaining rules and options to people with limited understanding of the ACA and health insurance took time. So did waits on hold with Marketplace call centers and frozen computer screens. Programs also report that often consumer questions about health plans couldn’t be easily answered by information posted on Marketplace web sites.
“The folks that signed up this year mostly aren’t working nine-to-five jobs at a steady salary,” Pollitz said. “They have a lot of volatility in their lives.”
The Internet survey was conducted from April 24 through May 12, shortly after the first open enrollment period concluded. A total of 4,445 outreach programs were invited to participate in the study; 843 programs responded.