Looking Forward: Enrollment Lessons from New National Survey Results

By William Tomasko

What lessons can be learned from the Affordable Care Act’s first open enrollment period and how can enrollment be improved for the next round?

Our newly released report on national survey results from PerryUndem adds to the growing body of knowledge about why some people enrolled in health coverage and why others did not enroll. It shows there was a high demand for health coverage, even among those who ultimately did not enroll. It identifies knowledge and perception barriers to enrollment, which may be hard to overcome. But perhaps most critical, the survey suggests there could be a large consumer market for the next open enrollment period – 84 percent of uninsured survey respondents seem at least open to looking for coverage.

Based on these survey findings, following are recommendations from Enroll America and PerryUndem for the next open enrollment period:

1. Recognize that most uninsured individuals want affordable health coverage. The survey suggests this is true and that individuals are willing to put time and effort into enrolling. They want insurance.

2. Understand that the law and fine (and how it is increasing) motivated many to enroll. Talking more explicitly about the mandate and the increasing fine may encourage more people to enroll next time. However, this will not be enough. Being able to see a doctor and avoid big medical bills were also important motivators and should be part of the conversation.

3. Address affordability perceptions/misperceptions. The belief that insurance is not affordable kept many from even looking for coverage. This is the barrier that must be addressed. Part of the issue may be the low awareness that financial help was available to low- and moderate-income individuals. Continuing to raise awareness about the tax subsidy may be important. 

4. Keep educating. There were many knowledge gaps about key aspects of the Affordable Care Act – and about insurance – that still need to be addressed. Those who enrolled knew more; knowledge may be a factor in enrollment.

5. Use the “news” to educate. For better or worse, “news” is where most survey respondents get their information on this topic – particularly local TV news programs and online sources. It may be important to consider the role of these sources in relaying important information about the law and enrollment to the remaining uninsured. Advertising may also be an effective tool – those who saw ads knew more facts about the law and enrollment. 

6. Provide Latinos with more details and enrollment help. They were more likely than others to find enrolling confusing and to question whether they were eligible or not. They also seem to value in-person enrollment assistance more than others. 

7. Activate moms (and other family members and friends) to enroll young adults. Moms played an important role in enrollment for young adults. Also important is talking about the mandate and the increasing fine with this age group.

8. Improve the enrollment process. While enrolling was easy for many, it was not for others. Many of those who did not successfully enroll dealt with website problems, confusion, and could not find answers to questions. Perhaps educating this population about free in-person enrollment assistance could help – people who enrolled this way were more likely to find the process “easy.”

For more details on these findings, click here to read the full research report.

And to see the top-line survey results, click here.

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