Confusion, Mistrust Hinder Insurance Sign-ups, Study Says

A new study of Colorado's first Affordable Care Act open enrollment period shows a range of missed opportunities.

Mistrust and confusion remain major barriers to the success of insurance expansion under the Affordable Care Act, according to a new study.

The Colorado Health Foundation commissioned the Rand Corp. to study outreach and enrollment efforts in Colorado following the first open enrollment period using Colorado’s state-run healthcare exchange. The exchange succeeded in helping 300,000 Coloradans sign up for health insurance or Medicaid. However, that’s less than half the state’s pre-Obamacare uninsured population, according to estimates.

Rand conducted focus groups with uninsured and newly insured Coloradans. They found politics and mistrust of the ACA’s individual mandate kept some away, while confusion, misunderstandings, or technical difficulties caused others not to enroll, even if they were eligible for Medicaid or insurance subsidies.

The Rand researchers recommended Colorado do more to target specific communities and populations with tailored information, focus more on the benefits of healthcare, and simplify plan materials. The authors said any health insurance material should be written at a fifth-grade reading level in order to reach the entirety of the uninsured population.

The study’s authors also suggested that marketing materials focus on the benefits of health insurance and steer clear of the political controversy surrounding the ACA.

“Most consumers felt that the messaging they heard through the media and other sources about health insurance was negative and threatening,” the authors wrote. “They felt a more specific discussion about the health benefits of insurance, such as coverage for immunizations, free visits for preventative care, and dental coverage, would be useful and compelling.”

Consumers also wanted more specific financial information about their plans. The website and plan materials laid out the cost-sharing structure of each insurance plan in terms of percentages — how much the insurer paid and how much the patient was responsible for.

“Percentages are not only harder to calculate, but the total cost of these services varies by provider and is not transparent,” the authors wrote. “For individuals on tight budgets, this quickly becomes a risk they are not willing to take.”

The Rand researchers acknowledged that it can be very difficult to give actual costs, but said many uninsured people have a good understanding of what a doctors’ visit will cost without insurance. The authors suggest patients may be unwilling to give up that certainty for an insurance plan whose financial requirements they don’t understand.

The authors also encouraged state leaders to make technical improvements to Colorado’s marketplace website. They said navigation problems and the need for technical support were barriers, particularly when patients were undecided about whether to enroll.

“These structural challenges led to a number of consumers who were initially ambivalent about obtaining healthcare coverage to choose to completely forgo coverage this year,” the authors said.