It’s been difficult to get uninsured North Jersey residents to sign up for health coverage over the past year – a fact confirmed by the nation’s top health official.
U.S. Secretary of Health and Human Services Sylvia M. Burwell recently identified the region as one of five top target areas for outreach during the third open enrollment period for individual and family insurance under the Affordable Care Act. Enrollment will run from November 1 to January 31, 2016.
Northern New Jersey was included along with four cities at the heart of some of the nation’s largest metropolitan areas: Chicago, Dallas, Houston, and Miami.
“Our research tells us, they’re going to be harder to reach,” Burwell said of the demographics of uninsured residents who are concentrated in these five target areas.
She added that the remaining uninsured tend to be younger, have lower incomes, and are disproportionately members of minority groups.
Burwell’s comments confirm something that local enrollment-assistance groups have long suspected – their efforts have been slowed by the area’s unique characteristics, including its population density and large immigrant population, as well as the relative lack of federal outreach funding.
Federal officials have not said whether the fact that northern New Jersey is a target for outreach will mean that additional federal dollars will now flow to the area. Even if there isn’t more government money forthcoming, Burwell’s comments could serve as a call to action for the many nonprofit organizations that seeking to enroll residents, as well as to the foundations that have supported their efforts financially.
“We know current marketplace customers are satisfied with their coverage, and we expect most to continue with it,” Burwell said during a recent speech at Howard University’s medical school. “We also believe we can continue to connect people with the coverage they need and further decrease the number of Americans without health insurance.”
Federal officials said the five areas targeted for outreach were chosen because they home to the largest number of uninsured people who are eligible for marketplace coverage.
Recent census figures show that the three New Jersey counties with the largest share of residents who are uninsured are Hudson, with 18.2 percent; Essex, with 15.4 percent; and Union, with 14.4 percent.
[related]The federally operated marketplace allows people to buy health insurance, and to learn whether they’re eligible for tax credits to subsidize their premiums. The credits are available to those with incomes up to four times the federal poverty line, which currently amounts to $97,000 for a family of four.
Gov. Chris Christie opted for the federally operated marketplace instead of a state-based exchange. The ACA provided more startup and outreach money for state exchanges than it did for the federal marketplace. However, state exchanges have had their own problems, including major issues launching and operating.
Rutgers Center for State Health Policy Director Joel Cantor noted that all five of the federal outreach areas have large Latino populations.
“Historically, dating way back before the ACA, the share of Latinos who are eligible but do not enroll (in government-supported health coverage) tends to be really high,” Cantor said.
Cantor said that compared to other densely populated regions – and even to some other parts of New Jersey – North Jersey hasn’t received as much federal attention.
“When you look at where the federal government has put resources to navigators and other outreach activities, it has not had very thorough coverage of northern New Jersey,” Cantor said.
Burwell said this year’s enrollment efforts will be “tougher,” since the remaining uninsured will be harder to reach. Both Burwell and New Jersey-based enrollment experts say that people need to understand exactly how they could benefit from having insurance.
HHS officials noted that about half of people without insurance have less than $100 in savings, so they can ill afford unexpected medical bills. In addition, nearly three in five uninsured people either don’t know that the ACA coverage and subsidies are available or are confused about how they work.
Crystal McDonald, director of organizing for Faith in New Jersey, said the federal attention will be welcome. Her faith-based advocacy group has been preparing for its third open enrollment outreach effort.
“As we’ve done outreach across the state – and specifically in northern New Jersey – there are a lot of people who are hard to reach, who don’t know that this new opportunity for low-cost and potentially free health insurance is available,” McDonald said.
Faith in New Jersey works with congregations in Essex County (as well as Middlesex and Camden counties) to inform their members about the insurance marketplace.
“In immigrant and low-income communities of color … there needs to be some really trusted people in the community who can share information and walk them through the application process – and then how to use the insurance once they get enrolled,” she said.
McDonald added that some immigrant families have members who are eligible for insurance and others who aren’t, based on their immigration status – and that faith leaders are well-positioned to gain the trust needed to divulge this information.
McDonald said groups doing outreach may have more success this year because they can point to examples of people who’ve benefited from getting insurance coverage. In addition, she said, some people need to hear about their insurance options more than one time before they’re willing to commit. Finally, she noted, the penalty for not having insurance will increase in 2016, reaching the greater of $695 or 2.5 percent of household income.
“This is definitely information that we share when we’re reaching out so that people are not surprised when they’re doing taxes,” McDonald said.
Maura Collinsgru, the healthcare program director for New Jersey Citizen Action, said that while she believes North Jersey warrants federal attention, she is “a little surprised” that it actually received HHS’s attention.
New Jersey for Health Care, a coalition organized by Citizen Action, will concentrate its outreach effort on the most populated northern counties. Collinsgru noted that the number of residents eligible for insurance subsidies in those counties is “significant.”