The Robert Wood Johnson Foundation recently released new research to help states identify messages that will encourage enrollment in Medicaid in 2014 when minimum eligibility levels are expanded to 133% FPL.  The research also explores issues relating to state Exchanges, including attitudes about enrolling and choosing health insurance online. It was conducted in three states: Alabama, Maryland and Michigan.

The research confirms much of what we have learned over the years in covering children. People value and want insurance but that doesn’t always translate to getting in the door. The two primary reasons people want to become insured are: 1) being able to stay healthy, and 2) protecting oneself from medical bills when the unexpected happens. The “staying healthy” frame resonates more with women, the “medical bills” frame resonates more with men. Health care settings are good places for outreach, education and enrollment activities.

In terms of Medicaid specifically, the research reaffirms that Medicaid is viewed as a good program and that there is high interest in enrollment. However, many of the newly eligible doubt they will ever be eligible, so public education about the expansion — including promoting new income ranges — will be important. As we discovered through the Covering Kids and Families Initiative, describing health insurance as “low cost or free” is the best way to portray coverage through Medicaid. Check-ups, hospitalizations and prescriptions are the most valued services and should be featured in promoting the benefits of coverage.

Participants think Exchanges are good ideas and are interested in using them. They favor aspects of the Exchange that provide the ability to search for and compare plans and being able to call customer service for assistance. The studies reveal insights into how to promote Exchange coverage. Insurance is viewed as a serious matter and enrollment experiences need to reflect its importance. Participants say that analogies to “search and compare” sites like “Travelocity” do not seem appropriate and are not necessary to convey the concept. They are drawn to Exchange names that convey its function as a tool for getting insurance.  Using words like “connect,” “connection,” and “link” seem to work well.

People are very interested in using a computer at home or elsewhere to enroll online with more than 70% of participants ranking this as a 7-10 on a scale of 1-10, with 10 being extremely interested. However, the research confirms the digital divide, noting that many will face major barriers to using or accessing the Exchange on a self-service basis. Between 19% (Maryland) and 35% (Alabama) of participants rarely or never use a computer. This group tends to be older and have less education.  In the focus group in Alabama, people from rural areas were most likely to be in this group.

Everyone, including the internet savvy, wants help using the Exchange and most prefer getting help over the phone or in person (although younger people like the idea of using a chat help function as well). The group less likely to access coverage online expresses the most interest in going to a government office to enroll.

To learn more about the findings, go here to download a copy of the full report.