Will the ACA’s special enrollment encourage more applicants?

The Affordable Care Act has gotten a lot of attention by President Barack Obama since October. His administration has been working in overdrive to promote it, urging the uninsured to sign up. It's up against a strong army of Republicans, though, who are railing against the law and urging people not to cooperate. 

But now the initial sign-up period is coming to an end. Americans are beginning to experience firsthand all the benefits and shortcomings of the law. 

One big rush to buy health insurance came at the end of 2013, when people who wanted to be covered at the earliest possible moments had to finish buying their new coverage. Another rush is coming now, with the final yearly deadline looming.

On Wednesday, the administration announced an extension for people who begin the process of applying for insurance by March 31 but have not completed it. It’s called a “special enrollment period.”

What does the new deadline extension mean?

How is the public taking to the ACA, five months on?

Will the White House make its insurer targets?

We consulted a panel of three experts for the Inside Story. 

Inside Story: The special enrollment period: good, bad, neither or in between?

Micah Weinberg: The reason to have an open enrollment period, in an environment where anyone can buy a health care plan at any time, you want to set it up to so that people who are less inclined can do it easily. That is not the issue here. We are just giving people who are already interested the time to do it. It is probably not going to apply to places like California, where it has been going well.

Has public ignorance made this harder?

This is a process that is going to take a decade. I know the political people want to take their short-term wins, but this is the process of getting people insured. It was always going to take years and years. We have gotten a solid start, particularly in places like California.

Has California’s Democratic government, leanings and lack of major conservative opposition helped its process?

No question at all. We have all of our public agencies working together. We have all of our political folks working in the same direction. It is still very difficult because of our relative size and diversity, but way easier than elsewhere.

Inside Story: What are we to make of the special enrollment period?

Dr. Kavita Patel: There was a lot of pressure on the administration to extend the deadline entirely — from insurers and nonprofits saying they are just starting to get more momentum. Now you have to go to the website and attest that you need an extension. This is a way to create a loophole. The thinking is that if you can get people to go to the website and press a button, you will increase the likelihood that they will seek out the care. There is a practical component, too: It is important to know who is in your system and who your target audience is. It is not like Nov. 15 — the next deadline — which is far away.

Will the administration meet its targets?

Yes. The 7 million target is the CBO’s estimate. The administration feels that if they enroll close to that number it is a pretty big success. And we have already gotten there with 5 million. We'll get more in the next few days, too.

Is ignorance posing challenges all the way through?

There is a general lack of awareness. And now there is also a lack of awareness that the mandate exists. What it suggests is that there is a lack of understanding of how to reach people with information successfully. I have tried through social media. It takes time. We need to make this a continuing process. People need to re-enroll again next year. I hope the administration hears that they need to put far more resources into the education process. The airwaves have been crowded by anti-ACA propaganda. It's clearly not being countered sufficiently. 

Inside Story: What has surprised you the most about your research into the ACA?

Katherine Carman: This study finds that there are a substantial number of Americans who are unfamiliar with the details of the Affordable Care Act or insurance more broadly. That study has not been done before. But in previous studies I have worked on financial literacy; the levels of knowledge are also extremely low. I was not surprised by the findings.
 

If Americans do not know what insurance is, does that likely limit their knowledge of the ACA?

They are separate things, but related. I think that the kind of person who is not likely to know a lot about insurance is the same kind of person who is not likely to know about a particular policy reform. Both of these points are correlated to specific ages, incomes and education levels. We looked at people under the age of 26 and people at different levels of the poverty line. The lower you go in terms of income, the less people know. Those are important income cutoffs because they directly relate to the application of the ACA.

What we know is that people have signed up for insurance. What we don’t know is whether they are making the best decisions that they are making for themselves. If they lack knowledge of deductibles, or the difference between HMO and PPO, it is not clear if they are making the best choice for themselves. That is something we are hoping to know more about in the coming months as more of the numbers come out. 

Any ideas on how it could be better?

There are a couple of things that can be done that we propose in our article. One is proposing simpler plans, or having more navigators. The other possibility is creating a safe, simple default suggested insurance. There is a lot of research that suggests that the latter is effective. It would say something like: "If you’re not sure, this is the choice you'll end up with, but you still have a choice." From our research, we are seeing that 15 percent of individuals remain uninsured, and 65 percent of people who were uninsured in 2013 are still uninsured in 2014.