July 16—Despite Obama administration hopes that hospitals would take the lead in enrolling beneficiaries in insurance coverage offered through the healthcare overhaul, hospitals and other providers operated only 15 percent of the 4,400 assister programs, according to a new survey.

The Kaiser Family Foundation survey of assister programs created to help enrollment in the government-run marketplaces of the Affordable Care Act (ACA) found the largest share (38 percent) of assister programs were operated by “non-profit community service organizations.”

The smaller share operated by hospitals was hailed by the survey’s authors.

“Provider organizations have long played a role in connecting consumers to coverage so it is perhaps not surprising that they signed up in large numbers,” the survey’s authors wrote.

Hospitals were expected to play a large role in signing people up for coverage on the ACA marketplaces.

In September 2013, federal officials urged all hospitals to obtain federal training to help uninsured people enroll in either an insurance marketplace plan or Medicaid coverage under the healthcare overhaul. For instance, leaders of the Centers for Medicare & Medicaid Services (CMS) joined the leaders of the three largest hospital advocacy organizations to urge all hospitals to enroll in the certified application counselor (CAC) program. The CAC program provides training to organizations so that their employees or contractors can provide in-person assistance to applicants enrolling for ACA coverage.

Some hospitals that were interested in participating in enrollment activities reported confronting a range of obstacles, including local political opposition and a burdensome CMS application and training process. Hospitals that successfully enrolled in sign-up assistance efforts struggled along with the general public during the technical failures that plagued the marketplaces’ first weeks of operation in the fall of 2013.

Funding Key

Although the CAC program does not provide funding for enrollment activities, CMS did issue grants for the navigator program.

The Kaiser survey noted the importance of funding for the enrollment programs. It found the enrollment programs were able to leverage $874 million in federal funds and unreported amounts of state and private sector funding to provide more than 28,000 full time and volunteer assisters for 2014 open enrollment marketplace applicants.

Funding drop offs may not bode well for 2015 enrollment initiatives. For instance, part of the 2014 enrollment funding was $67 million in navigator grants provided to more than 100 organizations, including some hospitals and health systems. That funding dropped to $60 million for 2015, and other federal enrollment funding sources remain in doubt.


Rich Daly is a senior writer/editor in HFMA’s Washington, D.C., office. Follow Rich on Twitter: @rdalyhealthcare.

Publication Date: Wednesday, July 16, 2014