Thursday, May 27, 2021

Obamacare enrollment at vaccination sites, part 1

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                                             Getting jabbed? Get covered too!

11 million uninsured Americans are eligible for ACA marketplace subsidies, according to KFF estimates. With the premium subsidy increases enacted in the American Rescue Plan Act (ARPA) in March, coverage can credibly be called "affordable" for most of them.  Another 7.3 million uninsured people are eligible for Medicaid, per KFF.

Ignorance of these offerings is rife. Less than a third of the public knows the ACA is still law, again according to KFF. Enrollment outreach, sabotaged by the Trump administration, has always been a challenge (as has the difficulty of navigating the application for some but not all enrollees).

While considering incremental ways to improve the ACA in my last post, it dawned on me that enrollment outreach at vaccination sites, or via email and texts connected with vaccination, was a golden opportunity to reach the uninsured.  Like most lightbulb thoughts, this one was far from unique.  It's occurred to many professional enrollment assisters -- probably hundreds. Some have acted on the thought.

I am learning about these efforts and maybe shouldn't front-run the work in progress. But airing the issue in a preliminary way here may bring more information. If you know anything about such efforts, please email me -- adsprung, gmail.

Suffice to say here that while some assister groups have done outreach at vaccination sites, and at least a couple of states have supported such efforts to some degree, the initiative has come mainly from assister groups (generally operating on a shoestring through the lean Trump years), not government agencies,  and efforts have been scattered. Below, a few thoughts as to potential. Perhaps I'll learn that ideas below are unworkable. But.. a blog's a blog, that is to say a scratchpad.

  • "Do you have insurance?" While vaccinations are free to those who don't have health insurance, all vacinees (?) are asked for their insurance. This constitutes a really golden opportunity to reach those who say they have none. They should at least be handed print information about getting covered via or a state exchange. Better yet would be a text or email with links both to the exchange and the exchange tool for finding free in-person help.

  • Ardent agencies. In Kentucky during the pandemic, the state unemployment insurance department sent all applicants' contact information to the state Medicaid agency, which followed up with phone calls and emails encouraging people to seek coverage if they'd lost it. Medicaid enrollment in Kentucky increased 14% from February to July 2020. Unlike UI benefits, vaccinations are not administered primarily by government entities. But with an opt-in, contact information for those who report no insurance could be sent to a state exchange, health department or Medicaid department for outreach.

  • Go national? I am still filling out post-vaccination health status surveys texted to me by the CDC. If I had reported not being uninsured, could "get covered" info -- with links -- not be sent to me as well?

  • Team Vaccinate is also Team ACA.  To get Americans vaccinated, the Biden administration assembled a crack logistics team that includes veterans of the successful crash effort to salvage the dysfunctional federal ACA exchange,, after its disastrous launch in fall 2013. These include Jeff Zients and former acting CMS administrator Andy Slavitt. The team's singular focus is understandably getting 200 million -- and eventually 300 million -- Americans vaccinated. But could the vaccination task force spare a thought --and spur some efforts -- to use this golden opportunity to get people enrolled in health insurance?  

  • Not too late. While the majority of adult Americans have been vaccinated by now, those who have not  -- the hesitant, the not-so-mobile, those with lack of tech access or tech know-how -- probably include high concentrations of uninsured.  In many states, the major pharmacy chains are now major vaccination providers -- can they not be enlisted to provide at least printed enrollment information?
Once again: 18 million uninsured Americans are eligible for free or subsidized health insurance. By KFF's estimate, 12.5 million of them are eligible for free coverage (that includes 3.4 million for whom "free" means high-deductible bronze coverage -- but probably half of those can get "platinum-equivalent" silver coverage for a premium amounting to no more than 2% of income). Yet estimates of the reduction in the uninsured population to be triggered by the ARPA subsidy boosts remain modest. CBO estimates that ARPA will reduce the uninsured by just 1.3 million in 2022. The Urban Institute estimates that making the ARPA subsidies permanent will reduce uninsurance by 4.2 million.

Getting the uninsured enrolled in health insurance programs for which they are eligible is harder than getting shots into arms. Can we not give a shot in the arm to enrollment at the vaccine sites?

Update, 6/29/21: Part II is here.

Photo by CDC from Pexels

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