Healthcare advocates are preparing for the challenge of enrolling New Jersey residents who remain uninsured after the first year of the Affordable Care Act’s expansion of health coverage.
The next open enrollment period for the marketplace is scheduled to begin on November 15 and will last until February 15 — roughly half as long as the first open enrollment. The first open enrollment and the deadline to sign up for insurance in 2014 were extended into April after the marketplace got off to a rough start due to problems with its website, healthcare.gov.
The organizations that have taken on the task of enrolling residents say that in many ways the next round of enrollments will be more difficult, since the remaining uninsured population is more skeptical or less informed about options.
But enrollment organizers also point out that the federal government has worked out the kinks and simplified the process of using the marketplace website. They also feel that the past year has yielded insights about enrollment efforts, drawing on data to reach target populations, and neighborhoods with higher rates of uninsured people.
While a recent Urban Institute survey estimated that roughly 520,000 state residents became insured during the past open enrollment period, most of those signed up through the Medicaid expansion included in the ACA and agreed to by Gov. Chris Christie.
The ACA used two primary methods to increase coverage: 1) the marketplace, which allows individuals and small businesses to purchase coverage, with most individuals eligible for tax credits to subsidize their insurance, and 2) the expansion of Medicaid eligibility.
The different success rates for each method over the first year reflect the challenges ahead for those helping residents enroll through the marketplace.
The 343,000-person expansion in Medicaid enrollment this year is nearly three quarters of the 466,000-person expansion-eligible population estimate by the Kaiser Family Foundation. But the 161,775 residents who enrolled through the marketplace are equal to just over one quarter of the estimated 628,000 eligible.
Maura Collinsgru, health policy advocate for New Jersey Citizen Action, said the message to the remaining uninsured is: “Get ready. Get informed. Get enrolled.”
Collinsgru said the community and healthcare organizations trying to enroll residents would be drawing on ZIP-code-level census data to identify pockets of residents in need of coverage. When combined with information about race and ethnicity, advocates have identified some targeted community outreach efforts that were successful, such as a high enrollment rate among Korean-American residents in Bergen County.
“It really helps us target the resources we have to where they’re really needed,” she said.
Collinsgru was one of several representatives of nonprofits, as well as the federal and local governments, to participate in an event marking the 30th day before the second open-enrollment period. New Jersey for Health Care, a coalition of different organizations that aim to increase enrollment, organized the event on the steps of the Statehouse in Trenton.
U.S. Department of Health and Human Services Regional Director Jackie Cornell-Bechelli noted that women make up 53 percent of New Jerseyans who’ve enrolled through the marketplace and have played a key role in signing up entire families.
“Women are really the conduit for educating the family,” she said.
She also noted that 84 percent of New Jersey residents who enrolled through the marketplace were eligible for tax-credit subsidies. The subsidies are available to those between 100 percent and 400 percent of the poverty line, currently amounting to between $23,850 and $95,400.
“One of the things that we’re trying to drive home with people every single day is not only all of the benefits” of the ACA’s added protections, Cornell-Bechelli said, “but that this is also affordable.”
Princeton Mayor Liz Lempert said her community was planning to several events to assist with enrollment.
“Having access to quality, affordable healthcare is a quality-of-life issue for every single resident in every community in this state,” she said.
Deborah Fennelly, senior staff attorney with the Community Health Law Project, said her organization is working with low-income and disabled residents to help them understand their options, including going over insurance terminology, like premiums and deductibles.
Collinsgru added that many categories of residents who remain uninsured present challenges to those who want to increase enrollment. They include residents who had a bad experience trying to enroll through the first open enrollment period; Spanish-speaking residents; and 26-year-olds who recently lost their eligibility for coverage by their parents. The ACA raised the age that adults can be insured under the parents’ plans to their 26th birthday.
“Every year, we’re going to have that pool of ‘young invincibles’ who we’re going to have to convince,” Collinsgru said, using a term to describe healthy young people who don’t believe they would benefit from insurance.
Cornell-Bechelli noted that 32 percent of marketplace enrollees were under 35, which disproved speculation that the demographics of the newly insured would skew older and sicker. If too many residents in an insured population are ill, average costs and premiums become unsustainably high.
“The data here in New Jersey and around the country is proving that to be false,” she said.
Collinsgru added that it should be easier to apply through the marketplace this year, since the federal government has streamlined the site and the agencies assisting residents have more experience with the process.
All Americans are mandated to have insurance under the ACA or pay a fine each year. While the current fine is the greater amount of $95 or 1 percent of household income, it will increase to the greater of $325 or 2 percent of income next year before reaching the greater of $695 or 2.5 percent of income in 2016.
Cornell-Bechelli said that the next step for the newly insured is understanding what that coverage means for them, such as their access to preventive services and the benefits of having a primary-care doctor, adding that these residents can become champions for adding others to the insurance rolls.