As one of its primary aims, Obamacare has always centered on the theme that all Americans should have access to affordable healthcare. When the PPACA (Patient Protection and Affordable Care Act) was passed, subsidies and tax credits were put in place to allow uninsured to be able to afford health insurance plans. With enrollment numbers picking up, it is still clear that there are many uninsured who haven’t signed up.

There are several reasons impacting the number of enrollments and most of those reasons can be split into three broad categories – flawed health exchanges, convoluted processes and a lack of knowledge. Although the administration has spent a lot of money and time for educating Americans on the health insurance marketplaces, several groups have cited that they do not have all the information they require, especially people who think they qualify for some kind of health insurance subsidy but are not sure about their status. Fortunately, volunteer groups and exchange navigators are making a big push toward educating these groups. Let’s take a look at each of these endeavors in detail:

1) Lack of information on insurance subsidies. The biggest hurdle for the uninsured is that they don’t have the financial resources to buy health insurance for their family. Furthermore, the prime benefit of Obamacare, the insurance subsidy, seems to have eluded the demographic that needs it the most. Most underprivileged don’t know that they are eligible for a subsidy. Addressing this issue requires a two-pronged approach — guiding and educating. In the majority of states, navigators and volunteer groups are conducting meetings to help uninsured citizens take advantage of the insurance subsidies available to them, answer specific questions for participating families and guide them through the enrollment processes.

2) Poor performing health exchanges. In the healthcare.gov mess, the uninsured were one of the biggest losing groups. With prevalent technical failures and unresponsive marketplaces, a large number of families have not been able to enroll through the online system. When you couple the technical problems with the low technical knowledge and limited access to resources, the problem becomes magnified. To tackle this, most exchange navigators and volunteer groups have taken up paper-based applications and have practically walked families through the whole enrollment process. Of course, the process is daunting, but with rampant technical errors on the website, there is no alternative for this demographic but to seek the help of these navigators for complete walkthroughs and process guidance. However, with exchanges getting better from January, the process has gained momentum, with total enrollments surpassing 5 million.

3) Convoluted processes and several implicit conditions. The side effect of having one of the most detailed health reforms is the convoluted processes and multitudes of if/then scenarios. According to surveys, most underprivileged and volunteers feel that there are too many scenarios in play while enrolling families, thus putting families in need of professional guidance. Voluneers and navigators have been available since the October 1, 2013 launch, but the strategy has its own limitations. A better strategy for this has been implemented in Maryland where Lower Shore Health Insurance Assistance Program, a group of volunteers and exchange connectors, have started holding events and educational sessions for taking questions and spreading information.

With lack of information on subsidies and convoluted processes, the uninsured have been dependent on volunteers and exchange navigators. With technical glitches out of the way, the enrollments have become easier, but there is still a large load on the volunteer groups.

The long term strategy here would be continuing to educate people, especially the uninsured, about the benefits of having coverage, as opposed to not having insurance and paying a tax penalty.

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