“What We Learned”: Preliminary Observations from Enroll America’s Extensive Data on Affordable Care Act Enrollment Efforts

Wednesday, April 4, 2014
Contact: Justin Nisly
Press@enrollamerica.org | 202-601-2494

It is now clear that the first Affordable Care Act open enrollment period was a success; despite early problems with the website, more than 7 million Americans were able to find coverage through the Marketplace, in addition to millions more who were covered under Medicaid. Enroll America’s vast grassroots, digital, and partnership outreach campaign gives us an unprecedented data set to analyze to learn more about the enrollment process:

  • Over 5 million consumers engagements – including one-on-one conversations with our volunteers, unique visitors to our website, and consumers reached through partners like churches and community colleges,
  • More than 22,000 events over the open enrollment period,
  • More than 635,000 one-on-one conversations with consumers.

Analyzing all of that data in order to learn what worked and replicate those best practices in the future will take time, and we will be releasing detailed analyses in the coming weeks and months. But throughout this first enrollment period, there were four initial lessons that proved core to our outreach and strategy over the course of the last six months.

1. Uninsured consumers – especially young, African-American, and Latino consumers – often need multiple touches to move them to action, but repeated engagement can significantly reduce the enrollment gap for young people and communities of color.

With each contact from an Enroll America volunteer or staffer, consumers became more likely to successfully enroll. This effect was particularly strong among difficult-to-reach populations: African-American and Latino consumers were about twice as likely to enroll after the third follow-up, and young people were more than twice as likely to enroll after the third follow-up.

In fact, even though young, African-American, and Latino consumers started out as significantly less likely to enroll than average, by the time they had been contacted four times, that gap significantly shrinks and they were nearly as likely to enroll as other consumers.


Source: Enroll America Field Program, October 2013-March 2014

2. Informing consumers about the availability of financial assistance was the single most important way to motivate uninsured consumers to enroll.

The survey by Perry/Undem that we released in January told us perceptions of unaffordability was the single greatest barrier to enrollment. So we stepped up efforts to educate the uninsured about the availability of financial help, through our outreach messaging, earned media efforts, and advertising. That shift in focus had an immediate impact:

  • Click-through rates on our digital advertisements jumped 16% as soon as we shifted to a financial help message, and continued to out-perform all other messages.
  • Emails to our list of one million consumers showed a 150% higher click-through rate when featuring an affordability message and access to consumer personalization tools, as compared to stories of consumers who had successfully enrolled.
  • A shift in homepage message from stories to consumer tools, including the Get Covered Calculator, resulted in a more than a ten-fold increase in clicks.
  • In fact, with more than 500,000 unique page views, the Get Covered Calculator was the single most popular tool on our site, the most popular tool used by our partners, and the page that connected the most consumers directly to their marketplace to enroll in coverage.

3. In-person help is essential, especially for hard-to-reach communities.

Consumers who received help from a navigator, certified application counselor, or other in-person assister were about twice as likely to successfully enroll as compared to consumers who attempted to enroll online without help. In-person assistance is particularly important in communities of color, where we saw African-Americans and Latinos to be 43% more likely to seek in-person help than their White counterparts.

For that reason, over the course of open enrollment the Enroll America field program placed more emphasis on large-scale enrollment events like the National Latino Enrollment Summits to make sure consumers had opportunities to enroll with in-person assistance. This tactic proved especially important during the final weekend of open enrollment, when long lines and high attendance at enrollment events across the country played a critical role in serving last-minute enrollees.

The digital program also emphasized connecting consumers with in-person assistance. The Get Covered Locator was developed to help connect consumers with in-person help. This tool was built upon internally audited data made publicly available by the Centers for Medicare & Medicaid Services, coupled with assister data curated by partner organizations and our field program. Featuring the Locator in our emails generated click rates roughly two times greater than those of stories of consumers who had successfully enrolled. The Locator has been used roughly 175,000 times to help consumers connect with local, in-person assistance.


Source: Enroll America Follow-Up Program, November 2013-February 2014

4. The deadline was highly motivating for consumers, and Enroll America and our partners were well positioned to manage the surge of interest ahead of March 31.

Based on past enrollment efforts, we always assumed that there would be a huge spike in interest as the enrollment deadline approached, which is why we focused on building the staff, volunteer, partner and digital capacity to handle that surge when it arrived. By the final month of open enrollment, we had engaged more than 27,000 volunteers and more than 2,300 partner organizations in our effort, and built a robust digital presence – including a Calculator, Locator, and Plan Picker – to help consumers quickly find information and connect to their enrollment options. That work paid off over the month of March, when we saw rapidly growing interest both online and in the field.


Source: Enroll America Digital Program, October 2013-March 2014

The above chart shows the cumulative growth in consumers connected to their state or federal marketplace or a local assistor from GetCoveredAmerica.org.


Source: Enroll America Field Program, June 2013-March 2014

The above chart shows the cumulative growth in both our events and in the event attendance.


Source: Enroll America Field Program, August 2013-March 2014

The above chart shows our cumulative growth of consumers we spoke with over time with a ramp in activity in the last month.


About Get Covered America and Enroll America

Get Covered America is a national campaign of Enroll America that is focused on educating consumers about the benefits of health coverage and the new health insurance options available under the Affordable Care Act. With operations in eleven states (AZ, FL, GA, IL, MI, NC, NJ, OH, PA, TN and TX), our grassroots team is powered by passionate staff and volunteers with one motivating goal: to give Americans the information they need to choose an affordable health insurance plan that’s right for them and their families.

Enroll America is the nation’s leading health care enrollment coalition, bringing together community and health organizations, businesses and others to inform consumers about new health coverage options and how to enroll in them. It is an independent, nonpartisan, nonprofit 501(c)(3) organization.

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