6 Strategies to Evolve the Affordable Care Act Marketplaces

The Affordable Care Act marketplace presents many opportunities for developing new strategies and technological solutions, particularly for states that are transitioning to state-based marketplaces, experts from Manatt Health and Robert Wood Johnson Foundation stated in a brief.

“The brief is intended for states that are considering a transition to SBM status as well as a broader audience interested in the role of Marketplaces in expanding and enhancing coverage,” the executive summary explained.

“While there has been a resurgence in states transitioning to SBM status over the past two years, the Biden Administration could change the calculus for some states by pursuing a stronger role for Healthcare.gov in driving coverage improvements.”

The first ten years of the Affordable Care Act saw the evolution of the Act’s two marketplace tracks—the federally-facilitated marketplace and the state-based marketplaces—and the third, hybrid option, the state-based marketplace on a federal platform.

Healthcare.gov and enhanced direct enrollment platforms were the online tools for navigating the federally-facilitated marketplace. State-based marketplaces developed and paid for their own distinct sites and also tended to invest more heavily in outreach.

State-based marketplaces may be better at outreach, but they struggle with technology, particularly marketplaces that departed from the federally-facilitated marketplace early on in the Affordable Care Act’s existence.

The brief argued that the federally-facilitated and state-based marketplaces can improve the consumer experience by sharing technologies.

There are six areas in which the Biden administration could improve the Affordable Care Act marketplaces technologically.

First, the administration can invest in consumer decision-making tools.

The federal government should dedicate more funding toward identifying successful site innovations around consumer decision-making tools, the researchers said. Then, CMS should share the information and capabilities with state-based marketplaces.

Both the federally-facilitated marketplace and the state-based marketplaces have advanced technologically in the last decade. Consumers can sort through their options using filter and sort capabilities on Healthcare.gov. States have implemented live chat features, which the federally-facilitated marketplace lacks.

Increased funding could further improve these tools, leading to better consumer experiences overall.

Second, the Biden administration should enable data-sharing between the federally-facilitated marketplace and state-based marketplaces on the federal platform. States could leverage this data to hone their outreach strategies while remaining on the federal platform.

Timely data is key for essential processes, including assessing enrollment variations, determining the demographics of non-enrollees, and targeting consumer support. Receiving such data from the federally-facilitated platform might support states in these processes. States would also have more incentive to remain on the federal platform.

Third, aligning Medicaid, the marketplaces, and other state entities—such as unemployment insurance—could allow states to integrate multiple coinciding processes, streamlining the consumer experience.

For example, when an individual is applying for state benefits such as unemployment insurance, the site could gather information about financial data in order to assess eligibility for Medicaid or tax credits.

Some states have already integrated their marketplace with other state benefits, particularly Medicaid.

Fourth, states could incorporate enhanced direct enrollment into their strategies more easily if the federally-facilitated marketplace shared enhanced direct enrollment technologies with states.

Enhanced direct enrollment has proven to increase enrollment, the researchers pointed out. Forty-five percent of consumers who enrolled for marketplace coverage through an enhanced direct enrollment platform during the 2020 open enrollment period were new customers.

The federal government has already invested in enhanced direct enrollment platforms. Sharing those technologies and insights with state-based marketplaces could be beneficial for streamlining processes overall, the researchers asserted.

States already have become innovative with their enrollment strategies, with Georgia going so far as to propose a model that eliminates state and federal marketplaces altogether opting instead to rely on private enrollment platforms.

Fifth, the federal government could set up a national eligibility service that calculates Marketplace premium tax credits. If implemented, states would be able to focus on outreach and enrollment, instead of spending their time, focus, and funding on assessing eligibility and determining premium tax credits

A national eligibility service would also complement enhanced direct enrollment platforms, the researchers suggested.

Finally, the brief recommended explaining policy flexibilities for federally-facilitated marketplaces, state-based marketplaces on a federal platform, and state-based marketplaces. States would benefit from a concise break down of the flexibilities that they could leverage in each marketplace track as they consider whether to become a state-based marketplace.

CMS recently did this with Medicaid social determinants of health flexibilities, releasing a detailed explanation of the various flexibilities that Medicaid programs can leverage to address social determinants of health.