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ACA enrollment experiences vary depending on state policies

Data from a recent study suggest that state policies regarding the enrollment and application process for the Affordable Care Act have a significant impact on how low-income adults perceive their experience with the process.

“The ACA was enacted as a national health reform law, but states have substantial discretion in its implementation,” Benjamin D. Sommers, MD, PhD, assistant professor of health policy and economics at Harvard T.H. Chan School of Public Health, and colleagues wrote. “Among low-income adults in three Southern states, ACA-related experiences varied widely and demonstrated strong associations with key state policy decisions.”

Researchers conducted a survey of 2,801 low income adults to gauge experience and exposure to the ACA. To determine how states’ policies affected experience with ACA exposure, cohort members were evenly divided between Kentucky, Arkansas and Texas. These three states were chosen due to their varying degrees of support for ACA implementation. Kentucky adopted ACA policies that provided application assistance and created an independent state marketplace, Arkansas adopted policies that provided limited application assistance and created a marketplace through a joint federal-state venture, and Texas adopted policies that limited ACA workers  and defaulted to use of the federal marketplace.

Kentucky had the highest ACA awareness of the three states, with approximately 50% of respondents reporting that they had either read or heard either “some” or “a lot” about ACA coverage. Both Arkansas (56.6%) and Texas (55%) had lower awareness, participants responding that they had “little or no” exposure to ACA coverage information.

The study found that respondents in states with more ACA support had more positive experiences than in states that did not offer support. In Kentucky, 64.5% of respondents reported having “good” or “excellent” experiences with the overall application process, while Arkansas and Texas reported 52% and 49.7%, respectively.

Researchers note that lack of funding and restrictions levied against ACA assistance by the state of Texas may have played a significant impact in low-income citizens’ experience of the ACA process.

“State policy decisions are likely having a critical impact not only on eligibility but also on who chooses to apply for coverage and whether they successfully enroll. Our findings suggest that effective implementation… and positive outreach efforts — most evident in Kentucky — may have major effects on the experiences and perceptions of low income adults under the ACA,” Sommers and colleagues wrote. – by David Costill

Disclosure: The researchers report no relevant financial disclosures.