Association for Public Policy Analysis & Management

AIMS: Health insurance decision-making in the United States is a challenging process plagued by complex eligibility guidelines, unfamiliar product choices, increasing financial burdens, and an ever-changing regulatory environment. Given that the core goal of the Affordable Care Act (ACA) was to reduce uninsurance rates, several policy components were included to simplify the process of choosing and enrolling in health insurance. ACA funded Navigator programs can be understood as a new type of health insurance decision-making support that is community based, diverse, and targets uninsured populations that typically are associated with low health (and health insurance) literacy.

For the various zip codes in Illinois, this study aims to assess whether:

1) A higher number of grant-funded ACA Navigators is associated with a greater reduction in the uninsurance rate from 2013-2015.

2) ACA Navigators had the greatest impact on communities with the lowest rates of health and health insurance literacy (i.e. those with high rates of minorities, English as a second language, low educational achievement, and high rates of households living below the Federal Poverty Level (FPL))

3) Higher amounts of navigator outreach activities (measured by a Navigator Outreach Activity Index), had greater reduction in the rate of uninsurance, relative to those with lower or no ACA navigator outreach.

DATA & METHODS:  Between 2013-2015 UIC trained and certified all of the 2,684 Illinois ACA Navigators. Their program enrollment data, along with a follow up survey to assess their outreach and enrollment activities provide the independent variables for each of the study aims. By linking this unique primary data set to ACS measures for uninsurance rates over the same time period, we explore the association between face to face health insurance decision support and health insurance enrollment. This study linked navigators each year to their geographic work region by zip code, and uses a year and zip code fixed effects model to estimate their effect relative to the locations with no (or fewer) navigators over time.

RESULTS: Preliminary results find that zip codes with Navigators are associated with a .23% higher reduction in uninsurance rates than those without Navigators during the study period. We also find some meaningful variation in navigator effect by targeted uninsured populations. Finally, early indications suggest that a higher Navigator Activity score is also associated with greater reduction in uninsurance rates.

CONCLUSION: These findings suggest that in-person health insurance decision-support can be effective in enrolling uninsured individuals in coverage. These findings provide future navigators and health insurance enrollment workers with important details about cost-effective best practices in a field with diminishing federal and state funding. While the ACA succeeded in reducing the uninsured rates overall, complexities persist and many Americans remain uninsured. Further, under a new administration in 2017 we can expect to see yet another revised health insurance landscape for individuals to navigate. This study provides preliminary evidence that would support the inclusion of navigator-like funding for any new policy change that aims to reduce uninsurance rates.