Asheville, North Carolina May 2013 United Way and the Affordable Care Act: What You Need to Know as Consumers, Advocates, and Social Entrepreneurs United Way Southern Institute

The Bottom Line: What you need to know… Connecting children and families to coverage is completely aligned with our mission There’s a good chance you could raise money to do it August 28,

The Bottom Line: What you need to know… ObamaCare is the law of the land and it’s not going anywhere Connecting Americans to coverage is completely aligned with our mission Insurance companies understand that the better the law works, the more money they will make United Ways and 211s have incredible reach to the uninsured, reach that no other organizations have United Ways and 211s should monetize our outreach and education efforts AND GET PAID TO DO THIS WORK! Figure out how broad your reach is, and shop it around – insurance companies and foundations will be very interested to know how you reach people and how many you can reach, and help us give them new customers August 28,

All insurance plans will have to cover doctor visits, hospitalizations, maternity care, emergency room case, and prescriptions. You might be able to get financial help to pay for a health insurance plan. If you have a pre-existing condition, insurance plans cannot deny you coverage. All insurance plans will have to show the costs and what is covered in simple language with no fine print. If you’re to remember anything from this preso…

Agenda Brief Overview of the Affordable Care Act Outreach and Enrollment for the new Health Benefits Marketplaces – Consumer Assistance Marketing – the Messaging that Resonates with Consumers Advocacy for the Full Funding of Medicaid August 28,

The Patient Protection and Affordable Care Act of 2010 Passed by Congress and signed by President Obama in March million Americans could gain coverage through an expansion of Medicaid to cover families earning 133% of the Federal Poverty Line (FPL) Graduated scale of premium subsidies for those between 134 and 400% of FPL Health Benefit Exchanges at the state level or by the federal government expected to cover roughly 16 million more Americans Private health insurance reforms, such as: No pre-existing conditions or lifetime caps Free prevention screenings Coverage for children on parents’ plans up until the age of 26 6

Who Can Be Navigators? Community and consumer-focused non- profit groups (like United Ways and 211s!!) Trade, industry and professional associations Ranching, fishing and farming entities Chambers of commerce Partners of the Small Business Administration Unions Licensed insurance agents and brokers Other entities capable of carrying out the required duties

Navigators assist with five things… 1.Public education campaigns 2.Medicaid and CHIP eligibility and Advanced Premium Tax Credits 3.Enrollment process 4.Referrals 5.Language and culture August 28,

SHOP Marketplace for Employers Purchasing pool to increase buying power and reduce administrative costs Small businesses with fewer than 100 workers eligible Those businesses with fewer than 50 are not required to provide health insurance August 28,

Open Enrollment 2013/2014: THIS is our moment.

The 2014 Enrollment Opportunity Source: July 2012 CBO estimates Millions Enroll more than 16 million people in new coverage options } 9 million in Exchange coverage 7 million in Medicaid or CHIP } 11

Enrollment isn’t a snap… Program Percent of Eligible People Enrolled Children’s Medicaid/CHIP, national average, % Medicare low-income subsidy, 2009*40% Unemployment benefits72-83% Earned income tax credit80-86% SNAP (food stamps)54-71% * Does not include populations automatically enrolled in the low-income subsidy. Take-up in optional public benefit programs

Where are the Uninsured ? 13 Two-thirds of the uninsured live in twelve states Arizona California Florida Georgia Illinois Michigan New Jersey New York North Carolina Ohio Pennsylvania Texas

Demographic Profile of the Uninsured (Nonelderly Adults, Ages 18-64) % 47 % Race/Ethnicity Percent of Uninsured Uninsured Rate White (non-Hispanic)45%13% Black (non-Hispanic)15%21% Hispanic32% Asian/Pacific Islander5%18% American Indian/Alaska Native 1%27% Two or More Races2%15% 62% Live in Families with at least One Full Time Worker Source: Kaiser Commission on Medicaid and the Uninsured, October 2012

Limited Public Awareness The majority of uninsured Americans who may be Medicaid eligible don’t know the health reform law will help them. 75 % Three out of four of the newly eligible want in- person assistance to learn about and enroll in coverage. 15 Enroll America Research, November %

Help, I Need Somebody! 16 Figuring out if they qualify for financial help (55%) Finding the best plan for them (52%) What Kind? Someone from your state whose job it is to help people with these new options (45%) Family member (37%), your doctor or nurse (36%), someone from a health insurance company (35%) Which family member? Spouse (42%) or mom (20%) From Whom? In-person (75%), telephone (33%), (20%), online chat (9%) How? Insurance agent or broker’s office (29%), family member or friend’s home (27%), clinic or doctor’s office (22%), Medicaid office (21%). Where?

Messaging that Works

Building an Effective Campaign Grassroots field efforts Creative use of social media National and local surrogates Education & engagement through partner entities with direct reach to target populations Earned media events and Activities in communities to magnify messaging Enrollment assistance by trusted community sources 18 Paid advertising on TV, radio online, and in print media Paid advertising on TV, radio, online, and in print media Data, Analytics, Micro- targeting Constituency engagement Strategic Partner- ships

Research Design 19 National Survey Fielded in October 1,800 adults, oversamples of uninsured, low-income, Latinos, African Americans, young adults Explore by target group motivations to enroll, barriers, trusted messengers, communications methods, awareness and attitudes toward ACA 10 Focus Groups November in Philadelphia, Columbus, San Antonio, and Miami Groups include Latinos (English- and Spanish- speaking), African Americans, young adults, parents (low and moderate income), childless adults (low and moderate income) Test branding and messages

Segmentation 20 Skeptical Young Men Unnecessary & Uninterested – 24% Young, Diverse Families Reluctant, but Reachable – 21% Medicaid, CHIP, SNAP connection Connected, Low-Income Women – 11% Sick, Poor, Least Educated Desperate & Believing – 13% Young, Under 250% FPL Insured & At-Risk – 11%

For many, looking for health coverage is a negative experience. 21 How they want to feel is confident, informed, secure, satisfied, and in control. If you had to look for health insurance now, what feelings do you think you would have?

Key Findings Almost all (91%) believe health insurance is necessary or very important. Cost and affordability are the biggest barriers. Financial & health security are the biggest motivators. Deep skepticism & confusion among consumers.

All insurance plans will have to cover doctor visits, hospitalizations, maternity care, emergency room case, and prescriptions. You might be able to get financial help to pay for a health insurance plan. If you have a pre-existing condition, insurance plans cannot deny you coverage. All insurance plans will have to show the costs and what is covered in simple language with no fine print. Four Key Facts to Reach Most Uninsured

Targeting Messages The leading perceived benefit of coverage across populations Financial Security & Peace of Mind A key message for women Prevention Resonated most with men and young adults in some states Protection from Financial Ruin or Injury Resonated with African Americans, Latinos, and Medicaid eligible Access To Care Key message for low income, Medicaid eligible Low cost or free health insurance coverage

An Action Plan for Organizations 25 1.Identify the leading partners in your state or area (you don’t have to be the expert!) 2.Recognize everyone’s role in outreach 3.Create an outreach and public education plan 4.Disseminate information 5.Follow up, follow up, follow up! Collaboration is the name of the game!

1. How are you currently partnering with organizations to discuss enrollment? 2. What are you currently doing in regards to current program outreach activities and planning for future health coverage outreach efforts? 3. What tools / resources have you used in the past and what are you currently using? 4. Have you leveraged your workplace giving campaigns to inform contributors of opportunities in the community? 5. Describe coalitions that you currently participate in that have a health as a focus. Successes? Unlikely partners? 26

What are the three things I can do? 1.Talk to your friends and family about Open Enrollment 2013/2014 and the new options that will be available to them 2.Get informed and prepared to handle the call volume and health insurance questions that are coming 3.Stay tuned to and for more informationwww.enrollamerica.org August 28,

Advocacy on Medicaid

August 28,

State and/or Local United Ways Advocating for Medicaid Maximization 1: Yes, we are absolutely advocating for Medicaid Maximization in our state! AlaskaNevada CaliforniaSouth Carolina ColoradoTennessee Illinois Iowa Florida Michigan August 28,

State and/or Local United Ways Advocating for Medicaid Maximization 2: Yes, but we are working behind the scenes. Arizona Georgia Indiana Louisiana Maine Montana Ohio Washington August 28,

3: We are not quite sure – we’re still feeling it out. AlabamaRhode Island Arkansas Texas MarylandUtah New JerseyWisconsin North Carolina Pennsylvania August 28, State and/or Local United Ways Advocating for Medicaid Maximization

United Way Advocacy on Medicaid 4: No, we do not plan to advocate on this issue at this time. District of Columbia Minnesota New York NB: The political leadership of these jurisdictions are fully supportive of accepting Medicaid money. Advocacy on this front is not necessary. August 28,

Key Medicaid Messaging DON’T CALL IT MEDICAID EXPANSION! Accepting Medicaid money Strengthening Medicaid Serving everyone eligible for Medicaid Maximizing Medicaid Families care about their health and financial security. Medicaid is a pocket-book issue A close look at the calculus shows that Medicaid is good for state budgets and economies Kids can’t learn if they’re not healthy. Education outcomes are dependent upon Health Access August 28,

Key Medicaid Messaging Expanding Medicaid is a good deal for our state. It’s a smart/small investment that saves dollars and is good for our bottom line. Use state-level data/research when possible that shows potential savings outweigh the costs It will ensure health dollars are spent more effectively by reducing uncompensated-care costs for hospitals and clinics that currently serve people without insurance It will bring millions in federal funding into the state. Let’s bring back our tax dollars to pay for our state’s priorities Republican Governors on Medicaid Maximization: August 28,

Key Medicaid Messaging Failure to maximize Medicaid will have negative consequences for local hospitals: Many of our state’s hospitals rely on Medicaid dollars to provide essential services and equipment, such as state-of-the-art NICUs and professional development training to doctors and nurses Without Medicaid, hospitals will be forced to absorb all the costs for treating the uninsured – causing some hospitals, especially those in rural areas, to close Hospitals are essential to keeping our communities healthy and they are also economic engines. Accepting Medicaid money helps keep them strong. August 28,

All insurance plans will have to cover doctor visits, hospitalizations, maternity care, emergency room case, and prescriptions. You might be able to get financial help to pay for a health insurance plan. If you have a pre-existing condition, insurance plans cannot deny you coverage. All insurance plans will have to show the costs and what is covered in simple language with no fine print. If you’re to remember anything from this preso…

Thank you! Patrick McIntyre, United Way