Enrollment is Closed (Sort of); Now What?
First, congratulate yourselves and each other
After a horrific start in much of the country, with not only the federal marketplace but also many states as well failing to perform, the first ACA open enrollment period finished on a strong note. Enrollment surpassed the Congressional Budget Office’s (CBO) original estimate of 7 million in state and federal marketplaces. Millions more have been covered by Medicaid, in plans sold outside the marketplaces and perhaps, although we don’t have the data yet, in new take-up of employer-sponsored insurance.
While the “tech surge” that brought Healthcare.gov back from the brink got a lot of ink, the robust enrollment results could never have been achieved without the herculean efforts of all kinds of assisters, both paid and volunteer, who spread the word and helped people navigate the often balky enrollment process. They are the unsung health care heroes of the hour.
Then take a deep breath…
It will take some time to sort out just how many people have gained coverage as of March 31. And even when we learn the enrollment numbers through March, that will not be a final number, and I don’t mean just because of the extension granted to those who started the process but were unable to complete it by March 31. Although Marketplace open enrollment is over except for those who are already in line, the enrollment process itself never really comes to an end.
…And get back to work
Enrollment (like a diamond) is forever. This is especially true for the lowest income households because Medicaid enrollment is continuously open year round. In addition, many people who have changes in life circumstances will still be able to enroll in the marketplaces. Graduating high school and college students probably represent the biggest wave of people with qualifying life changes, and efforts to help them enroll need to ramp up in just a few short weeks.
Beyond the need to keep up the enrollment efforts, there is still a lot of room to improve the enrollment process so that year two open enrollment, only half as long as year one, can be even more successful. Ensuring adequate funding for assisters of various kinds should be at the top of the to-do list, but it is not just a money issue. Improvements are still needed in the website and the call center, and it will be important to do a better job next time of distributing assistance resources. For example, a recent survey by Enroll America found that African Americans and Latinos were 43 percent more likely than whites to rely on in-person assistance to help with enrollment. If we want to make sure that the ACA fulfills its potential to reduce racial and ethnic health disparities, we have to make sure that there is adequate assistance in communities that need it most.
The battle for hearts and minds continues
I’m sure now that President Obama has declared that the debate over the ACA is over, all of the critics among the politicians and punditry will find something else to do with their time. Unfortunately, the truth is that while the facts on the ground have grown ever more favorable, there has been no let-up in the anti-ACA rhetoric, nor will there be in the near future. Although the ACA is not a candidate for any office and will not appear on any ballot, it will be attacked mercilessly (and largely speciously) throughout the election season.
In order to set the stage for a second successful enrollment period, supporters need to push back against the exaggerations and outright falsehoods that will fly even more thickly during campaigns than they have up until now and just keep lifting up the benefits of the law by putting a human face on it. Fortunately, thanks to the hard work of so many who engaged in the work of helping people enroll—simple in concept but difficult in practice—those benefits should be clearer than ever.