ACA opposition may explain uneven enrollment in comparable states

Opposition to the Affordable Care Act (ACA) may explain why two pairs of states had very different performance outcomes in the federally facilitated marketplace (FFM) during the first open enrollment period.

The new analysis from the Urban Insititute, with funding by the Robert Woods Johnson Foundation, compares enrollment rates between North Carolina and South Carolina, and Wisconsin and Ohio.

According to the report, demographics, uninsurance rates and FFM premiums did not appear to explain the differences.

The states were chosen because North Carolina and Wisconsin both had relatively high enrollment rates compared with other FFM states and states using state-based Marketplaces, while South Carolina and Ohio had rates below the average FFM.

In Ohio and Wisconsin, the decision to expand Medicaid appears to have had the most impact. When 80,000 people lost Medicaid coverage in 2014, this identifiable group was steered to alternate coverage. In Ohio, there was a lack of a centralized message, according to the report, and the state suffered from lack of a collective outreach and enrollment strategy.

READ: Insurers help states expand Medicaid; private options multiply

In North Carolina versus South Carolina, anti-ACA sentiment was significant in both states but was more consistent and intense in South Carolina, according to the report. In addition, North Carolina had a robust outreach/ enrollment effort. Brokers and agent were important partners, and the state also a centralized scheduling system and a statewide toll-free ACA assistance number.

South Carolina’s navigator grant, which was used to provide community-wide assistance, was awarded to an out-of-state vendor with few ties to the community, another aspect that might have hurt outreach.

Affordability, lack of understanding about uninsurance terms, verification issues, and tensions between brokers and navigators were all cited as ongoing challenges to enrollment.