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Thursday, January 21, 2016

Enrolling Hard-to-Reach Populations in Health Coverage Calls for Creative Outreach

Talia Schmidt


A new report released last week confirms the findings that enrollment experts emphasized on our teleconference with reporters last Wednesday: We still have a ways to go in getting “hard-to-reach” populations enrolled in health coverage.

As of January 13, 2016, 11.3 million people have enrolled in or renewed their marketplace health insurance. Since the Affordable Care Act was passed, nearly 18 million previously uninsured consumers have gained health insurance, and we have seen a historic decline in the number of uninsured consumers.

But who are the remaining uninsured, and what are the barriers to enrolling them? What can enrollment assisters and other advocates do to help break through those barriers?

Mike Perry of PerryUndem Research and Communication has studied enrollment trends since before the first open enrollment period in 2013. Last year, the Robert Wood Johnson Foundation commissioned PerryUndem to conduct a national survey to find out who the remaining uninsured are. Here are some highlights of their findings:

Perceptions about affordability remain primary reason hard-to-reach populations have not bought health insurance

In their research, PerryUndem found that cost is the number one reason why the uninsured still haven’t bought health insurance. 

However, PerryUndem also found that 73 percent of those who have not gone to the marketplaces have not heard about the premium tax credits that are available to help them buy insurance, or they don’t understand how the credits work. This underscores the importance of continued outreach and education to inform consumers that financial assistance is available to make coverage more affordable.

Three things that will make a difference in enrolling the uninsured:

  1. One-on-one help, which is becoming more important, not less important, as time goes on. The remaining uninsured are less informed and need more help filling in gaps in knowledge.
  2. Talking about the tax penalty: “We feel like it’s making a difference to talk about it,” Perry said. “It’s dicey because a lot of people don’t like talking about the fine, but it’s a motivating factor.” The individual mandate increased this year, and individuals who remain uninsured in 2016 will pay an average of $969 for going without coverage. Many people don’t realize they can actually get covered for less than it would cost to pay the penalty.
  3. Partnering with small employers: A large number of the remaining uninsured work in small companies, many with around 20 employees or fewer. Navigators and assisters can partner with these small employers to connect people to coverage.

One key to reaching uninsured is meeting people in their communities

States can also help enroll the remaining uninsured.

California, a state with a large Latino population, has worked to meet its hard-to-reach populations where they are. On Families USA’s teleconference call, Peter Lee, the executive director of Covered California, said that 85 percent of Californians know about the state-based marketplace. He credits that in large part to the significant outreach that enrollment experts have done to raise awareness in communities of color and other hard-to-reach populations. This includes sending insurance agents to Vietnamese communities, sending enrollment assisters to clinics serving Latino communities, and reaching out to African Americans at their local churches.

Heat mapping

Lee said that the state also has more than 500 “storefronts”—areas where enrollment assisters or insurance agents can set up shop to help people enroll. The state even created “heat maps” that show where people are likely to be uninsured. And they use these data to make game-time decisions:

“Just last week, we opened a storefront in Hawthorne (California) because of the heat map targeting,” Lee said. 

Trusted outlets within the community

Many Latino families have their local television station turned on while they’re cooking dinner, or they listen to the radio as they’re driving their kids to soccer practice or church. That makes these outlets important places where enrollment workers can get the message out that health insurance is available and affordable.

In Colorado, Mirna Castro of Servicios de La Raza has helped the uninsured in Denver, which has one of the largest uninsured Latino communities. That’s why she established a media coalition of trusted advisors to push out messaging that health insurance is available and affordable.

Local news anchors also play a pivotal role in Latino communities. So, the coalition encouraged local TV personalities and newspapers to create a common message to urge Latinos to call one phone number to reach Promotores (community-based health educators and advocates), who can answer any questions and help them enroll. The messaging is both informative and culturally appropriate because it comes from within the community.

California, too, has worked with local Latino media, and virtually every Hispanic newspaper in the state ran staff editorials encouraging people to sign up for health coverage, Lee said on the call. When advice comes from a trusted member of the community, these hard-to-reach populations are more likely to listen.

“We’re meeting people where they live, work, play, and pray,” said Castro.