KFF Brief Points to Need for Greater Investment in Consumer Assistance to Connect People to Health Coverage

This week, I’m reading findings from a new Kaiser Family Foundation (KFF) brief about who uses consumer assistance programs established under the Affordable Care Act, who does and does not get help, why they seek assistance, and the difference the programs can make in consumers’ ability to obtain health coverage.

Kaiser Family Foundation’s Consumer Assistance in Health Insurance: Evidence of Impact and Unmet Need

The Affordable Care Act (ACA) established consumer assistance programs to help people enroll in health coverage, renew their plans, and answer questions about insurance terminology, coverage options, and financial assistance. Both state- and federally-operated marketplaces must have a year-round Navigator program to help consumers enroll in both marketplace and Medicaid/CHIP coverage, and some marketplaces have additional assistance programs run by nonprofit organizations or community health centers, or other certified application counselor (CAC) programs.

KFF surveyed individuals most likely to use these programs between March and April 2020 in order to learn more about who receives assistance, the reasons they look for help, how they value the help they get, which organizations provide help, how satisfied they are with the coverage they have, and how consumers are thinking about their coverage during the COVID-19 pandemic.

What It Finds:

  • 18 percent of consumers, or about 7 million people, who were shopping for, applying for, or renewing their coverage received consumer assistance in the past year. Those who were applying for coverage for the first time and those who were renewing coverage were equally likely to seek assistance. This number was largely consistent across income, age, and race and ethnicity (Hispanic consumers were more likely than white consumers to get assistance). The most common reasons for seeking assistance included not understanding the coverage options, the process being too complicated to complete on their own, lack of internet access and other technical problems, and needing Spanish-language assistance.
  • 40 percent of consumers who enrolled in their coverage with consumer assistance said it was unlikely they would have found that coverage without help.
  • Another 12 percent of consumers, or almost 5 million people, sought assistance but did not receive any help. The most common reasons for not receiving help were not being able to find assistance close enough to home, not being able to get an appointment, not being able to find help in person and being uncomfortable seeking assistance on the phone, and not being able to find help in Spanish. Additionally, when respondents had consumer assistance programs described to them, two-thirds said they would be likely to use such a program if it were available in their area.
  • 94 percent of consumers who received assistance reported that it was helpful. The majority (60 percent) of people who received assistance this year returned to the same person who helped them previously, and 27 percent followed up with the same person for post-enrollment assistance.
  • 19 percent of people receiving Medicaid coverage in the past two years reported that their coverage or their child’s coverage had been terminated at some point. Of these, 29 percent reported that their coverage was terminated because they could not complete redetermination requirements, and another 17 percent didn’t know why their coverage was terminated.
  • Medicaid beneficiaries were significantly more likely to be satisfied with their coverage than marketplace enrollees overall (93 percent vs 75 percent), with their copays when visiting a doctor (92 percent vs 66 percent), copays for prescriptions (93 percent vs 73 percent), and choice of doctors and hospitals (86 percent vs 77 percent).
  • 55 percent of respondents are somewhat or very worried that they will not be able to pay premiums for their current coverage for the rest of the year as a result of the pandemic. Only 32 percent are confident they would be able to find another affordable coverage option.

Why it Matters:

  • Finding, applying for, and renewing coverage through the marketplaces is a complex multi-step process that usually includes creating an online account, reporting information or providing documentation about things like income and household size, and wading through information about coverage options, benefits, prescription drug formularies, and insurance networks. 83 percent of uninsured adults looking for coverage found at least one of these steps to be somewhat or very difficult. Overly burdensome or difficult processes can discourage low- and moderate-income people from applying for programs like marketplace subsidies or Medicaid, even if they are eligible to receive benefits.
  • Despite the KFF findings that show many people depend on these vital consumer assistance programs to help them find health insurance, the Trump Administration has cut funding for Navigator programs by $53 million in 32 federal marketplace states since 2017, leaving many counties without an available program. The Administration has also removed the prior requirement that consumer assistance programs have a physical presence in the communities they serve and cut overall funding for outreach and advertising during open enrollment periods by 90 percent.
Aubrianna Osorio is a Research Manager at the Georgetown University McCourt School of Public Policy’s Center for Children and Families.