MNsure, Minnesota’s health insurance exchange marketplace changed outreach strategy for the 2015 enrollment period. Navigators and community leaders anticipate health insurance sign-up through MNsure of hard-to-reach groups such as Somalis to drop, potentially leading to an increase of those without health insurance in Minnesota.
MNsure was a success in 2014 despite numerous problems with the website and the call center. Nearly 170,000 Minnesotans bought health insurance some for the first time helping to drive the uninsured below 5%.
More Minnesotans became qualified for subsidies due to an expansion of Medicaid under the Affordable Care Act (ACA) of 2010. The ACA raised the income level to be qualified for assistance. Many Somalis became qualified for assistance in the form of tax deductions and premium reductions. Small business owners and their employees were considered earning too much to be qualified for health insurance assistance. So are independent contractors such as taxi drivers and some janitors. Significant Somalis in Minnesota fall into these categories and MNsure helped find the right health insurance policy in 2014.
Intense outreach effort was one of the key reasons for the 2014 success. MNsure's outreach effort had three components running in parallel. First, there was mass marketing that featured Paul Bunyan and Babe the Blue OX. Second, Community based organizations were funded to do outreach. Third, MNsure had field operation targeting hard to reach demographics particularly rural and new American communities. The total budget for all three was around $10 million.
The campaign featuring Paul Bunyan and Babe the Blue OX was seen on TV and heard on radio across the state. It earned free media after it was criticized for lack of inclusivity. The advertisement campaign was later re-enforced by TV and radio spots featuring testimonials from ordinary Minnesotans attaining health insurance for the first time.
Community based organization were funded to conduct outreach to specific constituencies and help them navigate through enrollment process. Faith organizations and other nonprofits held over 50 events in the last weekend before the deadline helping many Minnesotans to overcome challenges with the website and the call center.
MNsure’s field operation developed targeted messages for hard-to-reach groups such as the Somalis and the young population. For example, MNsure enlisted the help of Captain Phillips Somali actors. The thriller was making big splash on the big screen and having Barkhad, Golden Globes nominee for best supporting actor generated a buzz for MNsure in a community sizzling with pride. Barkhad appeared community events encouraging community members to sign up. Barkhad's appearance with co-actor Faysal in both Somali and English public announcements were released online reaching young population as well.
The three component outreach strategy of 2014 was abandoned for the 2015 enrollment. The outreach budget was slashed to $4.8 million and field operation outsourced to Grassroots Solutions.
One assumption for the lower budget was that those insured in 2014 would be automatically enrolled at the same coverage in 2015 unless they response to a letter sent to their address on record. This was faulty assumption. Members of hard-to-reach groups are transient and the likelihood they still reside at the same address is small. Moreover, coverage doesn't start until premium is paid. Neither objective will be accomplished by a letter via snail mail leading to potential rise of Minnesotans without health insurance.
Another reason for the low forecast of Somalis signing up health insurance through MNsure is that Grassroots Solutions took over all field operations. Grassroots Solutions plan calls for leverage on other nonprofits. It’s a good plan on paper but other nonprofits have little financial incentives to get behind it. On the other hand, a field operation directly ran by MNsure as done in 2014 presented other nonprofits with future financial incentives thus created more cooperative atmosphere.
Of course, it’s early to gauge health insurance purchases through MNsure for 2015. It’s particularly early to judge the number of policies purchased from the basic public health system as enrollment is open throughout the year. But any rise from 2014 to 2015 of those without health insurance will be directly correlated to change of outreach strategy.