Feb, 07, 2020

Open Enrollment Recap: States Driving Progress

Julie Bataille  and Alison Kruzel , GMMB


As we round out the seventh year of ACA open enrollment, State Health and Value Strategies (SHVS) is reflecting on the successful steps that states have taken to provide quality, affordable health coverage to more residents and draw on lessons learned as this work moves forward. States are leaning in to implement new policy solutions to reduce premium costs and stabilize their markets, and doubling down on marketing and outreach efforts in the face of reduced federal funding. Seven years in, marketplaces and markets are stable, consumers have more options, and we continue to see a demand for quality, affordable coverage. In fact, early results show the number of new consumers enrolled through HealthCare.gov increased during this open enrollment period, and several state-based marketplaces saw increases in their total enrollment figures.[1] There is certainly more work to be done to increase access and improve affordability for all Americans, but the momentum is in the states. As such, SHVS is excited to launch a series of posts featuring policy and outreach strategies states are employing to meet the needs of their residents. This Expert Perspective highlights some of the key ways in which states are driving efforts to increase enrollment this past open enrollment period. Subsequent posts will include deep dives into certain specific state policies and outreach strategies, such as plan standardization and targeted outreach to address health disparities in coverage.

Policy and Outreach Lessons from States

As states seek ways to ensure that consumers have access to options for health coverage, many have implemented new policies to foster competition and participation in the market, so that they can remain robust and sustainable moving forward. Alaska, Colorado, Delaware, Maine, Maryland, Minnesota, Montana, New Jersey, North Dakota, Oregon, Rhode Island and Wisconsin have implemented reinsurance programs, ensuring carriers are reimbursed for covering the most expensive patients and lowering the cost of premiums for consumers by nearly 20 percent on average.[2] California, D.C., Massachusetts, New Jersey, Rhode Island and Vermont have established their own state-level health insurance mandates. Colorado saw the formation of a cooperative alliance, Peak Health Alliance, to leverage buying power and lower premiums for consumers. And 23 states have imposed limits on short-term health plans to ensure comprehensive coverage and protections for consumers—something we expect to remain a focus as results of a federal inquiry into deceptive marketing practices surrounding theses plans is expected in the coming weeks. Furthermore, some states are considering standardizing plans to allow consumers to make “apples- to-apples” comparisons. More states are considering similar initiatives as they see the results of these efforts taking hold.

Beyond these significant policy changes, the operational efficiencies and robust outreach and education efforts of the state marketplaces continue to be critical to their success. We’ve seen increasingly sophisticated customer support tools available to help consumers make informed plan selection decisions; improved online experiences reflecting user testing and optimizations; online chat features and integration of online, in-person and telephone customer support. Combined, these factors have eased burdens on call centers, lowering wait times and improving the overall consumer experience.

States have promoted these tools as well as enrollment dates and events via targeted integrated marketing campaigns, using research-based messaging that emphasizes the availability of financial help, annual changes in plans and prices, and enrollment deadlines. States have also employed targeted outreach strategies to improve access to coverage for specific populations, such as Hispanics, young adults, and the remaining uninsured.

The outreach happening in states—including in those who still use the HealthCare.gov platform—has been crucial in engaging the hard-to-reach populations and counteracting reduced federal marketing and outreach funding. By building on outreach strategies that have been successful year after year and continuing to innovate, states are making progress in reaching and enrolling residents.

States efforts helped counteract the Congressional Budget Office’s expected loss in coverage following the 2017 congressional action mandate repeal. And in part thanks to these enhancements, Maryland saw their highest enrollment numbers in four years, while Massachusetts’ enrollment increased by more than 5 percent compared to the previous year.

Looking Ahead

Despite the tireless work of state policymakers, health insurance marketplaces, outreach workers and others, much work remains to be done to provide consumers with affordable health care options. States are constantly facing new challenges as federal policies and rulemaking shifts, and as the Texas v. U.S. court case makes its way to the Supreme Court—this makes state innovation all the more important.

As the first state to transition from HealthCare.gov to a fully operational state-based marketplace platform, Nevada Health Link has seen promising 2020 enrollment numbers that demonstrate consumer demand and pave the way for other states positioned to make this move. Doing so allows states more autonomy in decision-making and complete access to data to drive their enrollment efforts. Other states have taken note—New Jersey, Pennsylvania and New Mexico have passed legislation authorizing the state to establish a state-based marketplace in the future, while others including Oregon, Maine, Virginia and Illinois are in the early stages of exploring this possibility. How states operationalize, implement and evolve their marketplace is something we will be watching closely.

It is clear that states are making progress and building on what they have learned in their ongoing efforts to make health care more accessible, affordable and equitable for their residents. We are looking forward to seeing more state innovations and sharing those stories.


[1] https://www.cms.gov/newsroom/fact-sheets/2020-federal-health-insurance-exchange-enrollment-period-final-weekly-enrollment-snapshot

[2] https://www.shadac.org/publications/resource-state-based-reinsurance-programs-1332-state-innovation-waivers