The Trump administration has proposed severely cutting the advertising budget for the Affordable Care Act (ACA) and significantly reducing funding for another program that helps connect people with coverage. Supporters of the ACA have extensively criticized this approach as an attempt to undermine the current law and drive down enrollment in Medicaid and the ACA marketplaces.
The administration says advertising and the federal navigator program that helps consumers enroll in health plans have been ineffective, pointing to lower than expected enrollment. The focus on enrollment, however, misses an equally important issue.
Enrollment in health coverage is not a goal, but a means to an end. Health insurance is intended to give people access to needed care and provide financial security against the risk of catastrophic medical bills. Connecting insured people with health care is a critical next step to any related outreach for insurance coverage. Yet, debates over proposed cuts to outreach and enrollment efforts largely ignore the fact that many people need support to help them know what to do once they have enrolled.
Advertising for the ACA uses the mass media to communicate general information about open enrollment dates and how to get help with the enrollment process. While such communication is helpful in raising awareness, it provides little practical help to those trying to obtain coverage, according to recent RAND Corporation research my colleagues and I conducted.
Our research did not shed light on whether cutting the ACA's advertising budget would have discernible effects on enrollment, but we did ascertain what most individuals want to know: “What does the ACA (and any proposed changes) mean for me, how should I select a plan, and then what do I do next?”
Americans' lack of knowledge about health insurance and inexperience with primary care pose significant threats to improving health and lowering health care costs.
ACA outreach programs help individuals understand whether they are eligible for health insurance, provide enrollment guidance for thinking about plan options, and help individuals complete the application process, but do little to support them once the enrollment process is complete. Americans' lack of knowledge about health insurance and inexperience with primary care pose significant threats to improving health and lowering health care costs in the U.S.
Health insurance provides an affordable opportunity to take advantage of well visits and other preventive services like health screenings, which are typically provided at low or no cost to the patient. This enables health care providers to identify risk factors for chronic disease like high blood pressure or high cholesterol before they pose a serious health risk and to suggest ways to become healthier, like modifying diet and exercise.
Similarly, common cancer screening tests like mammography for breast cancer or colonoscopy for colon cancer increase the chances that any changes in health will be detected earlier — potentially helping the insured avoid costly, more invasive treatments or hospitalization.
Each consumer approaches the health care system with a unique cultural perspective influenced by personal experience, literacy levels, language preferences and beliefs about health. Finding a provider who fits these preferences can be challenging, particularly within a limited network. In our research with newly insured individuals, the notion of “finding a provider who was right for them” was empowering.
Many were surprised to learn they could change providers if they were dissatisfied with their present one. Providing support for ACA enrollees to connect with care they are happy with can help minimize the risk they will stop seeking routine health care.
One potential solution would be to provide the necessary funding to train navigators and others who already provide in-person assistance to enrollees to take a natural next step — and continue giving support once enrollment is completed. Funding for such assistance needs to be strengthened not cut. Regardless of the shape the ACA takes, enrollees need support before and after they sign up for a plan so they can make the most of their health care.
Laurie T. Martin is a senior policy researcher at the nonprofit, nonpartisan RAND Corporation and a professor at the Pardee RAND Graduate School.
This commentary originally appeared on The Hill on October 11, 2017. Commentary gives RAND researchers a platform to convey insights based on their professional expertise and often on their peer-reviewed research and analysis.