Skip to main content

Advanced Search

Advanced Search

Current Filters

Filter your query

Publication Types



Newsletter Article


Urban Institute: Government's Spotty Insurance Enrollment Performance Could Harm Health Care Law Progress

By Nellie Bristol, CQ HealthBeat Associate Editor

January 6, 2012 -- The success of the health care overhaul will hinge on the number of uninsured receiving coverage under the plan compared to projections of those eligible, but the government’s insurance enrollment track record is mixed, says Stan Dorn, health policy senior fellow at the Urban Institute.

The Children’s Health Insurance Program (CHIP) and Medicare Part D low-income subsidies achieved high enrollment rates, Dorn said Friday at an Urban Institute panel session on enrolling the uninsured under national health reform.

But other programs, including COBRA subsidies for laid-off workers and a temporary high-risk pool under the health law (PL 111-148, PL 111-152) enrolled fewer than 30 percent of those considered eligible by the Congressional Budget Office (CBO).

The health law is expected to facilitate coverage for 19 million uninsured by 2014, half of whom will qualify for Medicaid. The number is projected to rise to 32 million by 2019, with 16 million Medicaid-eligible.

“Not many people are wildly optimistic about our chances of successfully enrolling tens of millions of uninsured,” Dorn said. “We know it’s really, really hard to reach the eligible uninsured because we’ve tried many times and sometimes fallen far short.”

To ensure the plan reaches everyone it needs to, Dorn said, the Centers for Medicare and Medicaid Services (CMS) will need to roll out a major national effort to find and recruit those eligible along with programs to provide consumer assistance. Also, to the degree possible, a single eligibility system for federal programs should be established, Dorn added.

“It’s essential but not sufficient to provide good benefits that are affordable, to publicize the program, mandate participation,” he said. “[But] if you really want to quickly enroll the eligible uninsured, you also have to do a proactive campaign of reaching out to the uninsured and qualifying them for assistance, minimizing the paperwork burdens on consumers absolutely as far as you can, eliminating [it] whenever you can,” he said.

The health care overhaul includes some tools that will improve enrollment efforts, including state funding to upgrade computers and simplified eligibility standards, Dorn noted. Nonetheless, he said, there are still “worrisome signs” that efforts could fall short, including a continued lack of effective technology.

“Most states’ computer systems are literally generations old,” he said. “Notwithstanding the federal money that’s available, will all states be able to make the technological and also the business transformations needed to thrive in this new world? Not entirely clear.”

He also said not all state officials are committed to enrolling everyone eligible. State budgets are tight and more enrollees means more state Medicaid funding.

Despite Dorn’s concerns, Penny Thompson, deputy director of the Center for Medicaid and CHIP Services at CMS, said she is “very optimistic” that the program will find and enroll those eligible. “We do have all of the tools we need in order to really achieve those goals,” she said.

She said CMS has a wealth of experience from other programs and now knows what works. Among new strategies are continuous eligibility, elimination of in-person interviews and liberalized asset and resource requirements in addition to a single national income standard and simple, coordinated rules.

Thompson said the agency’s goal is to make the application process short, simple and preferably online. Officials want to create “an experience for the consumer that leaves them—and we’ve actually been using these terms—delighted” and that they will commend to their friends and neighbors. “That’s what we’re aiming for,” she said.

Nellie Bristol can be reached at [email protected].

Publication Details