Despite partisan disagreements about the effects of recent policy battles, 2018 individual-insurance markets feature greater affordability.


Nov. 1—Amid unexpectedly affordable individual health insurance options, hospitals and insurers are aiming to increase enrollment efforts.

The increased enrollment push by health plans and providers followed a decline in federal outreach funding. The Trump administration cut advertising for open enrollment both in and outside the Affordable Care Act (ACA) marketplaces from the $100 million spent by the Obama administration last year to $10 million. The Trump administration also will cut funding for navigators, who help people sign up for coverage, from about $63 million last year to $36 million.

That’s why the healthcare industry is expanding its efforts.

“Our member health insurance plans are increasing their outreach and marketing efforts, given the federal efforts to cut that back,” said Jeanette Thornton, senior vice president of health plan operations and strategy at America’s Health Insurance Plans (AHIP). “It certainly will not replace the amount of advertising enrollment and outreach that was done prior, but our plans are going to be stepping up.”

Health insurers are stressing to potential enrollees that individual-market plans remain available despite the Trump administration’s opposition to the ACA. Insurers will have their call centers ready to answer specific questions about plans, benefits, provider networks, and other aspects.

“So plans will be stepping up their local presence, doing a lot of their own outreach and education and advertising, as well as working with other groups to help ensure that people know that open enrollment is upon us and that they can get the help they need to get covered,” Thornton said at a recent Washington, D.C., policy briefing.

For example, Florida Blue is participating in more than 1,000 events across the state, including at county fairs, churches, and community events, and is hosting educational sessions at 20 Florida Blue Centers across the state.

The insurer focused on that outreach strategy this year because “over the years we have learned that a grassroots approach is the best way to reach this audience,” said Paul Kluding, a spokesman for Florida Blue.

The insurer also is holding sessions to help agents educate current and future members, and it has sent out letters and postcards detailing 2018 coverage options.

After unsuccessfully urging Congress and the administration to boost outreach efforts, the American Hospital Association (AHA) has shared enrollment resources with member hospitals and encouraged them to help sign people up. The hospital group is focusing outreach on certain states.

Such efforts are vital, an AHA official said, not only because of the reduced federal funding but also because the leading outside enrollment group, Enroll America, disbanded shortly after the end of 2017 open enrollment.

An example of AHA outreach was the creation of a video that highlights the importance of health insurance and is geared to young adults. AHA encouraged hospitals to use the video and other materials to help spread the word about open enrollment through hospitals’ social media channels, websites, newsletters, and community outreach programs. 

Six hospitals and health systems among the 38 states with federally operated ACA marketplaces received navigator funding, and other hospitals are planning their own outreach efforts.

For instance, Parkland Health & Hospital System in Dallas will have certified application counselors to help enroll patients in marketplace plans. The system will also have certified health insurance navigators at several Parkland Community Oriented Primary Care health centers to provide enrollment assistance.

Such outreach efforts could prove critical given that, according to an analysis by The Commonwealth Fund, better information about choices and costs has a positive impact on enrollment, particularly among people who are eligible for subsidies. Two-thirds (66 percent) of adults who received personal assistance when they shopped for coverage enrolled in a plan, compared to fewer than half (48 percent) who had not received assistance, according to a tracking survey.

In addition to increased outreach efforts by the healthcare industry, several of the 12 states that run their own marketplaces are planning to increase funding for enrollment programs.

For instance, California is spending $111 million on advertising its ACA exchange. The total is $11 million more than the state spent last year and includes funding for navigators, advertising, and in-person meetings with agents.

After Oregon’s health insurance exchange, Cover Oregon, ceased operation due to technological failures, state officials switched to Healthcare.gov, but they retained a handful of responsibilities—including advertising and outreach. The state plans to provide $1.8 million in outreach support for the 2018 open-enrollment period, including the first round of spending on broadcast ads since the collapse of its own marketplace, according to media reports.

State-run marketplaces also have sought to increase access by lengthening open enrollment. The federal marketplace’s open enrollment is six weeks, from Nov. 1 to Dec. 15, while some states are allowing residents up to twice as long to sign up.

Greater Affordability

The hope for outreach success was somewhat bolstered in recent days by data indicating 2018 plans will be more affordable than expected. Although a new report from the Department of Health and Human Services found that unsubsidized premiums for the lowest-cost Bronze plan in the federal marketplace increased by an average of 17 percent and those for the lowest-cost Silver plan increased by an average of 35 percent, the cost of insurance will actually drop for many subsidized enrollees.

Outside analysis has echoed such findings, with a new Kaiser Family Foundation report finding that for a 40-year-old individual making $25,000, the premium tax credit covers the full cost of the premium for the lowest-cost Bronze plan in 1,540 counties.

“With premium subsidies, many people can get insurance FOR FREE,” Larry Levitt, senior vice president for the Kaiser Family Foundation, wrote in a tweet. “But with less outreach, will they know this?”

Effect Uncertain

Despite the uncertainty, many insurers have said they expect only small reductions in enrollment.

For instance, Florida Blue, which covers nearly 1 million ACA enrollees in all 67 counties in the state, expects a decrease relative to previous years, primarily because 2018 is the fifth year of coverage, but it does not expect a “significant” reduction, Kluding said.

The insurer is introducing 12 new plans outside of the ACA marketplace this year to increase options for those who do not qualify for subsidies.

Similarly, Curtis Barnett, president and CEO of Blue Cross and Blue Shield Arkansas, said at a recent Washington, D.C., health policy event that his company expects a “slight decline” in its ACA plan enrollments because of confusion over whether the federal government would provide funding for cost-sharing reduction payments.

The relatively optimistic expectations run counter to projections from various organizations, including the left-leaning Center for American Progress, which estimates that 1 million fewer people will enroll because of the Trump administration’s ACA-related policies.


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

Publication Date: Wednesday, November 01, 2017