Uninsured Adults Remain Unaware of ACA Coverage, Subsidy Options

Despite the White House’s efforts to increase awareness about Affordable Care Act marketplace health plans, uninsured adults are still largely unaware of their coverage options, according to a fact sheet from Urban Institute.

The researchers leveraged Urban Institute’s Health Reform Monitoring Survey to analyze whether uninsured individuals were aware of their coverage and financial aid options through the Affordable Care Act.

Nearly half of all uninsured, nonelderly Americans (48.2 percent) had heard of the Affordable Care Act marketplaces. Around seven in ten individuals in the nonelderly, uninsured population reported that they had not heard any information or only a little information about the health insurance subsidies that are available to qualifying uninsured groups.

The researchers noted that there was very little difference between the results from the April 2021 survey and the outcomes from a similar survey that Urban Institute fielded in September 2020. 

In the September 2020 survey, 53.9 percent of respondents said that they had heard a lot or some about the Affordable Care Act marketplaces, but almost 65 percent had heard nothing or very little about the subsidies and financial supports available to them.

These problems persisted into April 2021. Most of the uninsured individuals who had heard about the marketplaces but had not enrolled in coverage reported cost as their primary concern and barrier to enrollment.

Younger adults and unemployed individuals were less likely to be aware of the marketplace plans or the subsidy options available. 

Of the individuals who had not heard anything or had heard very little about their marketplace and financial assistance options, 27.7 percent spoke Spanish or were bilingual, 15.5 percent did not have internet access, 47.8 percent were not working, and 20.6 percent had a high school degree or less.

To the researchers, these results emphasized the need for improved outreach strategies. In particular, policymakers should focus on refining outreach efforts for the younger adult populations and should work through unemployment offices to reach the unemployed community with marketplace and subsidy information.

“Without well-targeted outreach and enrollment assistance efforts, uninsured adults’ knowledge gaps could keep some from taking advantage of newly expanded enrollment opportunities and subsidies under the American Rescue Plan,” the researchers explained. 

“Outreach will need to be multilingual and accessible for people with different levels of education, be available across various platforms (online and offline), and use trusted community members (e.g., community health centers, community colleges, legal aid workers, and employers).”

Despite the low awareness among currently uninsured individuals, the Affordable Care Act marketplaces received a significant enrollment boost in 2021 due to the special enrollment period.

As part of this effort to increase Affordable Care Act marketplace enrollment, the US Department of Health and Human Services (HHS) dedicated at least $50 million on outreach efforts during the special enrollment period. The funds went toward broadcast and digital advertising as well as email and text communications with consumers.

CMS also offered $2.3 million in grant funding to 30 eligible Navigator organizations in order to provide better support to individuals considering their options on the Affordable Care Act marketplaces.

The agency is already preparing to further escalate consumer support and outreach efforts for the Affordable Care Act’s 2022 open enrollment. CMS announced that it will be offering $80 million to 60 Navigator organizations and estimated that this funding could allow the organizations to hire 1,500 Navigators for plan year 2022.

The grantee organizations must be dedicated to targeting underserved populations with their outreach efforts, CMS specified.

Although the funding starts in 2022, the grants are for a full three-year cycle and CMS will distribute the funds annually. With this regular funding, CMS leaders expressed the hope that Navigator organizations would be able to provide more consistent and efficient support.