Implementing National Health Reform

A Five-Part Strategy for Reaching the Eligible Uninsured

Health coverage programs often fall short of their enrollment goals. Even the Children’s Health Insurance Program, now very effective in reaching uninsured children, had difficulty reaching all eligible children in the program’s early years. This issue brief written by the Urban Institute’s Stan Dorn explores why enrollment can be so challenging, and provides tactics for federal policy-makers to increase participation in health insurance programs created or expanded by the Affordable Care Act (ACA).

Dorn notes that programs like low-income subsidies for Medicare Part D and Massachusetts’ 2006 health reforms rapidly achieved high participation levels by using reliable data to identify eligible consumers, qualify them for assistance and enroll them in coverage. For similar results when ACA’s main provisions begin in 2014, Dorn says that federal policy-makers could pursue a strategy with five parts:

  • Conducting a national campaign that gives the uninsured the option of using their federal tax returns to request health coverage;
  • Basing eligibility determinations on reliable data, whenever possible;
  • Partnering with states to help consumers receive hands-on assistance completing necessary forms;
  • Creating consumer-friendly enrollment systems; and
  • Coordinating efforts among agencies that have a role.

By improving enrollment in available health insurance options, these steps could help achieve ACA’s basic goals for expanding coverage. At the same time, using reliable data to qualify the uninsured for coverage could lower administrative costs and prevent those ineligible from receiving assistance.