The Patient Protection and Affordable Care Act, more commonly called either Obamacare or the ACA, was signed into law in March 2010. Two initiatives were implemented to help people enroll in healthcare insurance:
- Navigator Programs: a network of individuals (Navigators) providing free in-person assistance for application and enrollment into health coverage options through the Marketplace, including completing eligibility and enrollment forms (see federal rules, 20583).
- Outreach activities: educating people about health insurance, their rights and responsibilities, and how to access application assistance. Outreach activities encourage people to enroll in health insurance.
Minnesota’s health insurance exchange, MNsure, used training and certification to develop a broad base of Navigators and grants to community-based organizations for outreach. Beginning in late 2014, The Improve Group evaluated the Navigator and outreach programs. The evaluation explored the effectiveness of the programs and challenges that exist in increasing enrollment through consumer surveys, Navigator surveys, interviews and analysis of MNsure data. The Improve Group findings determined that:
- Navigators spend significant amounts of time with each applicant, particularly when following-up about the status of an application and submitting verification information.
- Strong relationships served Navigators, and the applicants they served, well. When Navigators were able to establish relationships with insurance agents, counties, and other providers, they were able to answer questions more effectively for applicants.
- Navigators had to manage multiple technical challenges, including not being able to access online enrollment forms and not being able to check the status of applications. Many of the applicants they helped would have been able to enroll in insurance independently if not for technology barriers.
- Applicants sought out help to understand applications and learn more about insurance. They were satisfied with the help they received from Navigators.
Other states have evaluated their outreach and Navigator programs as well. For example, a study by Community Science used a survey designed to understand the impact of outreach events in Florida, Michigan, Ohio, Tennessee and Georgia. It studied changes in knowledge and intended behavior, such as whether people planned to enroll in health insurance after attending an event. As in Minnesota, strong relationships helped the enrollment process. For example, Oscar J. Espinosa described how the extensive outreach networks in Florida, originally designed to increase voter turnout in recent presidential elections, were used to encourage people to attend outreach events and enroll. Another study by the Kaiser Family Foundation also found that people sought assistance from Navigators because of glitches in technology. Findings from evaluation studies will help the Navigator Programs and outreach activities continue to grow and be successful in helping individuals enroll in healthcare. Each of the aforementioned studies focused on results in the first two ACA enrollment periods (2013-2014). Overall, the number of people without insurance has declined since the beginning of the programs; in Minnesota, the percentage of people without insurance fell from 8.2 percent to 4.9 percent between September 30, 2013, and May 1, 2014. In the years ahead, evaluation can continue to uncover what is working, what isn’t, and help develop the programs for maximum impact. You can access our Evaluation Plan for the Navigator Program here.
The full report of The Improve Group's Evaluation of the MNsure Navigator Program can be viewed here.