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Enrollment Is the Best Investment for Continued Access to Health Care

May 1 , 2025  |  By Lisa Chan-Sawin, MHA, and Heather Bates, MSW, ACC

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Outreach and enrollment for health insurance

Key Takeaways:

  • Access to affordable, comprehensive health insurance is good for people and the economy. Now entering its second decade, the Patient Protection and Affordable Care Act (commonly referred to as the ACA) made this possible.

  • Enrollment in health coverage is an ever-changing and complex process that often requires professional, trained, ongoing assistance as life events occur, and financial situations, coverage needs, benefits, and costs keep changing.

  • Retaining a stable enrollment workforce to provide free, impartial, unbiased help is an upstream solution to accessing care that reduces overall costs, contributes to local economies, and increases the likelihood of a healthy community. With coverage, people can access preventive care and avoid using the most expensive form of care — the emergency room.

Every federal administration has their own priorities when it comes to health care, such as the currently proposed focus on chronic disease and preventive care in the “Make America Healthy Again” movement. Within the U.S. health care system, sustained good health is not possible without affordable, accessible health insurance coverage, consumer protections, and benefits that are designed for all-comers to receive primary, preventive, and specialty care.  The success, or failings, of accessing health care in America relies on a critical factor — enrollment.

Enrollment facilitates access to care. Enrollment assisters provide accurate and unbiased support, culturally appropriate services, and health insurance literacy. Health coverage provides preventive care, specialty care, support for pre-existing conditions, choice of providers, and consumer protections.

Health Care Delivery Only Works When People Have Coverage

Enrollment makes it possible not only to receive health care, but also to access a range of comprehensive services that serve the whole person. Transform Health launched in 2016 and our flagship project was a whole-person care pilot in Sacramento, Pathways to Health and Home. This pilot addressed excessive emergency room usage driving up hospital and emergency department costs by unhoused residents who needed assistance navigating the complexities of the health and housing systems to stabilize in the community. At the center of the pilot was an enrollment navigator.

Whole-person care in California was made possible through an 1115 waiver, which states use to test innovative policy approaches to improve their programs and better serve populations in Medicaid. At the end of the five-year demonstration, the program evaluation determined that the pilot reduced emergency department visits, hospitalizations, and overall Medi-Cal costs. Like many similar programs, the navigation support was only available to community members who were enrolled in health coverage as a starting point.

Health Insurance Enrollment Contributes to Local Economies

We see the effects of long-term and stable insurance enrollment on the population through employer-sponsored coverage. A study from the U.S. Chamber of Commerce showed employer-sponsored health insurance programs have a return on investment of 47% for employers, due to lower medical and recruitment costs, higher productivity, reduced disability costs, and tax benefits.

The same is now true for anyone enrolled in Health Insurance Marketplace coverage through the Patient Protection and Affordable Care Act (ACA). The ACA was an important step in equalizing health care access through the three-legged stool of ending discrimination against people with pre-existing conditions, requiring everyone to be insured, and providing premium subsidies to keep coverage affordable. Each of these elements is necessary for a fully enrolled population, which in turn improves household-level financial security and the economy as a whole.

The ACA also mandated coverage of preventive services without cost-sharing — even for employer-sponsored insurance — and created a federally-funded health insurance Navigator workforce. Many of these benefits would otherwise not be included in employer-sponsored coverage, and some are currently up for debate again in the Kennedy v. Braidwood Management case.

Enrollment Assisters Are Essential to Facilitate Coverage

We can only enroll in health coverage if we know how to navigate this complex process. Enrollment in coverage is an ever-present need that requires assistance every time to be effective due to life-changing events and specified Open Enrollment Periods. As long as we see regular changes in provider networks, drug formularies, health plans, benefits covered, deductibles, premiums, and jargon, enrollment assistance will always be needed. The national enrollment assister workforce is held to strict programmatic and customer service standards to provide comprehensive, accurate, and unbiased support to consumers.

Similar to having an accountant help with filing taxes every year, Americans need continued guidance in health coverage enrollment. Armed with the right information, consumers can successfully maneuver the system and make informed choices about their own care, leading to more timely preventive care and a lower rate of avoidable hospitalizations.

Sustaining the Enrollment Workforce Makes Good Business Sense

A consistently stable enrollment workforce contributes to a healthy economy from the lens of participating in job creation and retaining experience and lessons learned over time from this work, both of which ensure people enroll in coverage to stay healthy.

Traditionally, funding for outreach and enrollment has been one of the first line items to get cut during tough budget times. In years with a surplus, funding for enrollment returns and hiring begins again. The costs of replacing an unstable workforce over time puts an enormous burden on the government and nonprofit assister organizations. This is compounded by the costs — ultimately shouldered by taxpayers — of an uninsured population delaying care or overusing emergency departments. Sustainable funding for a workforce with technical enrollment knowledge is key to supporting everyone who could benefit from enrollment assistance.

Transform Health’s staff have been through these cycles time and time again, and we have learned important lessons. Reach out to us today if you would like to work together. Contact us at lisa@transformhc.com and heather@transformhc.com.

Transform Health is an Inc. 5000-ranked national private health care consulting firm with a mission to drive systems change to build healthy communities.