The HIX marketplace’s 3.0 open-enrollment effort is roughly seven months away, but concern is mounting over a perceived plateau effect following the somewhat sluggish signup period for 2015 coverage among state-run health insurance exchanges and a possible U.S. Supreme Court ruling against Healthcare.gov subsidies.

State-run exchanges initially saw big coverage gains compared with states that relied on Healthcare.gov, whose technical glitches were infamous, according to a recent article in The New York Times. But a role reversal during the latest enrollment enabled states that relied on the feds to thrive while states that chose to go it alone saw mostly marginal gains. One reason is states that resisted Medicaid expansion under the Affordable Care Act and relied on Healthcare.gov were able to beef up their HIX enrollment due to an influx of signups from residents who would have been eligible for the Medicaid program.

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Even so, it’s still possible for state-run HIXs to rebound if they adopt the right strategic approach. Cathy Kaufmann, enrollment program director for the nonprofit Families USA, noted that the best-performing states, such as Florida, have thrived on strong, coordinated and targeted outreach, as well as enrollment-assistance programs that are embedded in the community.

“That’s a key lesson for the third open enrollment: With the right community-based help on the ground, more consumers will get enrolled,” she says, describing the nearly 12 million HIX signups thus far as “a phenomenal achievement.” 

Given the smaller pool of uninsured Americans, “there’s no doubt that enrollment stakeholders will have to continue to work harder and smarter to reach those who remain as we enter year three,” admits Jessica McCarron, a spokeswoman for Enroll America, a nonprofit that calls itself the nation’s leading health care enrollment coalition.

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She points to several lessons learned over the past two years. While the remaining uninsured Americans are harder to reach, for example, “they’re not necessarily harder to convince once they have the facts about the coverage options available to them under the Affordable Care Act,” she explains. “That’s why there’s a greater need for local coalitions to come together to spread the word in their communities to reach those who remain.”

Between the first two HIX open enrollments, Enroll America grew by more than 50% to over 4,600 partner organizations across the U.S. The organization is prepared to dive deeper into communities to identify those who stand to benefit, but lack the facts about new options, McCarron reports.

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Jon Kingsdale, a director at the Wakely Consulting Group who used to run the Massachusetts Health Connector exchange, believes state-run exchanges should seek to enroll 65% to 75% of eligible residents. “If we end up running out of gas before 50%, that’s very disappointing,” he told The New York Times.

That would be a huge improvement over the current 38% average, which is slightly lower than the 43% of eligible enrollees who signed up for Healthcare.gov, according to the article in which he was quoted.

Bruce Shutan is a Los Angeles-based freelance writer.

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