Taking Stock and Taking Steps

A Report from the Field after the First Year of Marketplace Consumer Assistance Under the ACA
A man fills out an insurance application.

The emergence of Marketplace Assister Programs around the country is a significant health policy innovation attributed to implementation of the Affordable Care Act (ACA.)

The Issue:

To facilitate the substantial volume of ACA enrollment and related activities around implementation, approximately 4,400 Marketplace Assister Programs, employing more than 28,000 full time-equivalent staff and volunteers, served consumers nationwide. All Assister Programs were expected to help consumers understand their coverage options, apply for financial assistance, and enroll. Additional functions undertaken by many assisters included outreach and education; help with post-enrollment questions and problems; assistance with appeals of eligibility determinations; and help applying for other public benefits and services.

The majority of these programs that were operational in 2013-2014 needed to organize, launch and scale-up quickly to be ready for the ACA’s first open enrollment period. Because so many programs were new or substantially expanded their scope during this first year, this period was also characterized by both the need and opportunity for widespread “learning by doing.”

The Kaiser Family and Robert Wood Johnson Foundations convened a national Roundtable on consumer assistance in June of 2014. The purpose was to engage practitioners and other experts in a conversation about the establishment of new consumer assistance capacity. Eighty-five leaders engaged in designing, directing, implementing, supporting, funding or coordinating with Assister Programs participated in the Roundtable.

Year One Challenges, Innovations and Lessons for the Future

Discussion throughout the Roundtable focused on what facilitated and what impeded assisters’ work during their first year of operation. A number of themes were developed as participants described their experiences, as follows:

  • The need for assisters to build relationships with many consumers prior to the enrollment process in order to successfully engage them and lay the groundwork for successful enrollment;
  • How complicated it is to implement a new national program and adapt it to a variety of local contexts and client populations;
  • The complexity of eligibility determinations, particularly for specific populations such as immigrants, those with special health care needs, and those who do not speak English;
  • The nuances associated with helping consumers match their health and financial needs to plan characteristics;
  • The extent to which clients continued to need help from assisters after initial enrollment;
  • How various components of Marketplace assistance fit together – and the need to create a functional infrastructure that can support both assisters and consumers.

This report summarizes the Roundtables’ discussions and highlights the challenges ahead, including some promising ideas and concrete next steps that might be taken to strengthen consumer assistance.