Electronic Health Reporter

By Meghan Marx and Jenna Phillips, healthcare experts, PA Consulting.

Now that the 2019 health insurance Open Enrollment period has concluded, healthcare industry stakeholders are watching closely for any shifts in consumer behavior regarding enrollment and the overall uninsured rate. After a record drop in the uninsured rate from 2008 to 2016 in response to the Affordable Care Act (ACA), the uninsured rate has begun to increase again, by 1.3 percentage points from 2016 to 2017, according to data from Gallup and Sharecare reported on the Health Affairs blog. Additionally, at the December 15 close of the 2019 open enrollment period, the Centers for Medicare and Medicaid Services announced that 300,000 fewer individuals enrolled for 2019 than for the previous year. Under the policies of the current administration, the trend of decreased enrollment in exchange market plans, coupled with an increase in the U.S. uninsured rate, is expected to continue.

The uninsured rate has fluctuated over time, but factors like the Congressional repeal of the individual health insurance mandate and reduced funding for health insurance enrollment counselors to support consumers to enroll in health insurance mean that the uninsured rate is expected to climb further in 2019. The increases in the rate of uninsured may seem small, but a 1.3 percent increase in the number of uninsured Americans represents 3.2 million more adults who were uninsured in 2017, compared to 2016. While the upward trend in the uninsured rate is consistent across population segments, a few specific demographics are at especially high risk of becoming uninsured, including young adults, low-middle income earners, and Hispanics.

Here’s what we know:

• Young people are less likely to purchase coverage than older adults, who tend to have higher healthcare utilization. The 18 to 25 age bracket was the least likely demographic group to have health insurance in 2017, while those aged 65 and older were the most likely group to be covered. Notable is the 2.9 percent rate difference in coverage of individuals who are 25 to 26 years old, the age when parent’s health plans end coverage, an option guaranteed under the ACA.

• Lower rates of employment and education are also associated with lower rates of health insurance enrollment. Low wages for unskilled labor are typically paid on an hourly basis, rather than as an annual salary, and employees in this situation may struggle to secure work with healthcare benefits. As a result, there is a lower rate of access to employer-sponsored coverage. While the poorest individuals and families qualify for government-sponsored coverage, there is a sizeable segment of the population that cannot afford to purchase commercial insurance but is disqualified from Medicaid based on income or personal assets.

• In 2017, Hispanic Americans had the lowest coverage rate of any U.S. demographic, at 83.9 percent, and the lowest rate of private insurance coverage, at just 53.5 percent. This gap in the insured rate was especially apparent in states where Medicaid has not been expanded to cover the undocumented population. Language and cultural barriers and economic disempowerment might also have exacerbated the disparity of coverage between Hispanics and other racial groups.

So, how can health plans engage young, diverse, lower-middle class populations that show greater likelihood of becoming uninsured?

In total, 8.8 percent of the U.S. population and 12.2 percent of the US adult population is uninsured, presenting significant opportunities for health insurance providers to capitalize on a sizable untapped market. Notably, a high proportion of the uninsured demographic are young, healthy individuals of working age. There is also significant overlap among the demographic groups previously identified, young adults, low-middle income earners, and Hispanic Americans.

According to the Brookings Institution, millennials are the most diverse generation in U.S. history, with 44 percent of individuals identifying as non-white. This demographic shift in the United States population will likely continue to intensify over time. Young and non-white Americans also tend to fall into lower economic tiers than older, white Americans. Payers that successfully reach this overlapping population will benefit from new sources of income with potentially low medical costs for patient care in a low utilizing population.

We suggest a few strategic and tactical approaches that health plans can take to engage and enroll uninsured Americans as plans reflect on 2019 open enrollment and prepare for the future.

• Apply technology to recruit and engage potential new members. Plans that provide telehealth options, interactive mobile apps, and secure communication platforms might help to make care more accessible and affordable to younger generations and encourage them think more fondly about their health plan and their engagement with health insurance. Online, payors might reward top health and fitness “influencers” for featuring their insurance product offerings on a personal blog or social media feed. Members could also be incentivized to refer their contacts to the payor through social media campaigns.

• Enhance outreach, education, and engagement to make young people more aware of their coverage options. Toward the end of the 2019 open enrollment period, influencers like former President Barack Obama took to the internet to encourage Americans to enroll in Federal Exchange plans. While some argue that that effort was too late, the tactic has been shown to work. Outreach and education campaigns help to promote awareness among young people about open enrollment and the coverage options available. For future enrollments, payers could consider a two-pronged approach to communication by targeting both young adults and their parents. Parents who currently support young people as beneficiaries under their health insurance plans might serve as important ambassadors for organizations by encouraging their adult children to purchase coverage ahead of their 26^th birthday. Insurers might also partner with schools and community organizations to educate young people about personal financial responsibility, including the importance of purchasing health insurance coverage. Additional emphasis could be directed into communicating with Spanish speakers, perhaps by further tailoring the existing multilingual promotional materials that feature diverse populations.

• Champion diversity as a core competitive advantage and make it part of the way the plan does business. By recruiting a diverse workforce, insurers can enhance their organization’s cultural competencies and create and communicate about offerings that truly appeal to the diverse communities they serve, especially in the key market segments we’ve identified. This heightened level of cultural understanding within the corporate ranks will enable payers to capitalize on new revenue streams by reaching population segments that might otherwise have gone unnoticed.

Many opportunities exist for insurance providers to pursue and entice the American population segments least likely to purchase insurance coverage. The health insurers that succeed can anticipate significant gains in the form of membership growth, improved community relations, and financial returns.