In the JAMA Health Forum, Coleman Drake and I laid out ways that state and federal regulators as well as insurers can optimize the ACA exchanges now and for the 2021 open enrollment period that starts this November to cope with the expected surge in demand.
There are several areas of focus.
First, exchange regulators need to minimize administrative burden for special enrollment periods. Accepting attestations of changes in circumstances is an immediate and ongoing step that will help people enroll and stay enrolled. Normal SEPs have significant validation and documentation requirements. As there have been mass lay-offs and furloughs, not all HR departments will be sending out timely paperwork. Accepting attestations should be sufficienct.
Next, states that run their own exchanges should be directly linking social service data to both the state based Exchange and Medicaid enrollment portals. Any data that can be legally shared between eligibilty systems should be shared and pre-populated. Maryland and Colorado are aggressively linking tax data to eligibility files to maximize the targeting of outreach. States using Healthcare.gov should be setting up frequent splash pages with ACA explainers and direct links to Healthcare.gov account creation.
The ACA markets are not intuitive. They are also markets with significant churn. People, especially individuals who are typically insured by employer sponsored insurance, don’t know how the ACA works. Aggressive media and communications campaigns employing both paid and earned media by trusted local intermediaries should be implemented to encourage people to look for options on the marketplaces.
Finally, states can work on pricing. The few states that have not Silverloaded should silver load. States and insurers should seek to maximize the premium spread between the benchmark and the plans priced below the benchmark. State regulators should strongly discourage “Silver spam” practices and strongly encourage insurers to offer plans that are truly meaningfully different.