Selling Health Coverage: Steps to Ensure Active Enrollment

Jennifer Sullivan is the Director of the Best Practices Institute at Enroll America, a nonprofit, nonpartisan organization whose mission is to ensure that all Americans are enrolled in and retain health coverage. The Best Practices Institute identifies, develops, and disseminates information on policies that will promote American enrollment in health coverage. Prior to joining Enroll America, Ms. Sullivan was a Project Officer in the Division of Children’s Health Insurance Programs (CHIP) at the Centers for Medicare and Medicaid Services, where her work focused on crafting CHIP eligibility regulations for the Affordable Care Act. Ms. Sullivan holds an M.H.S. in Health Policy from the Johns Hopkins Bloomberg School of Public Health and a B.A. in Sociology from Kalamazoo College.

The recent national survey that Enroll America conducted with Lake Research Partners outlines the difficulties ahead in convincing people of the affordable and high-quality health insurance options available for them through the Affordable Care Act. Did any of the survey results surprise you?

We had seen similar surveys completed before our survey was fielded that suggested a real public knowledge gap in terms of the new coverage that is coming, so I wouldn’t say that it was necessarily surprising to us. I think there were a lot of things in the survey that were comforting to know.

I would say the first is that the vast majority of the folks we surveyed recognize the value of health insurance. And they wanted it. If you think about our campaign as a marketing campaign, people want our product. That is a huge positive step in the right direction; you might not know it’s available or how to buy it, and you might want help learning how to buy it, but you want the product. And that is a tremendous hurdle we have overcome that we otherwise would have really struggled with.

The last thing was how much we could move the dial about the affordability of coverage when we did not talk about how much the coverage would cost out of pocket for somebody. We instead gave them the cost of coverage in the exchange as compared to the amount per month if there was no exchange. When you compare it with what they would have been faced with in the private market absent the health insurance exchange and premium tax credits, you really were able to significantly increase the percentage of respondents who thought that coverage was now affordable. This is key because affordability is the number one barrier they have encountered when trying to get health insurance in the past.

As you explain to the general public (or advise others in their attempts to educate the general public) about the pending changes, what are the key messages you are trying to convey?

I think the overarching message is extremely simple: there is new coverage available and there is help with the cost of it. When we try to dig deeper to lure folks in and get them interested in and intrigued to apply, the four messages are:

• All insurance plans will have to cover doctor visits, hospitalization, maternity care, emergency room care, and prescriptions.
• If you have a preexisting condition, insurance plans cannot deny coverage.
• You might be able to get financial help to pay for a plan.
• All insurance plans will have to show the cost and what’s covered in simple language and no fine print.

From the survey, we saw that 89 percent of the population, regardless of geography, income, race/ethnicity, educational background, and gender, hears the most important motivator to them from one of these four messages.

How do you employ family and friends in the outreach strategies you recommend to other groups? Furthermore, how is Enroll America utilizing this group in the large campaign you announced in January?

We are very much still in the creative process of figuring out how the campaign is going to look, but you can check out a preview at our newly launched campaign website, Get Covered America. When we look at the research results, people do want to hear from a family member. So there are different ways for us to think about what that means for the campaign. Does that mean that the voice in the advertisement or article is somebody that is a relatable family member? Or do we make sure that we cast a wide net and communicate with as many people and members of the community as possible?

Although there is a question about who the messenger should be, when we ask people in the survey where they are going to go for information, most folks say online. So even though they might want to hear about it from a family member or partner, when it actually comes to taking that step, they are probably going to go online.

Which items on Enroll America’s checklist, Seven Things to Do in 2012 to Keep Enrollment Progress on Track, have been most difficult for states to carry out?

We created the list with the idea of helping every stakeholder that might have a place in the outreach effort. For example, there are roles for state agencies, hospitals, health educators, and consumer advocates. Hopefully they can see themselves in that list somewhere.

When I think about which one is the most challenging to execute, it is probably the auto-enrollment piece for Medicaid and the Children’s Health Insurance Program (CHIP) because that usually requires legislative authority. The authority is not just from the state legislative level, but possibly also at the federal level, depending on what a state wants to do.

The federal government has been very supportive of  novel approaches to this, but there are still a lot of hoops to jump through to make auto-enrollment something that a state can actually do. Auto-enrollment is on the list is because it is such a powerful tool: it could possibly connect the largest volume of folks to coverage. It allows you to potentially reach thousands of people if every parent of a child already on Medicaid or CHIP should automatically be connected to the coverage option that is available and suits them.

Are there any elements on the checklist you feel have not been given adequate attention? Are there any low hanging fruit of which stakeholders should be aware?

First, we recently submitted a round of comments to the federal government on the model, streamlined application they are creating for every state. The idea with this new application is that your family or the household fills out one application and then everybody in the household gets connected to the coverage programs for which they are eligible.

The federal government has done a good job with their model application, but of course there is always room for improvement. We have encouraged them to do as much usability testing as possible because it is one of the best ways to catch problems and correct them.

We are also making sure there is as much collaboration as possible. We have tried to convene large and inclusive groups of stakeholders at the national level and in a number of states, but there are always groups that are late to the table. All of these perspectives, whether it’s consumer groups, tax preparers, hospitals, health centers, health insurance companies, pharmaceutical companies, or drug stores, are relevant. If the messages aren’t consistent or if the referrals don’t work, consumers could get lost in the system and fail to enroll. We know that bad news travels much more quickly than good news. If somebody has a problem with the process, they are going to go tell ten friends. But it might take ten successful processes for one person to tell one friend that it went well.

In terms of more general challenges, we also cannot overestimate the need for assistance. As simple as the new process will be, people are still going to need a lot of help. They think they are going to need help, they expect it, and they are going to be looking for help enrolling. Making sure that states and the federal government are able to leverage enough resources to get enough really well-trained folks on the ground and be able to provide that assistance is one of our number one challenges right now. Thinking about the role for private philanthropies and funding, outreach efforts, and training actual on the ground assistors is really important because I think we are going to need a lot of private efforts to augment what the states and federal government are going to be able to do.

Feature Photo: cc/Luca Rossato