The Importance of Assisters for Successful ACA Enrollment

Under the Affordable Care Act (ACA), millions of people gained access to healthcare coverage through state-based marketplaces and Medicaid during the open enrollment periods in 2013-2014 and 2014-2015. A recent study in Health Affairs found that ACA marketplace assisters played a vital role in helping these consumers with smooth and successful enrollment. Assisters included CMS-funded navigators, private nonprofit application counselors, and federally funded in-person assisters.

Study authors evaluated different strategies by state to determine which were most successful in achieving high enrollment rates. Analysis of nationwide surveys and evidence from published evaluations suggest that assisters were most successful in supporting marketplace consumers when: assisters maintained continuing relationships with consumers; assisters came from the communities they served; local programs were well-coordinated; and post-enrollment issues could be easily addressed at later times. Also, consumers who received in-person assistance were twice as likely to enroll successfully as those who tried to enroll online without assistance. The assister programs were particularly useful for consumers with little prior experience or trust in healthcare.

Quantitative data was gathered by the Kaiser Family Foundation Survey of Health Insurance Marketplace Assister Programs. These findings showed that new consumers typically needed 2 to 4 hours of help, and the majority needed more than one session and post-enrollment work—especially those consumers with limited understanding of English and/or insurance.

This data is helpful in showing that while assisters should have a focus on enrolling patients in the ACA programs, good communication and substantial outreach/education are still imperative.

“Evidence from the field suggests that enrolling cannot be separated from educating and engaging—and that assisters are positioned to do this work,” said study author Rachel Grob, director of National Initiatives at the Center for Patient Partnerships.

The importance of the study results lie in pinpointing what needs to be improved or continued to optimize each open enrollment period. Looking ahead, the study also anticipates more hard work for assisters. Ongoing demands will remain substantial and perhaps even increase as assisters strive to continue successfully connecting consumers with health coverage.

“Assisters have a complicated and important job to do,” Grob said. “If these programs are to be treated as a lasting instead of a transitional part of health reform, investment in and development of the assister workforce will be important.”

She anticipates the use of multi-year grants, funding from marketplace profits, increased team building and education to help reach this goal. More reliable methods of evaluation (outside of limited evaluations and data) will also be required.