Has all the Low-Hanging Obamacare Fruit Already Been Picked?

The first open enrollment period under the Affordable Care Act shattered expectations, with more than 8 million Americans finding quality, affordable health insurance through the Marketplace. And that doesn’t even include the more than 6 million consumers who got covered through Medicaid and CHIP since the beginning of open enrollment. However, the second open enrollment period is on the horizon – it begins in November – and reaching the Congressional Budget Office projection of 13 million for the Marketplace alone is a much higher bar to clear. Who will these new enrollees be?

Conventional wisdom suggests that new consumers will be harder to come by in the upcoming enrollment period because the most motivated among the uninsured – those with pre-existing conditions and those who qualified for the largest financial subsidies – already got covered. Consequently, those who have not yet signed up, the theory goes, will be difficult to convince. The Affordable Care Act has already snagged the so-called low-hanging fruit, and the rest of it is too high.

New research paints a different picture, though. Enroll America released a survey last month conducted by national polling firm PerryUndem that showed a whopping 84% of those who did not enroll are open to enrolling in the next period.  Four in ten uninsured Americans said they will “definitely” or “probably” enroll, and about the same proportion said they weren’t sure, but only 14% said that they would not. Importantly, too, the survey showed that the uninsured want health insurance. Most of those who did not enroll wanted coverage (61%) but could not find anything or say things got in the way of enrolling. Fifteen percent did not even know they could enroll. But again, only 15% did not want coverage.

The uninsured want coverage, and they are open to enrolling: this tells us we have a great opportunity ahead of us. The next question is why didn’t these consumers enroll the first time, and how can we overcome some of the barriers they faced?

One area that requires close attention is the issue of cost – or rather, the perception of cost. Because the truth is that while affordability remains a very real challenge for some families, the much bigger problem was that many consumers didn’t even check out their options, because they assumed they wouldn’t be able to afford them. In fact, among those who didn’t enroll, 63% didn’t even look for insurance, and the assumption (often rooted in past experience) that insurance is unaffordable was far and away the biggest reason why they didn’t try.

In reality, of course, 85% of Americans who signed up on the Marketplace received financial assistance to help defray the cost of premiums and make coverage affordable. However, 74%
of those who did not enroll did not know about this financial help for low- and moderate-income consumers. That tells us that there is a large population of uninsured Americans who want insurance, and – if they learned that they could receive financial assistance – would be eager to look for coverage. Our outreach experience backs this up; for instance, our Get Covered America Calculator has been by far the most visited part of our website, because it gives families a quick, easy idea of what their monthly cost might be, and what financial help they can get.

Challenges remain. Certainly, some consumers – young people, Latinos, African-Americans, for instance – will be more difficult to reach than others. But unlike the fabled fox who gives up on the grapes because they seem just out of reach, we will keep pushing to reach every consumer who needs answers about enrollment. That’s why our over 200 staff members and more than 30,000 volunteers across the country will continue this outreach work in communities across the country, from barbershops in Charlotte, North Carolina to back-to-school expos for parents in Austin, Texas. And encouragingly, African-American and Latino consumers are even more likely than their white counterparts to say they plan to enroll during the next open enrollment period.

So once you take a closer look, “low-hanging fruit” isn’t really the right way to think about this: there are still millions of Americans who very much want and need health insurance. It will take steady, determined work to overcome the very real barriers and knowledge gaps during the next open enrollment period. But we now know what works, and most importantly, we know that the uninsured want coverage and are open to signing up during the next enrollment period. It’s our job in the coming months to keep meeting uninsured consumers where they are with information about their new insurance options and the financial assistance that is available. If we do our job right, then come November, even more Americans will be able to take advantage of this opportunity to experience the security and peace of mind that comes with quality health insurance.


Anne serves as President of Enroll America, a non-profit organization dedicated to maximizing the number of Americans who enroll in health coverage made available through the Affordable Care Act. 

Morning Consult