The passage of the Affordable Care Act (ACA) in March 2010 marked an important change in the course of healthcare regulation and reform in the U.S. The law aims to cut the uninsured rate in the nation and expand public and private insurance coverage options through the introduction of new requirements and provisions such as the state Health Insurance Marketplaces.
Community Science, in partnership with other organizations involved in the National Partnership for Action to End Health Disparities (NPA), worked to document the outreach and education activities conducted by a select number of members of the NPA’s Regional Health Equity Councils in various states, including Michigan, Georgia, Tennessee, and Ohio. The events were designed specifically to inform vulnerable populations on the ACA and its enrollment process. Analyses of data collected by outreach and education event organizers showed that outreach events that were most effective were held in locations that were convenient to the target population (i.e., easy to get to, familiar, comfortable, and safe). These locations included places of worship, education settings, community health centers, and health fairs.
Follow-up conversations with event organizers confirmed that to effectively design outreach and education events where vulnerable populations reside, there needs to be a clear definition of the population being targeted as well as knowledge of how the community is organized. Part of the information gathering should include understanding how the target population participates and accesses health services, identifying who they trust and regard as leaders, and where they feel comfortable and will likely be more receptive to receiving health information. In addition, Community Science found that there was a lack of health insurance literacy across all states, including those newly enrolled in coverage. This has the potential to result in under-utilization of preventive healthcare services that are available to new enrollees, which potentially limits the effectiveness of the ACA.
For the ACA to be successful and deliver on its promises of increased coverage, quality health care, and cost containment, there must be widespread adoption. This requires reaching out to the uninsured, including those that are young and healthy as well as vulnerable populations that have limited access to care. The objective of the outreach is to raise awareness of the benefits, requirements, deadlines, and penalties associated with the implementation of the law and to get them enrolled by the deadline. To that end, there was a flurry of outreach and education events leading up to the first open enrollment deadline, which ultimately contributed to an increase in the enrollment numbers that reached eight million, exceeding the Congressional Budget Office’s estimates. However, after the proverbial dust settled, the government and community-based organizations were left with little information about which outreach and education strategies were most effective in educating and enrolling vulnerable populations in the Insurance Marketplace. Needless to say, this information is essential to making future open enrollment seasons more effective and efficient.
This year, Community Science has expanded the number of organizations it has partnered with to evaluate different types of outreach strategies that will be delivered by community-based organizations located in areas that have the highest uninsured rates and number of potential enrollees remaining. The objective of this work is to identify the needs of racial and ethnic minority populations and other underserved populations, especially as it relates to effective outreach and communication strategies for increasing their enrollment under the ACA, as well as familiarity with coverage available under insurance plans for new enrollees. To conduct this work, we have selected organizations with a deep level of understanding of their communities’ organization, e.g., its culture, languages, neighborhoods, and needs related to health insurance and health care. Data from this project will be disseminated to the community of navigators and other practitioners and organizations engaged in outreach and education under the ACA. This work will be conducted to support the mission of the Office of Minority Health within the Office of the Secretary at the U.S. Department of Health and Human Services and the ACA education and outreach priority area of the National Partnership for Action to End Health Disparities.