What We Learned from Open Enrollment and Where We Go

January 18, 2019 | By Liz Hagan

While a few state-based marketplaces are still finishing up the most recent open enrollment period, we already have a few key lessons we can take away and some key achievements that must be lauded, despite the significant cuts to outreach and Navigators during this Administration. Past years have taught us that funding for marketing, advertising and outreach remain critical in order for Navigators, Certified Application Counselors (CAC) in community health centers, and others who still do enrollment to be successful. Consumers need help finding and staying enrolled in affordable health coverage throughout the year and from year-to-year. As long as plans, formularies, networks, and providers continue to change, consumers will still need help with enrollment and we also know that this work sets consumers on a path to address key social determinants of health. Enrollment work must continue and it remains important to share lessons learned and find ways to improve upon the mission-critical work happening  our communities across the country.


What the Numbers Show So Far

Many of us are anxiously awaiting final enrollment numbers from all the marketplaces across the country, including the state-based (SBMs) and federally-facilitated marketplaces (FFM). When the FFM’s open enrollment closed on December 15, there were still eight SBMs with time left to go, so preliminary numbers didn’t paint the full picture. With the release of the FFM numbers, we learned that there was a slight 3.8% decrease in enrollment compared to the previous year. But we also learned that more people renewed their coverage from the previous year than we’ve seen in years past. All the headwinds that marketplaces faced leading up to and during the enrollment period, including the rhetoric around the election, cuts to enrollment and navigation programs, limited news coveragenew and different plan offerings, and the elimination of the individual mandate penalty, made for an extremely confusing and challenging enrollment period.

What to Do Next?

Enrolling consumers in coverage during the actual open enrollment period is only part of the work Navigators and CACs do year-round. In fact, enrollment taken altogether is only part of the work being done across the country. This work  never stopped at enrolling someone in coverage or helping them renew their plan. Enrollment work includes a tranche of services that result in helping our most vulnerable address social determinants of health including public education about coverage and what it means to use health insurance, incorporating culturally and linguistically appropriate explanations at the local level, providing in-person help, ensuring that consumers use primary care and understand the differences between urgent and emergency care, accessing other community benefits such as transportation, food programs,housing and much, much more.

At this point, it’s been reiterated that enrollment through special enrollment periods, Medicaid, and the Children’s Health Insurance Program happens throughout the year. But perhaps more importantly, Navigators and CACs are using that window of time to help consumers and patients navigate the complex health care delivery system as a whole. More often than not, community-based organizations getting involved in initiatives to address the health and wellbeing of consumers through community health worker programs, patient navigation pilots and programs, and other critical interventions which result in Navigators and CACs also serving in Community Health Worker roles and are now part of the health care delivery system. All of which  goes a long way to ensure we are serving the whole person and that we can begin to tackle the many health disparities communities are facing. The increased focus on improving access to primary care, integrating health and housing, improving access to behavioral health care, addressing other social determinants of health, and other activities, remain mission-critical and require increased funding.  


Protecting Programs that People Need

While there is still a ton of work that needs to take place to help consumers, there is also work we can all do to protect and defend the Navigator and CAC programs that consumers need and want. The new Democratic majority in the House of Representatives is looking to push forward health policy agenda items while also playing an oversight and investigative role. There are already oversight actions that the new majority has taken to further look into the cuts to marketing, outreach, and enrollment that the Administration took this past year. With this brings increased opportunity for funded enrollment navigation supports and the stakeholders who support their efforts locally, particularly in communities of color and non-English speaking consumers. As Congress continues to move forward with a health policy agenda and debates how to effectively structure safety net programs, these enrollment and navigation programs need to be highlighted as integral to the delivery system.

Get in Touch!

If you would like to work with Transform Health on any of these initiatives or have questions about what is taking place across the country, please contact Heather Bates at heather@transformhc.com or Liz Hagan at liz@transformhc.com. Also, remember to keep a look out for new materials and webinars hosted by other national groups, including the Get Covered Coalition and  In the Loop.