Association for Public Policy Analysis & Management

The objective the Affordable Care Act (ACA) is to expand health insurance coverage to as many individuals as possible within the framework of the law.  Effective outreach and enrollment capacity are instrumental in educating citizens about their insurance options, as well as helping them navigate through the new ACA systems. Focusing on six states that opted to create their own marketplace exchanges, this study analyzes the implementation of the ACA.  We explore state outreach and enrollment (“navigator”) strategies and the nature of contracting arrangements and their impact on “take-up” effectiveness.  We are primarily interested in the administrative, financial, and political aspects of these experiences.

We focus on a sample of six states that were assessed in previous research as exchange-launch “failures” and “successes.” By incorporating some variation in the overall success of the exchange implementation, we expect to also observe state-level variation in capacity and strategies related to enrollment and outreach services. To date we have completed more than 30 of our targeted 50-60 semi-structured interviews with state officials and administrators, representatives of private and non-profit organizations that contract for outreach and navigation work, as well as representatives of advocacy groups. The interviews are generating qualitative data that are analyzed using Nvivo10.

Our preliminary analysis of 30 interviews conducted to date suggest emergent implementation patterns concerning: the importance of the role of Medicaid integration, the use of existing networks of health insurance assisters to enroll new individuals and families, and the importance of informational hubs in collecting and disseminating information related to procedural and system issues. Additionally, we are observing variation in the financial coping mechanisms adopted by states in response to the expiration of federal grants for navigation and outreach activities.  The policy implications of this study for federal, state and local administrative audiences, as well as public health and social welfare policymakers, uniquely position us to make an impact in professional and research arenas.