Could shifting the ACA enrollment season lead to more sign-ups?

A study released earlier this month by the Commonwealth Fund found that 9.5 million adults who were previously uninsured are now covered under the Affordable Care Act. In California, the number of uninsured adults has been cut in half.

Despite variation between states, some of the greatest gains have come from low-income adults. However, a recent article published in the policy journal Health Affairs suggests that Health and Human Services could do an even better job in capturing these individuals by moving the open enrollment period from the fall to the spring.

According to authors Katherine Swartz of the Harvard School of Public Health and John Graves of Vanderbilt University, the fall is a particularly difficult time for those with limited resources. The pressures of the holiday season lead many to become financially stretched, and the stress of a tight budget can mean that individuals have less psychological “bandwidth” to make complex decisions about matters such as health insurance.

But fall and early winter is precisely the time frame in which uninsured consumers must decide between health plans. Open enrollment for the federal exchange is set to run from Nov. 15, 2014 to Feb. 15, 2015. Open enrollment for the following year and beyond is slated to take place between October 15 and December 15.

Swartz and Graves propose an open enrollment period from February 15 to April 15. That’s the time, they claim, when low-income individuals are less anxious and have more mental energy to choose a health plan. And, conveniently, most of these consumers will have just received their tax refunds and earned income tax credit payments – sums that could go directly towards paying their premiums.

“Buying coverage is costly, and if you want more people to enroll, you want them to perceive that coverage as affordable, and that’s more likely in the spring than in the fall,” said Stan Dorn, a senior fellow at the Urban Institute.

Dorn has been advocating for a shift in the open enrollment period even before the publication of Swartz and Graves’s Health Affairs piece. One of Dorn’s arguments in support of the enrollment shift is also cited in the article: Tax preparers can assist with health insurance applications if the enrollment period coincides with tax season.

“The information [people are] giving their tax filer is the vast bulk of what they need to apply for health coverage,” Dorn said. “We’re not going to have the same resources for health application assistance as in the past, so we need to think about how we’re going to leverage available resources to deal with the challenge of enrolling consumers.”

According to a brief Dorn authored earlier this year, “More than 74 percent of uninsured consumers who qualify for ACA health coverage file federal income tax returns.” Swartz and Graves also point out that “the majority of households with income less than $50,000 use professional tax preparers.”

The assistance of a tax filer can be especially helpful in gaining a more accurate idea of the amount of subsidies to expect, Swartz said in an interview. “If you’re talking about lower income people who are really worrying about every dollar or fluctuating incomes, they really don’t know what their subsidy – their premium tax credit – is going to be in the fall,” she said.

So why is the open enrollment period in the fall? It’s the time when many are enrolling in employer-based insurance or making decisions about Medicare. Having everyone sorting out their plans at the same time, the thinking goes, eases confusion among consumers.

That overlap can create problems for insurers, though.

“Turns out that insurance companies don’t like it because the same people who handle the insurance applications do it all,” said Dorn of the Urban Institute. “They’re handling multiple markets. Brokers and insurers would be much happier if it was staggered, and consumers would get better service.”

HHS has not yet responded to the idea of shifting the open-enrollment season. At the state level, there are no plans to change the timing of the marketplace, according to Covered California spokesman Roy Kennedy. “We’re currently aligned with the federal government, and believe it’s a good amount of time for consumers to enroll,” Kennedy wrote in an email.

The 2015 marketplace dates are unlikely to change, Swartz points out: “I don’t think politically the White House would approve any kind of change for the dates for open enrollment for the 2015 year before the election.”

But according to Dorn, now is the time to rethink dates for 2016’s open-enrollment season.

Image by Ken Teegardin via Flickr.