Looking to Open Enrollment Seven: What’s new for 2020?

October 22, 2019 |  By Heather Bates and Sara Gleysteen

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Open enrollment for health coverage is November 1st through December 15th. Consumers are asked to prepare by using a checklist made available at healthcare.gov. The national list serves to get on to be in-the-know for outreach and enrollment information include Young Invincibles, Center on Budget and Policy Priorities, Beyond the Basics, Georgetown University’s Center on Health Insurance Reforms, and APIAHF.

While there are alternative options in the form of short-term plans made available by the current Administration that fall outside of the consumer protections in the Affordable Care Act’s (ACA) Qualified Health Plans, it is important to distinguish the differences and know what to look for this year. Navigators or Certified Application Counselors, who, according to federal law, are independent, impartial and do not accept compensation from any issuers, and are primarily located in nonprofits, clinics and Federally Qualified Health Centers around the country are still available in person and can help consumers decide on coverage options, as well as help consumers address key social determinants of health such as food and housing.  It is still important to know that the plans made available through the ACA provide consumer protections like key essential health benefits, while catastrophic, short-term, or limited-duration offerings do not.

To gear up for serving their communities this year, many states like Pennsylvania and Maine have created plans to transition to their own state based marketplaces (SBM). Previously, at the outset of ACA implementation, IT infrastructure was not in place to facilitate this transition. Now, however, technology to run state-based exchanges has been developed and is available for these states to utilize and adapt to their specific needs, thus significantly lessening the financial and operational burden of operating an exchange. In addition to reducing the cost of operating an exchange, SBMs have the flexibility to fund their own outreach and enrollment navigation services. For example, in New York, their statewide Navigator program reported cost efficiencies with an average cost per enrollment of only $100, and almost 2.5 times more productive than other types of assistors (Certified Application Counselors, Facilitated Enrollers, and Brokers).

The uninsured numbers are rising. Data released by the U.S.  Census Bureau in September found that for the first time since ACA implementation, the rate of uninsured has increased. In 2017 the rate of uninsured was 7.9% and in 2018 the uninsured increased to 8.5%. We anticipate that in-person assistance will continue to be mission critical, as it has been in states that control their own marketplaces. The Enroll Act, a house bill that would allocate $100 million to fund outreach and navigation, while is not expected to pass the Senate, justifies the need and sets a precedent for continued funding considerations in the near future. 

Transform Health staff participated and led special workshops around the country this year in order to help Navigators and CACs gear up for open enrollment in a very complex environment after the new rule released around the public charge, despite the recent national injunction, severe funding cuts in the face of  increased consumer demand and confusion, the elimination of the individual mandate, and the Texas v. Azar court case. While in Wisconsin, Navigators and CACs were concerned about these challenges and how to appropriately educate consumers while also making sure they were educating themselves as the training and support previously provided by CMS during the last Administration to stand up Navigators has dramatically decreased. All of this is taking place in a climate of fear where highly technical, contradictory messaging, and policy changes are happening simultaneously.

Similarly, in Texas, many of the Navigators and CACs were focused on helping consumers unpack their rightful concerns and reticence to enroll or keep coverage, given the climate of fear created and reinforced through this Administration’s immigration policies, mixed media messages, and the revised public charge rule. In addition to learning about the policies impacting consumers this year, Transform Health focused on shoring up Navigators and CACs this year by offering free, skill-building work plan development and scoping, strategy and planning, while brainstorming with Navigators and CACs how to respond to consumer requests. These activities are imperative, in a time where there is no clear direction or guidance, and the federal government is undermining their contractors and public that they are charged to serve. In Pennsylvania, the focus was on affordability for consumers, explaining the dangers of short-term plans, and what the transition to a state-based exchange meant for funding.

Figure 1: Annual Open Enrollment conference in Texas, 2019.

Transform Health’s work is grounded in health system transformation. We are a nationally certified women and minority owned firm and as such, we support the workforce committed to helping to reach, educate and enroll consumers in life-changing coverage. We see this workforce as part of the health care delivery system and key contributor to accessing affordable, sustainable coverage and care. In a politically charged climate where many have been forced to abandon their dedication to this work, we are doubling down on our commitment to funding and supporting unbiased, on-the-ground, in-person navigation work through nonprofits, community health centers and community-based organizations who know their communities best and can most effectively meet their consumers where they are in culturally and linguistically appropriate ways.

In sum, as we approach this upcoming enrollment period, the array of changes in addition to those already mentioned, vary greatly in who they affect and how. For more information on the technical changes happening with open enrollment head to the Center on Health Insurance Reform’s blog.

If you are an Navigator, CAC or CHW, or work to support this workforce such as Primary Care Associations, community health centers, state governments, or advocacy organization, we also hope to see you during the annual Families USA Health Action 2020 conference in Washington, DC this coming January. Message us for a special discount code for enrollment assisters and join us for our enrollment track and dedicated events to honor your work.

Contact Us

If you would like to learn more or work with Transform Health please contact Heather Bates at heather@transformhc.com