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SHADAC in Health Affairs: High-Risk Pool Enrollees Need Targeted ACA OutreachOctober 03, 2018:
September 9, 2013: A SHADAC study published in today’s issue of Health Affairs finds that the majority of surveyed enrollees in Minnesota’s high-risk pool (the Minnesota Comprehensive Health Association, or MCHA) were satisfied with their current coverage, were unfamiliar with health care reform and its impact on their current coverage, and were worried about the impact of health reform on the cost and affordability of coverage. Other study results include:
- Enrollees were an average of 52 years old, and more than half had incomes greater than 400 percent of the federal poverty level (FPL) and will likely not have access to federal financial support (their current income exceeds eligibility for Medicaid or subsidies through health insurance marketplaces).
- Two-thirds of MCHA enrollees have carried their high-risk pool coverage for more than three years, and more than a third were enrolled in high deductible plans ($5,000 or $10,000 deductibles).
- Enrollees particularly value prescription drug access, the ability to see specific providers, and having access to coverage despite their health condition.
- Despite having coverage through MCHA, a sizable portion of enrollees still reported unmet health needs due to cost (this is particularly prevalent among those with lower incomes and higher deductibles).
These findings, which come from a 2012 mail survey of 2,600 adult MCHA enrollees, point to the need for immediate and targeted education and outreach to high-risk pool enrollees in order to ensure their successful transition into new coverage options in 2014. These efforts should focus on the cost and access benefits of new coverage under the ACA, such as no exclusions based on preexisting conditions, no copays or deductibles for preventive services, no lifetime limits on medical claims, and federal subsidies in the form of tax credits for those who qualify. Additionally, the authors recommend providing specially trained brokers to help smooth the transition from high-risk pool coverage to coverage in the newly reformed market so that high-risk pool enrollees understand their coverage options and choose the most appropriate plan for their needs/preferences.
While the MCHA survey findings are specific to Minnesota high-risk pool enrollees, they do raise important issues for other states to consider regarding the transition of high-risk pool enrollees to new coverage. If the findings of this research are used to effectively target education and outreach to high-risk pool enrollees, gaps in coverage for high-risk pool enrollees will be minimized, and their pre-existing conditions will be appropriately managed throughout the coverage transition process, thereby preventing foregone and/or delayed care, both of which place cost burdens on the healthcare system.