Lack of knowledge about insurance especially complicates enrollment efforts among Hispanics. A survey of uninsured Hispanic adults by the Robert Wood Johnson Foundation found that 91% of respondents indicated that they had limited knowledge about how to acquire coverage. Norberto Gonzalez, program coordinator with MHP Salud, has seen this while working in outreach efforts in Texas' Rio Grande Valley.
“We discovered that many applicants were not well informed about the Affordable Care Act,” Gonzalez said. “We learned not to give up.”
Access Health CT, Connecticut's insurance exchange, is focusing its outreach on 10 cities where the bulk of the state's uninsured population is concentrated. Roughly half of the state's African-American and Hispanic residents, who are disproportionately represented among the state's uninsured population, live in those metro areas.
The exchange is using cable TV buys to more precisely target potential customers in those cities. The Connecticut exchange also plans to run ads on Spanish-language TV stations and in black newspapers, said Jason Madrak, Access Health CT's chief marketing officer.
While 286,000 Connecticut residents enrolled in private coverage or Medicaid for 2014, there still are about 200,000 uninsured residents. Access Health CT hopes its more targeted outreach efforts will lead to an additional 70,000 individuals signing up for private plans.
Many outreach organizers say they are seeking to precisely target their resources where enrollment efforts will make the most difference. Christus Health, based in Irving, Texas, analyzed its market and patient data to create maps showing where the most uninsured and subsidy-eligible people live. The analysis will help tailor Christus' direct mailing to uninsured households in January and help identify which community groups the system will solicit as partners to promote enrollment. Christus will seek to enroll 100,000 in health plans this year, or 30% of those eligible in their markets.
But not all hospitals and insurers are spending a lot of effort on enrollment, based on their own cost-benefit assessment. Some say they are simply notifying uninsured patients about the exchanges. That's true for Excela Health, which owns three hospitals in and around Greensburg, Pa. Other providers and insurers see little benefit in trying to convince consumers who are reluctant or unwilling to buy insurance.
North Shore-Long Island Jewish Health System, based in Great Neck, N.Y., launched a health plan a year ago to compete for customers on the New York exchange. The health plan, CareConnect, has 15,000 members and ambitious plans for growth. But the uninsured aren't the primary target of its marketing efforts during the next three months.
Alan Murray, the health plan's CEO, said his organization's marketing will target consumers who already are shopping for health plans. Many who have decided not to enroll have done so based on personal reasons and their specific financial and other circumstances, and advertising and outreach likely won't convince them to reconsider. “That may take longer than one page in the newspaper or a 30-second commercial,” Murray said.
Among younger uninsured people, the calculus of whether or not to buy coverage may come down to cost. A survey by Deloitte Consulting of young adults ages 19 to 34 found that 66% of respondents indicated that they did not buy coverage during the first open enrollment because it was too expensive.
But such perceptions often are based on incomplete information. Just 55% of young adults said they were aware that federal subsidies were available to help pay for coverage. That may have led individuals to wrongly conclude that they couldn't afford insurance, said Paul Lambdin, a director with Deloitte Consulting.