RWJF Grantees Help Shore Up Enrollment in the Health Care Marketplace (Research Brief)
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RWJF Grantees Help Shore Up Enrollment in the Health Care Marketplace (Research Brief)

Published: Jun 20, 2018
Publisher: Ann Arbor, MI: Mathematica Policy Research
Health Delivery System Reforms Research and Evaluation Evaluation Design Policy Analysis
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Key Findings

Key Findings:

  • Navigator budget cuts forced Navigator organizations to cut staff and resources, resulting in reduced institutional knowledge, uneven geographic coverage, and difficulty engaging hard-to-reach populations. To address these challenges, Navigators relied more on volunteers and partners, offered overtime pay to expand availability, and triaged consumers who needed help with non-marketplace enrollments to local health centers.
  • Efforts to bolster the enrollment infrastructure, such as those supported by RWJF, were critical; Navigators and assisters also relied heavily on the networks, coalitions, partners, and online tools previously developed to create efficiencies.
  • RWJF funding made a major difference to grantees and subgrantees; without it, some groups would have had no budget for outreach and enrollment work, whereas others would have been unable to engage at the same level.
  • Total enrollment for 2018 in federally-facilitated marketplace states declined by about 5 percent from 2017, but given the lack of resources and shortened enrollment period, most respondents interpreted this as a win. Enrollment outcomes don’t suggest a direct correlation between Navigator budget cuts and declines in enrollment.
The coverage provisions of the Affordable Care Act (ACA)—along with numerous efforts to raise awareness about coverage opportunities and help people enroll in coverage—have helped millions of Americans gain coverage. However in 2017, the federal government made several policy decisions that were expected to curb 2018 marketplace enrollment, including cutting the length of the fifth open-enrollment period (OE5) in half, reducing grants to Navigators—people trained and certified to help consumers enroll in and renew coverage—by 40 percent, and cutting the federal advertising budget by 90 percent. In addition, congressional efforts to possibly repeal and replace the ACA left many consumers unclear about available coverage. Given concerns about consumer confusion and a possible decline in coverage levels, in fall 2017 the Robert Wood Johnson Foundation (RWJF) invested over $3 million in several organizations to shore up outreach and enrollment support during OE5. This research brief explores the following questions: How did the new policy landscape affect the enrollment infrastructure and consumers? What difference did RWJF funding make to grantees and subgrantees? What were the OE5 marketplace enrollment outcomes?

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