HELPING UNINSURED AMERICANS ACQUIRE HEALTH COVERAGE INTERIM REPORT: RESULTS AND BEST PRACTICES

HELPING UNINSURED AMERICANS ACQUIRE HEALTH COVERAGE INTERIM REPORT: RESULTS AND BEST PRACTICES

Helping Uninsured Americans Acquire Health Coverage Interim Report: Results and Best Practices

The consequences of being without health insurance are beyond debate. The respected Institute of Medicine (IOM) has concluded that uninsured adults have a 25 percent greater risk of premature death than those who have health coverage. According to the the Urban Institute, approximately 22,000 between the ages of 25 and 64 died unnecessarily in 2006 because they didn t have health insurance. The societal costs are significant, as well. People without health coverage are more likely to go without preventive or diagnostic care and, thus, when they need medical assistance, it s frequently in expensive emergency room or acute care settings. Health care costs are higher for all Americans because of the uncompensated care dispensed throughout the country by physicians, hospitals and clinics. Policymakers are working diligently on ideas to make health coverage more accessible. Today, we re seeing collaboration on the uninsured issue that transcends ideology and partisanship, and the vigorous discussions taking place now will, no doubt, yield positive results in the near future. While that process is underway, the members of the Healthcare Leadership Council decided that action needs to take place immediately to link uninsured families and individuals with resources that are already available. This determination manifested itself in the Health Access America initiative described in this publication. Health Access America was developed under the premise, supported by research, that a significant number of uninsured citizens don t have to be without coverage. We have long known that not all of those eligible for public programs like Medicaid and the State Children s Health Insurance Program are enrolled for benefits. And studies have shown that many small businesses and working individuals don t know how to get information on how to compare plans and prices. As you ll see in the following pages, we ve demonstrated the strides that can be made when people are provided with the information they need to make sound decisions for their and their families health and well-being. We re very proud of the results we ve achieved thus far through Health Access America, but we know there is much progress yet to be accomplished. It is our hope that the information we ve generated thus far will encourage other communities and organizations to launch their own initiatives, and that the lessons learned from this project will be incorporated into the nation s health reform debates as we move closer to the day when all Americans have the health care coverage they need. Mary R. Grealy President, Healthcare Leadership Council page 1

RESEARCH Research Emphasizes The Need For Outreach The need for a health coverage outreach campaign like Health Access America was confirmed by research commissioned by the Healthcare Leadership Council (HLC) prior to launching the campaign. HLC commissioned the services of the Schapiro Group, an Atlanta-based public opinion research firm. Schapiro has, in the past, performed important research for HLC in determining the communications avenues that would be most effective in reaching senior citizens with reliable, useful information about Medicare benefits. In shaping the direction of Health Access America, HLC asked the firm to determine the types of outreach approaches that would be most effective in driving uninsured people to take action on their own behalf toward finding health coverage. This three-step research project included (1) a national public opinion survey, focused on key segments of the population with high rates of uninsurance (young adults, families with children, small business owners and Latino Americans), (2) one-on-one in-depth interviews with many of the survey respondents, and (3) a simulation experiment in which different communications vehicles were used to urge uninsured individuals to call a toll-free number or go to a website to request information on affordable health coverage options. The results of this research were illuminating, to say the least. Several important points emerged: H Many people do not know how to find information on health coverage options. Fifty-four percent of survey respondents said they did not know of a reliable source of information on health coverage options. (And that number jumps to 73 percent among families with children.) Among those who said they knew where to find such information, almost half cited either the Internet or friends and family members as their predominant sources. H The preconception that health insurance costs too much is one of the largest obstacles in prompting people to pursue coverage. The Schapiro poll showed that 66 percent had a pre-existing belief that they could not afford health insurance, with only 34 percent believing that they could. H To effectively reach uninsured audiences, repeated contacts and persuasive arguments are essential. The Schapiro simulation experiment used both objective stimuli (a just the facts approach presented in both written and audio forms) as well as a more persuasive advocacy-oriented approach. The objective was to convince individuals to call a toll-free number or go to a website to get more information on health coverage options. There is an interesting contrast here with HLC s earlier work with Schapiro on Medicare benefits and programs, in which a presentation of basic facts generated a positive, pro-active response among beneficiaries. That is not necessarily the case with health insurance. Many uninsured people do not feel an immediate, compelling need to acquire insurance if they are currently healthy. Yet, repeated persuasive contacts proved effective. For example, positive responses among young adults doubled between first and second contact. Among parents with children, a second contact with health insurance information combined with compelling reasons to acquire coverage generated a tripling of positive responses. This research made the point abundantly clear that there is a strong need to link uninsured Americans with information about health coverage options, and that outreach can be effective in convincing people to take the proactive steps necessary to leave the uninsured rolls. page 2 Helping Uninsured Americans Acquire Health Coverage

S t ru ct u re o f He a lt h Acce s s Amer ic a Health Access America: Community-Based Health Coverage Outreach Health Access America has succeeded in linking people with health coverage by embracing an approach focused on helping communities to help themselves. In each of the cities in which the campaign has been implemented, Health Access America organizers began the work by building coalitions of community-based organizations such as civic clubs, business groups, churches and faith-based organizations, schools, ethnic alliances and others. These coalitions were critical in developing health coverage educational events and providing the local credibility that encouraged residents to attend to find out more about the importance of health coverage and their various public and private options. The public-private focus of Health Access America cannot be emphasized strongly enough. The initiative began with the precept that, although there are not coverage options available for every single uninsured person, public programs and private plans are available for many individuals without coverage and a proactive effort is essential to make sure that people are linked with the available option best suited to them. Consequently, at health coverage educational events, experts were on hand who could answer questions about programs like Medicaid and the State Children s Health Insurance Program. There were also independent health insurance representatives who could present a plethora of private plans from a variety of different insurers. In all, Health Access America activities and resources were directed toward the following types of activities in the target cities: Grassroots Outreach H Distributed materials and conducted enrollment/education events in establishments in which key populations naturally congregate, i.e., community health centers, schools, hospitals, workplaces, job fairs, health clubs, meal sites, pharmacies, hospitals, physician offices and grocery stores. H Developed and delivered presentations on health coverage to community organizations, including rotary clubs, service organizations, local disease support groups, workplace lunch and learn sessions and faith-based institutions. Int e ri m Re port: Results and B es t Pract ic e s Using contemporary materials and events on college campuses, the Health Access America delivered a message on the value of health coverage to young adults entering the job market. page 3

Earned Media Development H Conducted intensive outreach to local reporters to ensure that there is a continuing drumbeat of interest on the nation s uninsured problem and to stimulate public discussion on possible solutions. H Placed articles and informational pieces in publications produced by national offices and local chapters of various organizations, as well as in weekly community newspapers, local seniors publications and faith-based community weekly bulletins. Information Dissemination H Using Health Access America enrollment/education events as a platform, provided current information to local media and community groups on the impact of uninsurance on health and well-being and the effect of high numbers of uninsured Americans on overall health care costs. H Provided expert speakers on health care and the uninsured to various events in Health Access America target locales. page 4 H e lpin g U n in su re d A m e ric a n s Ac q u ire H e a lt h C ov er age

RESULTS In 2007, the Health Access America campaign launched outreach initiatives in Cleveland, Ohio; Memphis/Nashville, Tennessee; Columbia, South Carolina; Baton Rouge, Louisiana; Corpus Christi, Texas; Saginaw, Michigan and Las Vegas, Nevada. This came after the Health Access America approach was tested with abbreviated pilot programs in Las Cruces, New Mexico and Raleigh, North Carolina in late 2006. In these cities, efforts were focused on four population groups with high rates of uninsurance young adults, children, Latino Americans and small business employers and employees, with a special emphasis on low-income individuals and families. Events were geared to attract members of these demographic subsets, from college campus displays that provided information for soon-to-be-graduates to holiday themed events at local schools for uninsured families with young children. Of the accumulated data from the more than 1,000 events that were held in these nine cities, one fact leaps off the page. Health Access America attracted over 33,000 participants who received information on how to acquire health coverage, and today more than 16,000 individuals have some form of public or private coverage. These results underscore the need for aggressive outreach to provide information about health coverage options, public and private, to uninsured Americans. Most of these results were compiled in the last eight months of 2007. The beginning of the year was devoted to coalition building and reaching out to the more than 500 partner organizations that helped host and organize the many Health Access America events. Interim Report: Results and Best Practices page 5

public private programs The Value of Public-Private Cooperation In the Health Access America results detailed on page 5, readers will note variations between locations in the percentages of new enrollees who acquired private or quasi-private health insurance. These numbers underscore the significant gains being made in states and localities that have taken bold, innovative approaches to make health coverage more accessible for their working individuals and families. Take Tennessee, for example. Of the more than 4,000 people who attended Health Access America events and eventually acquired health coverage, almost 60 percent enrolled in a private insurance plan. Many of these newly insured in the Volunteer State came to Health Access America events and learned more about their eligibility for the Cover TN program in their state. In 2006, the Tennessee state legislature passed and Governor Phil Bredesen signed legislation creating a new program called Cover Tennessee. Cover Tennessee has several components, one of the particularly noteworthy being CoverTN, which was created to help employed persons having a difficult time affording health insurance premiums. As one columnist wrote, the program is affordable by almost anyone, and designed to promote wellness and prevention, not encourage further misuse of an already overburdened system. The intention is to encourage subscribers to use the program for annual physicals and screenings, to find problems early before they become more serious, and to become more self-responsible about nutrition and other habits, to reduce the long-term issues of palliative and nursing care further down the road. Under CoverTN, the state pays one-third of an eligible individual s insurance premium with employers and employees sharing the remaining costs. With the help of this program, many people working for small businesses are now getting basic health care coverage for less than $100 per month. The coverage is geared to keeping employees healthy and minimizing future health care costs. As one columnist wrote, the program is affordable by almost anyone, and designed to promote wellness and prevention, not encourage further misuse of an already overburdened system. The intention is to encourage subscribers to use the program for annual physicals and screenings, to find problems early before they become more serious, and to become more self-responsible about nutrition and other habits, to reduce the longterm issues of palliative and nursing care further down the road. A number of similar programs are being developed in other jurisdictions throughout the country. In fact, the HLC instituted an Honor Roll for Coverage award in 2001 to place a national spotlight on programs that are implementing innovative ideas to help small businesses and their workforces better afford health coverage. Initiatives like these are demonstrating that it s not necessary for a subsidy program to cover the entire page 6 Helping Uninsured Americans Acquire Health Coverage

Components of a Successful Health Coverage Subsidy In its work surveying subsidy programs aimed at helping working Americans who are without health insurance, the Healthcare Leadership Council have witnessed some common threads that link those programs that have had high levels of success. In order to achieve a high participation rate among small businesses and their employees, subsidy programs should: H Reduce administrative burdens on small business owners. H Avoid narrow definitions for eligibility and participation that make enrollment in the program difficult. H Devote part of the program budget to energetic outreach to the target population. Simply sending a letter won t generate participation. H Focus on sustainability. Some programs couldn t continue over the long run because they set the subsidy at an unsustainable level. H Allow choices of coverage to meet employees personal needs, so that some families can elect, for example, to pay for obstetric services, which others may not need. The Impact of Outreach H Leon, a Louisiana minister, adopted his grandson to give him a better life but had too much income to maintain his grandson s SCHIP coverage. Working with Health Access America, Leon was able to find an affordable private insurance policy and the peace of mind that goes with it. H To the greatest extent possible, develop a coverage model that can integrate seamlessly into the existing health insurance market. cost of health care premiums to be effective, but to help bridge the gap between the cost of coverage and what working families and individuals can afford. In order for these programs to be effective, they must be structured to make it relatively easy for small businesses and employers to participate. In Saginaw, Michigan, Health Access America did a great deal to draw attention to the local Tri-Share program, which is intended to help local workers afford health coverage premiums. Stringent eligibility requirements, however, made it difficult to link many small business employers and employees with the program. HLC president Mary Grealy said much can be accomplished by matching outreach initiatives like Health Access America with coverage programs like Tennessee s CoverTN measure. We know that a majority of Americans say they don t know where to find information about health insurance. We also know that many small business owners and employees are seeking affordable coverage. If we have governments willing to take bold steps to help make private insurance more affordable, and if we engage in a concerted effort to get the word out about these programs, we can make a big difference in reducing the number of uninsured in this country. Interim Report: Results and Best Practices page 7

LESSONS LEARNED Replicating Success: Key Elements For Effective Health Coverage Outreach In putting together over 1,100 education/enrollment events in 2007, assembling a coalition of more than 500 partner organizations and working with thousands of uninsured individuals, the many organizers and volunteers who were the engine of Health Access America have developed a lengthy list of best practices for health coverage outreach programs. Among the most important: Know the environment. Before launching an outreach initiative, it s critical to take an inventory of what s already taking place within the area in question. What organizations are currently working to help the uninsured? What kinds of programs and activities are in place? What types of insurance products are available? How does the enrollment process work in the state for registering for programs like SCHIP and Medicaid? It s essential to answer all of these questions in order to assemble effective coalitions and create successful outreach events. Build a strong partner network. As research has shown, many uninsured Americans aren t immediately inclined to hunt for the best available health insurance policy, particularly if they are healthy and see coverage as a luxury instead of a necessity. It takes dedicated partner organizations, with high levels of local, on-the-ground credibility, to encourage citizens to spend some of their time at an event to learn more about the value of health coverage. National analysts often wonder why so many people eligible for public programs aren t enrolled. Local partner groups can identify the people who most likely need assistance and can help link them to the best coverage options. Themed events, like this Halloween health fair in Las Cruces, NM, attracted families with children to events discussing health coverage options. page 8 H e lpin g U n in su re d A m e ric a n s Ac q u ire H e a lt h C ov er age

Leverage already-scheduled events and activities. Organizations can make their outreach dollars stretch farther by working with local groups to inject a health coverage message into events already taking place. Not only does this avoid the time and expense of re-inventing the proverbial wheel, but it makes it possible to emphasize the importance of health coverage to a ready-made audience. Localize your message. Research has shown that generic direct mail missives sent to tens of millions of people nationwide are not as effective as the advice of a local radio talk show host. People do not respond to bland, prepackaged, one-size-fits-all advice. Communities have their own character, and that needs to be reflected in the message as well as the individuals and groups delivering that message. Local media is valuable in establishing credibility. Studies have shown that the local newspaper has a greater impact on people s decisions than a national publication, and individuals tend to listen more attentively to the local television or radio news than they do to network nightly news. It helps ease the way toward attracting uninsured individuals to an enrollment or education event if they have already familiarized themselves with the effort by reading about it in the local paper. HLC Regional Director Tom Maher discussed health coverage options with an audience in New Mexico. Health Access America events featured both group seminars and one-on-one counseling opportunities. The Impact of Outreach H Omar, a self-employed carpenter in Nevada, had no health insurance for his children, one of whom is hearing-impaired. Through Health Access America, Omar One-on-one counseling is vital. learned about Nevada s SCHIP Decisions about health insurance are intensely important and personal matters. program and received enrollment A lecture to a large group may pique some interest, but it s not likely to be assistance. His children now a catalyst for action. Asking questions about the cost of health insurance, receive the health care they need. eligibility for public programs, pre-existing conditions and other matters cannot and will not be done in front of an audience. Any effective outreach initiative must utilize qualified counselors who can meet with people privately and face-to-face to help them make those personal health coverage decisions. Make outreach easy for busy parents and small business owners. The millions of small business owners with fewer than 20 employees don t have human resources departments to compile information on health insurance policies and compare them for price and quality. Health Access America found great benefit in hosting local seminars for small business owners, at which experts could answer questions on issues such as tax deductibility and the various types of insurance plans available. Often, these seminars would be held at times and locations that would make it easy for local merchants to attend. The same holds true for the busy schedules of parents with young children. It s useful, as well, to tell people in advance what information they should bring in order to facilitate the enrollment process for either public programs or private plans. Int e ri m Re port: Results and B es t Pract ic e s page 9

H Healthcare Leadership Council Members H Abbott Aetna Amerinet Amerisource Bergen Corporation Aptuit Ascension Health Assurant Health AstraZeneca Baxter International, Inc. Baylor Health Care System BlueCross BlueShield of Tennessee Cardinal Health, Inc. Cleveland Clinic Foundation CVS Caremark Eli Lilly and Company Evanston Northwestern Healthcare Franciscan Missionaries of Our Lady Health System, Inc. GlaxoSmithKline Hospira, Inc. Johnson & Johnson Lahey Clinic Marshfield Clinic Mayo Clinic McKesson Corporation MedAssets, Inc. MemorialCare Merck & Company, Inc. New York-Presbyterian Hospital Novo Nordisk Pfizer Inc. Premier, Inc. sanofi-aventis Texas Health Resources Theragenics Corporation Thermo Fisher Scientific University of Wisconsin Health VHA Inc. Vanderbilt University School of Nursing The Healthcare Leadership Council (HLC) is a coalition of leaders of many of the nation s premier health care companies and organizations. For HLC members, accessible health care coverage for the nation s uninsured has long been a top priority. To do its part to address this challenge, in 2001, HLC members launched the initial Health Access America initiative to bring greater visibility to the issue of the uninsured. The foundation of that project was research that led to a greater understanding of the uninsurance problem. Data that emanated from HLC research that nearly eight of every 10 uninsured Americans live in a wage-earning household has changed conventional wisdom about the face of the uninsured. As part of this campaign, HLC also launched a program called The Main Street Initiative, which made information on the price and availability of health insurance more accessible for small business owners. This project succeeded in a number of pilot jurisdictions and was then utilized on a statewide basis by the Commonwealth of Virginia. Today, HLC is taking Health Access America to a new level, demonstrating the significant gains that can be made and the number of lives affected by investing in outreach and education to link uninsured Americans with the health coverage resources that are available to them. 1001 Pennsylvania Avenue N.W., Suite 550 South H Washington, D.C. 20004 H P: (202) 452-8700 H www.hlc.org