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State Marketplaces Step Up Pursuit of Uninsured Groups

By Marissa Evans, CQ Roll Call

November 9, 2015 -- The folks who run the health insurance marketplace, or exchange, in Massachusetts are using tax records to identify state residents who could benefit from, but haven't yet signed up for, coverage under the federal health care law.

In California, exchange officials are touring the state in a bus to sign up uncovered Californians. 

As the 2010 federal health care law's  third open enrollment season got underway this month, many of the states that have established health insurance exchanges under the law say they are trying new approaches to sign up members of hard to reach populations such as minority groups and non-English speaking communities. 

Reaching those populations is no small challenge; a Kaiser Family Foundation study released in October found there are still 15.7 million uninsured people in the U.S. who could qualify for financial assistance with premiums if they applied.

Trish Riley, executive director for the National Academy of State Health Policy, said that state exchanges—established in 16 states and the District of Columbia—are in a refining period with revamping outreach beyond fliers and word of mouth. 

"They have to balance the day to day operation of the exchange and the benefits of their outreach and community work," Riley said.  

Tax Credits

During the first two open enrollment periods, the number of Minnesotans receiving tax credits to help them offset the costs of health insurance premiums, as well as the value of tax credits they received, were lower than national average.

This year, with premiums for some policies expected to jump by as much as 49 percent, MNsure, the Minnesota health insurance exchange website, will include more information to make consumers more aware of the credits, said Shane Delaney, the exchange's director of communications and marketing. 

"We're trying to tell consumers, 'yes these premium increases are out there but there's this solution called MNsure that you can use,'" Delaney said. "The discussions about the tax credits are going to be a driver to our site."

Besides letting users know financial help is available, MNsure is also adding tools to help consumers pre-shop for insurance, including a widget that will rank plans best-suited for them based on information they provide such as how often they go to the doctor, their age, and where they live.

Covered California, while long lauded as a model state exchange for its high enrollment numbers and outreach strategies, is also hunkering down for the open enrollment period. Aside from a statewide bus tour to help residents sign-up for insurance, exchange officials are also focused on spotlighting the subsidies available. 

It's about making sure they see what the bottom line is without having to do the math, according to Covered California spokesman James Scullary.

"Many California residents are still not aware of all the elements," of the health care law, Scullary said. "One of them is the subsidies available."

Louis Gutierrez, executive director at Massachusetts Health Connector, said that the exchange is focused on the remaining uninsured population. 

Prior to the federal health law, Massachusetts had its own statewide insurance mandate for residents, pushing its insured population rate up to 96 percent. Gutierrez said the goal now is to focus outreach in underrepresented communities. Using tax filing information, the Massachusetts Department of Revenue mailed Connector information to roughly 120,000 uninsured residents. 

More Hours

On top of that, the Connector is adding an additional 200 call center hours to help consumers sign up for insurance. Officials also added four new walk-in centers, as well as an ombudsman to help with user complaints. The site also added a plan comparison tool and a provider search function.

Gutierrez said what struck him most during focus group sessions was the disbelief people had when realizing they could afford health insurance. 

"There's a prevailing assumption [among consumers] 'well of course this has to be too expensive,'" Gutierrez said. "But when you put existing examples in front of them and they see what premium prices are with subsidies there's this fascinating head turn and they say 'huh this could be made to happen.'"

Among the states without exchanges, it's up to consumers to find help on or a local community organization that is helping with enrollment efforts.

In March 2014, the Republican-led Arkansas legislature went as far as enacting a law that prevents the state's Insurance Department from using state funds to promote or provide information about the federal health law.

Even in non-exchange states without such laws, many health department websites have little to no information for consumers about where to find help.

National organizations like Enroll America are increasing efforts for the open enrollment period, in those states. The organization said in an October news release that it will increase staff, especially in Alabama, Illinois and South Carolina. The organization works with a coalition of more than 6,000 local community partners.

"Our goal in year three is to identify the remaining obstacles for consumers to enroll in or renew their coverage, and take action to address those challenges," said the organization's president, Anne Filipic.

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