The Future of Enrollment: Modest Policy Changes in Year Three Will Go a Long Way

While consumers still have until February 15 to sign up for health coverage during the second open enrollment period, Enroll America and our coalition partners are already thinking about how we can improve the process in the years ahead. From our observations on the ground in communities, to our careful data analysis, we have a unique perspective on how policymakers can execute improvements in the best interest of consumers.

Last month, we submitted comments to the Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) in response to their proposed rule on benefit and payment parameters for 2016. Importantly, that rule will serve as a blueprint for future enrollment periods. Because our mission is to make sure Americans both get covered and stay covered, we focused on some simple changes that could make it significantly easier for consumers to get and keep coverage in the coming years.

Don’t Make Consumers’ Decisions for Them

Helping consumers keep coverage that meets their needs and budget is critical to our mission, and in our outreach work, we encourage all consumers renewing coverage to go back into the Marketplace and shop around. It’s the only way to guarantee that the consumer gets the right amount of financial help and is aware of changes in premiums and plan design from year to year. But we know that the auto-renewal process is an important safety net for those who choose not to take action every year. One of the much-discussed proposals in the rule would allow consumers the option to be automatically renewed into a plan with lower or the lowest monthly premiums (rather than into the same plan they received coverage through, as is currently the case). As many have noted, this could potentially have significant and harmful unintended consequences for many consumers. Premiums are only one factor to consider when choosing a plan. Simply shifting consumers into the lowest cost plans overlooks other important considerations like provider networks, out-of-pocket costs, and cost-sharing benefits, and it undermines one of the core elements of a successful marketplace: competition. Reach out to consumers. Educate them. Give them all the help they need to make smart choices. But don’t make their most important enrollment decisions for them.

Make it Easier to Make Smart Choices

As we suggested in our comments and have mentioned previously in this column, there is still an unmet need for consumer-tested, effective tools to help people weigh their options and choose a health plan that’s best for them and their family. We have seen improvements in the way plans are displayed and sorted on this year, but the final decision about what plan to select remains stubbornly perplexing for many consumers. Having a comprehensive plan comparison tool is needed to help consumers understand their options so they can be more confident that they’re making the best decision for the new coverage year, and potentially have greater satisfaction throughout year. As we’ve said before, knowledge is power, and we believe that confidence and higher rates of satisfaction may make consumers more likely to stay covered. Plus, as more and more consumers get enrolled and experience plan selection primarily through a comparative lens—how do my options for next year compare with the plan I was enrolled in this year?—there’s a need for better resources to show how plans change from year to year.

Demystify Financial Help

Consumers get information related to health coverage from their marketplace, from their health plan issuer, from their health care providers, and potentially their tax preparers. This barrage of information can be overwhelming, particularly given the inherent complexity of the ways these issues—health coverage, health care, financial help, and taxes—intersect. We’ve recommended in response to this most recent rule and previous federal rules that insurers and the Marketplace coordinate the information they send to consumers about how much financial help a consumer is receiving, how much they qualify to receive the following year, what this means for their premiums, ways their existing coverage may be changing from year to year. Time will tell how successful the first round of renewals and automatic reenrollments were, but it also remains critically important that consumers continue to get clear information about the advantages of active renewal. Clear, concise, and consistent information will help consumers maintain coverage that meets their needs and fits their budget, and reduce the risk of surprises at tax time.

Make the Most of the Tax Filing Moment

But what about consumers who still haven’t enrolled at all? We also think that CMS should create a very important new Special Enrollment Period (SEP): Allow uninsured tax filers subject to the fine the opportunity to enroll in coverage for the remaining months of 2015 in order to avoid the fine next year. Some consumers may not find out about the fine – or about the financial help available to lower the cost of coverage – until after the enrollment period ends on February 15. We shouldn’t make them wait another full year to enroll in coverage. Plus, when consumers file taxes, they likely have all of the documentation and up to date information they would need to enroll in coverage. Allowing them to enroll through a one-time SEP would both serve as a motivator to get coverage and also help them avoid a fine when they file their taxes next year.

We know millions of consumers are enrolling in coverage right now, and the proposals from CMS are a great first step towards building on that momentum. With a few consumer-focused changes, I’m confident that together we can make sure the Affordable Care Act continues to provide American families with quality insurance and peace-of-mind for years to come.


Anne Filipic is the President of Enroll America

Morning Consult