Health Policy$ense

Can Philadelphia Reduce its Number of Uninsured?

What Will it Take to Win the President’s Challenge?

President Obama has challenged 20 cities to decrease the number of uninsured people who have not yet signed up for insurance on the Healthcare.gov Marketplace. Timed with the start of the Marketplace’s third open enrollment period on November 1, the Healthy Communities Challenge pits 20 cities against each other to win bragging rights and a visit from him.

Philadelphia is one of the cities, and Obama even sent us a pep talk. Will the city rise to the occasion?  We asked some of our expert Senior Fellows for their recommendations on what it will take to make the Challenge a success:

Highlight the coverage benefits that target populations prioritize. For young adults, these include preventive health coverage, which is included in all plans without any cost-sharing. Also, provide access to certified application counselors and insurance navigators as online tools may not be enough to help consumers choose the plan best for them, especially those new to insurance purchasing.

--Charlene Wong, MD

The initiative must recognize that health literacy is very low.  The uninsured may not know that they are eligible for coverage or federal subsidies. Considerable help navigating through this process is essential. The idea that a good website will do the work is wishful thinking. This is not sufficient.

--Daniel Polsky, PhD, MPP

Marketing is critical. Advocacy groups and some state-based health insurance exchanges have had success with clever marketing strategies to reach the uninsured. Also, given the proliferation of narrow networks, consumers need decision support tools to understand the trade-off between cost and network breadth.

--Amanda Starc, PhD 

Engage with target populations through social media and crowdsourcing. We’ve researched Twitter’s role as a real-time barometer of public sentiment on the ACA, and determined that this sentiment (the positivity or negativity of tweets) correlates with state-level marketplace enrollment. This finding suggest Twitter’s potential for real-time monitoring during enrollment periods. Marketplaces could track Twitter sentiment to more rapidly identify enrollment trends and potentially emerging issues. 

--Raina Merchant, MD, MS

The Affordable Care Act (ACA) has had a remarkable impact on reducing the number of uninsured nationwide, which is at a historic low of 9%. Despite progress in reducing the numbers overall, 10.5 million people eligible for Marketplace coverage remain uninsured. 178,000 of these people are in Philadelphia and the surrounding area.

The Challenge will need to overcome remaining barriers to signing up, including: a lack of awareness about the enrollment period; a perception that health insurance isn’t affordable for low-wage workers; and, concern that ‘narrow’ network plans don’t provide adequate access to care.

The remaining uninsured are likely the hardest to enroll, and creative and concerted efforts are needed to reach them. Early reports indicate that national enrollment on the Marketplace is outpacing last year, but fewer newcomers are signing up. Community organizations like the Pennsylvania Health Access Network are providing important help navigating the enrollment process as our experts suggest. We’ll keep you posted on how the Challenge is going, and whether we’ll get that visit from the President.