Oct. 1 is a big deal for health advocate Nita Carter: It is the day that Ohio’s new health insurance exchange begins open enrollment. Ideally, on that day, more than 1 million uninsured Ohioans can begin using the exchange to buy affordable insurance.
However, making sure those people know just how, why or whether they should sign up is a monumental task.
“This particular law has met with so much opposition and challenge that I think people have become a bit confused,” said Carter, LSW, health equity director at the Universal Health Care Action Network of Ohio.
To help raise awareness, Carter and her colleagues in Ohio are educating community organizations, social service and health care providers about upcoming health insurance changes, creating public service announcements, and working with groups that will be particularly adept at reaching underserved communities. But the question remains: If you build it, will they come?
Medical Director Elisa Melendez examines Maximo Chavez at Clinica Tepeyac in Denver in March 2012. The majority of patients at the clinic are uninsured, which may change as health reform changes take effect in the state this fall.
Photo by Craig Walker, courtesy Denver Post/Getty Images
“I think it’s going to take us a while to get the word out and get people to enroll,” Carter told The Nation’s Health. “What I hope will happen is that in Ohio, we develop a more coordinated approach to outreach and education so we’ll maximize the coverage we have. No one group will be able to reach everyone in the state — we need a collaborative approach.”
Ohio is hardly alone. Polls find widespread public confusion about the Affordable Care Act, which could spell trouble as insurance marketplaces are expected to begin open enrollment in October. A Kaiser Family Foundation poll released in April found that about half the public said they did not have enough information to understand how the health reform law will affect their families, with even higher rates among uninsured and low-income households. And four in 10 Americans were unaware that the Affordable Care Act is still law.
“We have over 40 million Americans estimated to be eligible for coverage under (the Affordable Care Act) and a majority of them have no idea this is coming,” said Jessica Kendall, MPH, outreach director with Enroll America, which is working to maximize the number of uninsured Americans nationwide who will benefit from new insurance options. “So raising awareness is really the most important thing we can be doing right now.”
Fortunately, a number of efforts are underway to prepare Americans for the start of open enrollment in the marketplaces. The state marketplaces are designed to be one-stop shops where people can shop for and buy insurance and find out if they qualify for subsidies, Medicaid or the Children’s Health Insurance Program. Among those working to raise awareness is APHA, which is providing information advocates can use to educate their communities about the health reform law. Vanessa Forsberg, MPP, APHA public health policy analyst, said public health workers will be critical to raising public awareness.
“Public health practitioners are already connected to their communities and skilled in cultural competency,” Forsberg said. “There’s a huge need and opportunity for public health to play a role in enrollment activities.”
At Enroll America, work is underway to partner with community groups planning to provide enrollment assistance to make sure consumers know where to get help. In June, the organization launched its Get Covered America campaign with 50 awareness-raising events nationwide.
“I’m extremely optimistic,” Kendall told The Nation’s Health. “Oct. 1 isn’t the end; Oct. 1 is the beginning.”
Kendall noted that Enroll America is taking care to “complement, not complicate” the work of federally funded navigators, who will help residents understand the new system and enroll. Funding awards for the navigator program are expected to be announced this month. In addition to the navigators, federal officials launched a revamped Healthcare.gov site in late June as well as a 24-hour consumer call center. In October, consumers will be able to visit the site’s Health Insurance Marketplace to enroll in health plans.
“Our experience running Medicare for nearly 50 million people has given us valuable skills and lessons for preparing to run the Health Insurance Marketplace,” Joanne Peters, a spokeswoman at the U.S. Department of Health and Human Services, told The Nation’s Health.
However, reaching certain populations will take some unique tailoring. At Young Invincibles, a group launched in 2009 to highlight the voice of young people in the health reform debate, staff are going state to state training organizations on how to reach young adults and will also be on the ground enrolling people in October. While some might think young adults do not care about health insurance or do not think they need it, Tamika Butler, JD, the organization’s director, said she disagrees. In fact, a June Kaiser Health Tracking Poll found that many young adults worry about paying medical bills and that most of those who lack coverage want it. When the Affordable Care Act allowed young people to stay on their parents’ plan until age 26, they did so “in droves,” Butler said.
“Young people are definitely going to have to be educated on the new low-cost options, and that’s where the challenge comes in,” Butler told The Nation’s Health. “Right now, our generation has very low levels of insurance literacy and we think that’s precisely because there were such few good options before.”
Among its engagement efforts, Young Invincibles developed a new mobile app, Health Care Finder, which helps users find clinics and doctors and includes a glossary of insurance terms. Butler said the app is about “meeting young people where they are.”
In California, health advocates are working to reach Hispanic residents where they are as well, specifically via Spanish-language media. According to Daniel Zingale, senior vice president at the California Endowment, “We recognized in California that the (health reform) law would succeed or fail based on the level of awareness among Hispanic residents.” In turn, the endowment partnered with Spanish-language media shortly after the law’s passage, and today 70 percent of California’s Hispanic residents report positive awareness about the Affordable Care Act, Zingale said.
This summer, the Spanish-language campaign, known as Asegúrate, or Get Covered, transitioned to focus on enrollment with the help of Covered California, the state’s insurance marketplace. The campaign will use live broadcasts, online resources and mobile apps to connect people with enrollment assistance.
“I genuinely think this will put California in front of the nation in successful implementation,” he said.
APHA member Jay Bernhardt, PhD, MPH, professor and chair of the Department of Health Education and Behavior at the University of Florida and former director of the Centers for Disease Control and Prevention’s National Center for Health Marketing, noted that the “primary challenge up until now has been to get (health reform) legislation passed and work on implementation, so I think our attention has been correctly focused…but now is the right time for consumer-facing messages.”
“Messages need to be targeted and tailored — a one-size-fits-all approach is not going to be effective,” he said. “The other challenge is not simply a matter of knowledge and awareness but of getting people to take action…and as we know in public health, that’s a challenge, but an achievable one.”
To learn more about enrollment activities, visit www.healthcare.gov or www.enrollamerica.org.
- Copyright The Nation’s Health, American Public Health Association
