Heads Up: Less than 45 days until ACA open enrollment and re-enrollment

Tempus fugit—time really flies!

On November 15, the state Health Insurance Exchanges will begin the second Affordable Care Act (ACA) open-enrollment period. This period will extend from November 15, 2014, to February 15, 2015. Although health insurance enrollment likely will not receive the same, unrelenting, daily fanfare and scrutiny as last year, we should not make the mistake of thinking that this new enrollment period is any less important for us than last year’s. Also, we must remember that enrollment in the state Medicaid Expansions is continuous throughout the year.

Enrollments during 2013-14

First, let’s recall a few basic statistics. The state Health Insurance Marketplaces are seeking to enroll about 21 million persons. For the 2013-2014 open enrollment period, HHS estimates that about 10.5 million persons actually were enrolled. That means an equal number remain to be enrolled. The state Medicaid Expansions intend to reach a population of about 19 million persons. Thus far, in the 27 states and DC undertaking the Medicaid Expansions, about 8.5 million persons have been enrolled. That means 10.5 million remain to be enrolled.

Informative maps are available from the Enroll America site that show state Health Insurance Marketplace enrollments during the initial open enrollment period.  The maps depict information on the number of individuals who enrolled in Marketplace plans between October 1, 2013, and April 19, 2014, in the 36 states where consumers enrolled through HealthCare.gov. You can access these maps here.

A total of almost 13 million people with a mental or substance use condition, or both, were without health insurance at the beginning of the 2013-2014 open enrollment period.  Optimistically (federal data are not available), we estimate that up to 2.6 million were enrolled through the state Health Insurance Marketplaces this past year, and 3.7 million more through the state Medicaid Expansions. That leaves almost 7 million more to be enrolled this coming year.

We all have a personal responsibility to help these 7 million people become enrolled in health insurance. For some, that will involve our direct work with uninsured individuals and families. For others, it will involve our significant advocacy efforts to demand that the state undertake the Medicaid Expansion. Social justice principles require nothing less of us.

Enrollment will be more difficult in 2014-2015

In addition to being more difficult to reach than those enrolled last year, we also can predict that persons with these conditions will be more difficult to enroll in health insurance, as documented by almost a decade of experience with mandatory insurance in Massachusetts. Thus, it should cause all of us to pause by noting that up to 7 million of the remaining 21 million persons to be enrolled—fully one-third—have a mental or substance use condition.

Re-enrollment, a second feature of the approaching open-enrollment period, simply did not exist in the earlier period. Although HHS will attempt to do auto re-enrollment in the same plan unless the beneficiary chooses otherwise, a number of factors can potentially derail this approach. These include failure to provide appropriate documentation of citizenship, income, etc., other incomplete information on the 2013-14 application, and even high out of pocket costs for care, particularly for those persons between 100 percent and 150 percent of the Federal Poverty Level  (see  https://www.behavioral.net/blogs/ron-manderscheid/rethink-insurance-persons-between-100-400-poverty-level ).

Enroll Individuals and Families   

Some things to consider in doing outreach to individuals and families include:

Do personal outreach yourself to identify uninsured persons with mental or substance use conditions. Likely places to encounter these people are public behavioral health programs, city and county jails, and hospital emergency departments.  Peers in your community can be particularly effective in such outreach.

Know where and how to enroll these persons. The Get Covered America site offers a very useful zip code locator system to identify local organizations that can assist with enrollment either in private insurance offered through the Marketplace or in Medicaid. These organizations, such as federally qualified health centers, can enroll persons directly or put then in contact with insurance navigators or enrollment assisters.

Advocate for the Medicaid Expansion

If you live in one of the 13 states that has not yet undertaken the Medicaid Expansion, then you also will have a major advocacy role to help turn this decision around. This effort will be difficult, but not impossible, especially as time elapses and decision makers realize what other states are doing and what is being foregone by failure to participate.

Your potential steps include:

Develop a state Coalition for Whole Health to coalesce a broad array of organizations around advocacy efforts. The national Coalition can provide advice and assistance in this endeavor (see www.coalitionforwholehealth.org).

Align the state Coalition with hospitals in your state. Because Medicare and Medicaid disproportionate share funds are slated to disappear by 2018, hospitals have much to lose if a state does not undertake the Medicaid Expansion. Hence, they can become a natural ally for your efforts.

Enroll as many persons as possible between 100 percent and 138 percent of the Federal Poverty Level in state Marketplace insurance. This will highlight the uninsured “gap population” below the 100 percent level who are not eligible for insurance without the Medicaid Expansion. It also will reduce the magnitude of the population requiring Medicaid once the state elects this option.

Plan a Local Kickoff Event

As we approach the eve of the second round of ACA insurance enrollment, you also may wish to do a kickoff event, both to celebrate the upcoming effort and to draw broad attention to it. Be creative!

Very best wishes in this exceptionally important work. We can’t let the approaching darkness of fall and winter benight us so that we lose sight of the importance of this endeavor!