The NCSL Blog


By Martha King

With fall leaves painting the landscape, it’s time to think about the next open enrollment period to purchase health insurance under the Affordable Care Act.

Second year enrollments begin Nov. 15 and run through mid-February, a shorter period than last year. Aside from hoping that the marketplaces operate more smoothly this year, what other enrollment issues are percolating?

The Department of Health and Human Services reports that 7.3 million paying customers enrolled in subsidized insurance plans as of mid-August. Those people will have the opportunity to switch plans during open enrollment if they find one more suitable to their needs and pocketbook.

Millions of additional uninsured Americans may qualify for insurance subsidies as well, but have not yet enrolled. Some of them may have been discouraged by the technical glitches that most web-based marketplaces experienced in their first year, others may have been confused about their choices and the application process, while the remainder may have been unaware, skeptical or not interested. 

According to a Commonwealth Fund Survey, 18 percent of young adults, 23 percent of Latinos and 24 percent of low-income adults remain uninsured. States are gearing up their outreach efforts to find and assist these groups. Several outreach and enrollment strategies have shown promising results in reaching uninsured people and assisting them with obtaining coverage:

  • Marketing and public education delivered through materials in multiple languages raises awareness of coverage options.
  • Targeted messages are needed to reach and enroll hard-to-reach individuals.
  • Trusted community groups, such as faith-based organizations, nonprofit agencies, community health centers, schools and health care providers connect with individuals who are traditionally hard to reach.
  • In-person, one-on-one application assistance can have a significant impact on enrollment.
  • Simplifying enrollment policies and procedures facilitates enrollment.

NCSL’s report, “Medicaid and Marketplace Outreach and Enrollment Options for States” provides additional information about successful enrollment strategies. 

Looking forward, many state legislatures will again be considering legislation about these issues in the upcoming legislative session. In 2014, NCSL tracked more than 100 bills in 33 states related to regulating navigators, in-person assisters and/or certified application counselors.

Martha King is group director for NCSL’s Health Program.

Email Martha.

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About the NCSL Blog

This blog offers updates on the National Conference of State Legislatures' research and training, the latest on federalism and the state legislative institution, and posts about state legislators and legislative staff. The blog is edited by NCSL staff and written primarily by NCSL's experts on public policy and the state legislative institution.