From The Field A U G U S T 1 8 , 2 0 1 4 Optimizing Health Insurance Marketplace Enrollment through Collaboration,Technical Assistance, and Promotion MORGAN HYND ALYSON CUMMINGS Program Officer, Maine Health Access Foundation Communications Officer, Maine Health Access Foundation T he passage of the Affordable Care Act (ACA) in 2010 For three years, MeHAF’s ACA Outreach and Education provided many health foundations an unprecedented grantees built strategies on grassroots outreach, targeted opportunity to expand affordable coverage to lower- organizational inreach, and provider education. The cohort income and vulnerable people through the new health included small community-based organizations that were insurance marketplaces. The national enrollment strategy for trusted sources of information, and statewide organizations states using the marketplace at healthcare.gov (the that were recognized for their technical expertise and under- Marketplace) focused resources on states with higher numbers standing of the ACA and health insurance law. Together, they of uninsured, such as Florida and Texas, with fewer resources developed resources such as consumer-friendly brochures provided to states like Maine with high coverage rates (11 per- highlighting specific elements of the law. Grantees vetted cent uninsured or approximately 140,000 people). Maine’s materials by sharing drafts with the entire cohort on the two navigators received less than $600,000, and neither the Google Group and through working subcommittees. The Centers for Medicare and Medicaid Services (CMS) nor Enroll collective expertise of the group always resulted in a better America spent any marketing money in the state to promote finished product and well thought out strategies. the Marketplace, and our state government remained largely disengaged from assisting with enrollment efforts. Despite these odds, Maine still had one of the highest enrollment rates By ensuring that partners worked together early on per capita of the 27 Federally Facilitated Marketplace states and as a result of MeHAF’s leadership in fostering with a total enrollment of 44,258. transparent communications throughout the state through enroll207, Maine has become an enrollment Why was Maine so successful? and outreach leader around the country. EARLY INVESTMENT IN COLLABORATION – Heather Bates, Enroll America Three months after the ACA was signed into law, the Maine Health Access Foundation (MeHAF) funded 10 organizations to work as a statewide ACA Outreach and Education team to By the summer of 2013, the group was collaborating so well get the word out to Maine people about the benefits available that it seemed as though organizational boundaries no longer through the new law. Collaborative strategies and message existed. Before applying for the federal Navigator funding, several development were requirements of the grants, which made for organizations convened at MeHAF to decide how they could a bumpy road for the first several months. Many of the grantee include each other in their respective Navigator applications and organizations had worked together in the past, but crafting the best way to incorporate their work as a collaborative. common messages and building collaborative strategies Ultimately, the bulk of the Navigator funding was awarded required a more rigorous level of commitment. However, to one of our grantees, Western Maine Community Action through regular, facilitated, in-person meetings and the use of (WMCA). WMCA partnered with seven of Maine’s other Google Groups to support group interaction, the grantees nine Community Action agencies, leaving only two geographi- became a true collaborative. This early focus on relationship cal coverage gaps in the state. Their proposal also included building proved to be one of MeHAF’s most valuable resources for other MeHAF grantee partners to support their investments. enrollment efforts. ROBUST, INTEGRATED TECHNICAL decisions to make were small businesses. Small and micro- ASSISTANCE businesses represent 97 percent of all employers in Maine and are an important channel to reach our uninsured population. Once the Navigator grants were announced, MeHAF In partnership with Maine’s state and regional Chambers of awarded a $250,000 grant to Consumers for Affordable Commerce, we organized several ACA forums where small Health Care (CAHC) to provide policy analysis and ongoing business owners heard from local experts and the three support for certified assisters. CAHC also provided additional Marketplace insurers. Local insurance brokers were invited and assistance in the geographic areas where WMCA had few encouraged to attend, both to connect with small business resources, and they focused on harder-to-reach populations owners, but also to build their own understanding of the Small such as young adults, immigrants, and refugees. They built Business Health Options Program. more capacity into their existing health insurance HelpLine, MeHAF has tracked awareness of the Marketplace and and quickly took the lead on coordinating regional assister enroll207.com since launching the campaign through a meetings to provide additional training and technical assis- tance. The regional meetings allowed assisters to connect with statewide pre- and post-enrollment poll based on Kaiser each other and find ways to share resources locally. polling questions. As of May 2014, a majority of Mainers now CAHC also built a statewide network for all navigators and say they have heard “a lot” about the ACA, up from only one- assisters to receive rapid responses to the complex questions quarter of those surveyed in the fall of 2013. Also, after just six they encountered during enrollment appointments. CAHC’s months, a third of Maine people indicated they were now policy expertise and expedient problem solving on enrollment aware of enroll207.com. We plan to continue polling through issues were key factors in Maine’s enrollment success. 2015 to help inform our decisionmaking for future enrollment strategies and investments. M E HAF’S ENROLL207.COM PUBLIC Despite being the oldest state in the nation with an average AWARENESS CAMPAIGN age of 43.5, our targeted marketing to young adults boosted Maine’s enrollment of 18 to 34-year-olds to 22 percent of total Even with early ACA outreach and education activities, enrollees for the first open enrollment period. MeHAF main- Maine still faced an awareness gap like the rest of the country. tained an intense focus on reaching young adults both through As October 1 approached, polls continued to show a lack of the enroll207 campaign and through the work of our grantees. awareness about the Marketplace and the financial assistance While the data cannot support a direct correlation, our strong that would be available in Maine. With no significant promo- investment in reaching that population seems to have paid off. tion of the Marketplace planned by CMS, Enroll America, or state government, it became clear that MeHAF was the only Maine is not unique in the many challenges we faced getting organization in Maine positioned to orchestrate a broad pub- the word out about the ACA and the Marketplace. However, lic awareness campaign. Maine’s experience may offer some ideas for other states and With the unanimous approval of our board, MeHAF began health philanthropies. By taking advantage of a foundation’s the process of developing a Marketplace enrollment ad cam- capacity to be quick and nimble with decisionmaking, MeHAF paign. The campaign was built around a website developed by was able to leverage the existing strengths of Maine’s health MeHAF: enroll207.com (207 is Maine’s only telephone area care and nonprofit landscape. Rapid and strategic deployment code). We hired a local advertising agency to guide our mar- of MeHAF’s resources allowed us to fill an essential role with keting plans, ad buys, casting, and voiceovers. Using the the enroll207.com marketing campaign, and our early and enroll207 brand, the campaign deployed a number of strate- long-term investment allowed our partners to be highly effec- gies to reach uninsured people, including city bus ads, tive with their outreach and enrollment efforts when it television commercials, radio spots, and social media, as well mattered most. These strategies have truly made a difference as print, mobile, and online ads. In particular, the campaign and helped to make Maine’s first Marketplace open enrollment targeted young adults with clever, attention-getting ads and a resounding success. internet memes. One print ad that received national attention featured a naked young man holding a strategically-placed laptop computer with the headline, “Dude: it’s time to get For more information, contact Morgan Hynd at covered!” mhynd@mehaf.org or 207.620.8266 x116. The anchor of the campaign, enroll207.com, provided Maine-specific, consumer-friendly information on the ACA, but its primary purpose was to connect people with local, cer- tified enrollment assisters and insurance brokers through a zip code locator. Mainers could quickly find out where to get free help in their communities, make an appointment, or simply call to have questions answered quickly. Views from the Field is offered by GIH as a forum As MeHAF launched the enroll207 campaign, we learned for health grantmakers to share insights and experiences. If you are that the group with the most questions and the hardest interested in participating, please contact Osula Rushing at 202.452.8331 or orushing@gih.org.