HHS Targets Young Adults In Efforts To Improve Marketplace Risk Pool

On June 21, 2016, the Department of Health and Human Services (HHS) released a fact sheet  reporting on yet another series of efforts to strengthen and improve the sustainability of the Affordable Care Act marketplace risk pools. The initiatives announced by HHS supplement efforts disclosed earlier in June, including the release on June 8 of a notice of proposed rulemaking and a series of guidances to address perceived problems potentially undermining the risk pool, a forum on June 9 on marketplace insurer innovation, and the announcement on June 15 of $22 million in grants to states to support health insurance regulation.

The June 21 fact sheet focuses on efforts to improve coverage for young adults. Although the overall uninsured rate has been cut by 40 percent since the ACA was adopted and the uninsured rate among young adults has fallen by more than half, young adults are still more likely than the general population to remain uninsured. This leaves them at risk for lacking adequate access to health care and preventive services. It also undermines the individual market risk pool, as younger individuals tend to be healthier and, under the ACA's limited age rating, to cost less to cover in proportion to the premiums they pay than older enrollees.

Outreach To Those Who Paid The Individual Responsibility Fee Or Claimed An Exemption

The fact sheet reports on four initiatives to increase young adult participation in the marketplaces. First, HHS will partner with the Internal Revenue Service (IRS) to conduct outreach through a special mailing to individuals who paid the individual responsibility fee for lacking coverage during 2015 or who claimed an exemption from the fee. The mailing will call their attention to the fee and to the availability for financial assistance.

In 2014, 7.90 million tax filers paid the fee and millions more claimed an exemption from the requirement. About 45 percent of those paying the fee or claiming an exemption were under age 35. In other contexts, heightening awareness of the fee in outreach emails has increased enrollment in response by about 13 percent. Targeted information on financial assistance has also proven effective in increasing enrollment by individuals who paid the penalty or claimed an exemption.

Learning From Experience To Improve Messaging And Outreach

Second, HHS will build on lessons learned in earlier enrollment periods to improve outreach during the 2017 open enrollment period, particularly to young people. First, it will increase the use of targeted emails, which have proven effective in communicating with young people. Individuals who create a marketplace account will receive an email instructing them how to enroll; individuals who complete an application will receive an email telling them to pick a plan; and individuals who pick a plan will be reminded to pay their first premium.

Prior experience has shown that informing consumers about premium increases in their own plan and about the potential benefits of shopping has more than tripled the share of consumers coming back to the marketplace to shop. Providing information about financial assistance has also proven effective in encouraging enrollment. Experience has also shown that young adults in particular are highly deadline driven; they are most likely to enroll when the deadline for January 1 coverage or the end of open enrollment is at hand. These lessons from experience will drive the timing and content of messaging during the 2017 open enrollment period.

Transitions At Ages 19 and 26

Third, HHS and the Labor Department are taking steps to improve transitions at ages 19 and 26. The uninsured rate among children fell to a historic low of below 5 percent in 2015 while the uninsured rate among young adults fell to 15.8 percent, less than half the uninsured rate in 2010. But the uninsured rate increases by almost 7 percentage points at age 19 and another 4 percentage points at age 26.

Under the ACA, health insurers and group health plans must cover adult children up to age 26. Group health plans must provide individuals aging out of coverage at age 26 with a notice that they are eligible for Consolidated Omnibus Budget Reconciliation Act (COBRA) coverage. Under existing Labor Department guidance, group plans must also inform enrollees losing coverage of the possibility of marketplace coverage.

A new frequently asked question (FAQ) released by Labor with the June 21 fact sheet further clarifies that group health plans may provide in the COBRA election notice information as to how to obtain marketplace enrollment assistance (including information about special enrollment periods), contact information for the marketplace, general information on particular marketplace products, and other information that could help qualified beneficiaries choose between COBRA and other coverage options. COBRA notices can be tailored for particular populations, like young people losing coverage.

HHS is also encouraging states and managed care organizations to help children who are covered under Medicaid or the Children's Health Insurance Plan (CHIP) transition to adult Medicaid (in states that have expanded Medicaid), or to marketplace coverage.

Partnerships

Finally, the fact sheet announces that HHS is working with a number of partners to improve outreach to young adults. These include:

• Lyft, which will offer discounts to people going to enrollment events and encourages its drivers to enroll;
• The American Hospital Association, which will develop a social media toolkit for reaching young adults and encourage hospitals to incorporate enrollment tools into their websites, direct hospital website traffic to enrollment assistance, and develop hospital messaging materials to encourage coverage;
• More than 75 national partners, including Enroll America, Young Invincibles, and Out2Enroll, which will engage in a number of campaigns in 2016 aimed at young people, including #HealthyAdulting, focused on health and life choices; "My Campus, Our Coverage," in conjunction with community colleges; "Young Families for Health" aimed at young parents; and "Committed to Communities Call to Action" aimed at young consumers within specific communities, such as LGBTQ. These outreach efforts will be supported by the National Coalition on Millennial Health, which will hold a summit at the White House on September 27, 2016.

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