Emergency COVID-19 enrollment period: Just what the doctor ordered?
While President Biden is expected to announce the re-opening of the federal ACA exchanges, several enrollment challenges still exist.
The beginning of both a new year and a new presidential administration is a good time to take the pulse of the Affordable Care Act. Included in President Biden’s plan for the first 10 days in office is a list of orders targeting the ACA, including one expected this week that will reopen the federal exchanges for those who have yet to purchase a health insurance plan.
“As he takes office, President Biden faces a daunting list of challenges as he endeavors to make progress on the health reform proposals he made during the campaign,” according to a new KFF report. “Beyond just reversing Trump administration cuts, there are opportunities to make the marketplace more responsive to consumer needs and to work with Navigators to identify and address problems as they emerge. The availability of unspent, carryover user fee revenue could make possible immediate investments in marketing and outreach, support for enrollment assistance and other improvements.”
Related: The dismantling of the ACA: An (updated) timeline
Unspent marketplace user fee revenue has accumulated. The Trump administration substantially reduced spending on key activities that support marketplace enrollment, including navigator consumer assistance, marketing and outreach, the HealthCare.gov marketplace website and the federal marketplace call center. Spending cuts on consumer assistance and outreach activities, even as revenue held steady, contributed to the user fee carryover. Most spending for federal marketplace operations is for consumer information and outreach activities and for information technology.
Biden has said he favors providing a COVID-19 special enrollment period in the federal marketplace for people who are uninsured. Navigators and other marketplace professionals who recently shared their insights agree. Their observations about the 2021 open enrollment period, general and pandemic-specific challenges facing consumers seeking coverage, and suggestions to improve enrollment outcomes include:
- Navigators stressed the importance of reopening the federal marketplace for enrollment in 2021. For the first time in several years, marketplace enrollment increased in a number of states. Nevertheless, navigators noted unresolved problems that hindered access for some consumers during the regular open enrollment period. They also pointed to the importance of making every effort to get people covered during the pandemic.
- Navigators urged that an emergency COVID enrollment period extend for longer than the six-week federal open enrollment period that just concluded. They said that time will be needed not only to sign up new consumers but to follow up with those who experienced difficulties during the regular open enrollment.
- Navigators also stressed the importance of investing substantially in publicizing a COVID reopening of marketplace enrollment. As KFF tracking polls have found for years, most consumers are unaware of marketplace open enrollment deadlines.
- Navigators noted the importance of targeted outreach strategies to reach some consumers, including those who do not speak English, non-citizens and those who have been uninsured for a longer period of time. The perceived high cost, lack of awareness about subsidies, fear of how getting coverage subsidies could affect their immigration status and other factors discourage millions of uninsured consumers from even looking into coverage options.
“A reopened ACA enrollment period has the potential to get more people covered during a public health emergency and in the midst of massive economic dislocation,” the report concluded. “There are, however, challenges and trade-offs involved. Without any increase in federal subsidies, many people who are uninsured may still find coverage unaffordable.
“A new enrollment period could also provide an opportunity for people who have recently developed health conditions to sign up, which would provide them greater access to care but could also worsen the risk pool and lead to an increase in premiums. A concerted outreach effort could help get more people covered, including those who are currently healthy, thus improving the risk pool and reducing the number who are uninsured.”
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