Urban Insitute: Outreach to uninsured about ACA exchanges, subsidies lacking

Affordable Care Act highlighted
A new analysis finds many uninsured Americans are uninformed about their options on the Affordable Care Act's exchanges. (Getty/Ellenmck)

Many uninsured Americans lack information about the Affordable Care Act's exchanges and the subsidies that may be available to them on the marketplaces, according to a new report.

Fewer than half (48.2%) of nonelderly adults who were uninsured in April 2021 said they had heard "a lot" or "some" about the marketplaces, according to the study from Urban Institute, a left-leaning think tank. In addition, 32.2% said the same about subsidies.

Urban found similar results in a September 2020 survey, suggesting limited outreach has taken place in the interim, even as the Biden administration rolled out enhanced subsidies on the exchanges and an extended special enrollment period due to the pandemic.

The report also found that among people who were aware of their options on the exchanges but who did not select a plan, the main deterrent was cost. Both of these findings suggest there is a significant need for policymakers to enhance their outreach efforts around the exchanges and programs that can ease cost concerns.

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"Without well-targeted outreach and enrollment assistance efforts, uninsured adults’ knowledge gaps could keep some from taking advantage of newly expanded enrollment opportunities and subsidies under the [American Rescue Plan]," the researchers wrote.

"As federal and state governments prepare for the next open enrollment period, beginning November 1 for the federal Marketplace, it will be important to assess the adequacy and effectiveness of outreach efforts and enrollment support from navigators to help uninsured adults learn about and obtain the coverage they need," they said.

The report outlines some specific ways federal and state policymakers could enhance their outreach. For one, many of the people who said they lacked information about the exchanges were younger, which indicates targeted messaging may be needed.

In addition, many people with limited awareness of the exchanges were not working at the time of the survey, meaning unemployment offices could be an avenue for enhanced outreach to these people.

Effective outreach should be multilingual, the researchers said, as well as available from trusted sources such as community health workers, employers and legal aid services. People should also be able to access the information they need both online and offline, according to the report.

"Difficulties reaching populations with information about the [American Rescue Plan's] new affordability provisions could limit their effectiveness," the researchers wrote.