The former head of Massachusetts' health insurance exchange thinks that advertising and outreach will make or break the enrollment success of federal and state-based HIXs.
In a conference call hosted by Citi Research, Jon Kingsdale, who ran the Massachusetts Connector as executive director between 2006 and 2010, said that one of the largest challenges facing exchanges is communicating to consumers the individual mandate, premium support and the benefits of coverage.
In Massachusetts, the state government spent about $4 million trying to reach about 600,000 uninsured residents in the first year, with advertising partnerships that included the Boston Red Sox, CVS, banks and public transportation authorities, along with an additional $2 million campaign launched by a coalition of hospitals and health plans.
"We had tremendous advertising and frankly political leadership," said Kingsdale, now director of the Wakely Consulting Group's Boston office. Although the HIX Covered California, for one, is devoting close to $100 million to advertising and outreach, many state exchanges and the federally-facilitated exchanges are not being promoted as heavily as the Massachusetts Connector was, he said. The federal exchanges operating in 33 states will be marketed with $54 million, shared between them, in outreach grants for community groups.
"Even in states that are doing exchanges, we see some tepid political leadership. The business community is not necessarily supportive the way it was in Massachusetts."
That tepid support and the potential for low participation in the first year of enrollment could end up shaping exchanges' success down the road, he said.
"I think there's the potential for significant public frustration in the first few months of enrollment for 2014. Those wrinkles will get ironed out presumably, but they will create some problems that will be hard to overcome in reputation, brand and customer service."
Communicating the ACA's requirements and the options offered through the exchange is crucial, Kingsman said, for shaping public opinion and in turn driving enrollment, especially in states with federal exchanges -- such as Texas and Florida -- and especially in the wake of the ACA's political controversies and lingering opposition among Republicans and some grass roots Tea Party-esque groups.
"My experience was it was very much a cultural issue: Did people feel they had to have insurance? Were they, you know, armed, rebellious and 'Over my dead body' in their reaction? Or were they, 'Gee this is really something that's good for me, I need it, I'm glad there's subsidies, and gosh there's penalties of some sort. I don't know what they are, but I better get it.'"
While state governments and exchanges do bare the brunt of the outreach work, Kingsman said insurers also will have to contribute for enrollment to be robust.
"The wildcard I think in all of this is: Will the carriers and the brokers actually be effective at outreach for low and moderate income populations?"
Citi Research has estimated that between 10 and 15 million Americans will be enrolling in public exchanges by 2016; the research arm of the financial services firm Citigroup also thinks that the Congressional Budget Office's estimate that 7 million previously uninsured people would be enrolling by 2014 is "too aggressive."
Either way, Kingsman thinks predicting enrollment is "a wild guess." And if enrollment falls short to the extent that people are forgoing coverage, "I'm going to think it's because of a lack of effective outreach -- probably a feeling of resentment and resistance."