Some States Spent Hundreds to Help Sign Up Each Obamacare Enrollee

State-based exchanges spent far more per consumer than states in the federal marketplace did.

National Journal
Sophie Novack
May 2, 2014, 1 a.m.

Hawaii spent $920 to en­roll each new Obama­care con­sumer, while Flor­ida spent only $16.

New data from the Robert Wood John­son Found­a­tion de­tails the amount spent on con­sumer as­sist­ance for the Af­ford­able Care Act in each state, and like over­all en­roll­ment num­bers, the state totals vary a huge amount.

Con­sumer-as­sist­ance pro­grams are those in­ten­ded to help in­di­vidu­als un­der­stand and en­roll in cov­er­age un­der Obama­care, in­clud­ing the Nav­ig­at­or pro­gram, the In-Per­son As­sister pro­gram, and Cer­ti­fied Ap­plic­a­tion Coun­selors. The totals do not in­clude fund­ing for the ex­change sys­tems or oth­er types of pub­lic and private out­reach.

Over­all, the state-based mar­ket­places spent far more to help get res­id­ents en­rolled than states in the fed­er­al mar­ket­place. State ex­changes ac­coun­ted for 50 per­cent of total con­sumer-as­sist­ance funds, yet have only 31 per­cent of all un­in­sured, ac­cord­ing to RWJF. Fed­er­al mar­ket­places ac­coun­ted for 33 per­cent of the fund­ing but house 63 per­cent of the un­in­sured, and the five part­ner­ship states re­ceived 17 per­cent of the as­sist­ance fund­ing, yet in­clude only 6 per­cent of the total un­in­sured.

State-based ex­changes had far more dis­cre­tion over how much of their ex­change es­tab­lish­ment grants they would al­loc­ate for con­sumer as­sist­ance, while fund­ing on the fed­er­al ex­change was based to a lar­ger de­gree on the num­ber of un­in­sured res­id­ents. Thus state-based ex­changes had a much lar­ger range in as­sist­ance fund­ing: While spend­ing in fed­er­al-mar­ket­place states ranged from $16 per en­rollee in Flor­ida to $186 per en­rollee in Alaska, spend­ing in state-based ex­changes was across the board, from $40 in Idaho to $920 in Hawaii.

Top Five Spend­ers per En­rollee:

1. Hawaii: $920 per en­rollee, $7,904,918 total (state-based ex­change)

2. Dis­trict of Columbia: $645 per en­rollee; $6,906,057 total (state-based ex­change)

3. Arkan­sas: $442 per en­rollee; $19,211,296 total (part­ner­ship ex­change)

4. West Vir­gin­ia: $385 per en­rollee; $7,647,178 total (part­ner­ship ex­change)

5. Mary­land: $385 per en­rollee; $25,620,449 total (state-based ex­change)

Bot­tom Five Spend­ers per En­rollee:

1. Flor­ida: $16 per en­rollee; $15,932,367 total (fed­er­al ex­change)

2. Wis­con­sin: $20 per en­rollee; $2,772,728 total (fed­er­al ex­change)

3. Vir­gin­ia: $20 per en­rollee; $4,263,053 total (fed­er­al ex­change)

4. Pennsylvania: $22 per en­rollee; $6,905,518 total (fed­er­al ex­change)

5. Geor­gia: $23 per en­rollee; $7,194,944 total (fed­er­al ex­change)

The state that spent most on con­sumer as­sist­ance was Cali­for­nia, at $61,631,657 total. But Cali­for­nia also en­rolled the most people in cov­er­age by far, with 1,405,102 Cali­for­ni­ans signed up for cov­er­age through Covered Cali­for­nia, the state ex­change. Wyom­ing — part of the fed­er­al ex­change — spent the least on con­sumer as­sist­ance, at $914,232, and en­rolled 11,970 res­id­ents, the fourth-low­est num­ber of all states.

The 25 low­est spend­ers per en­rollee in­cluded only three state-based ex­changes: Idaho, Cali­for­nia, and Con­necti­c­ut. The top half of big spend­ers in­cluded only six states in the fed­er­al ex­change: Alaska, South Dakota, North Dakota, Wyom­ing, Montana, and Mis­sis­sippi.

“The avail­ab­il­ity of fed­er­al money and the type of mar­ket­place were huge factors in the amount states spent to en­roll the un­in­sured,” said Kath­er­ine Hemp­stead, who leads cov­er­age is­sues at the RWJF. “The real ques­tion, which can only be answered in time, is how big of a role states’ con­sumer as­sist­ance pro­grams played in over­all en­roll­ment suc­cess.”

A num­ber of oth­er factors are at play as well, in­clud­ing func­tion­al­ity of the ex­change sys­tem, the de­gree to which the state has em­braced the health care law, and in­volve­ment of oth­er en­roll­ment out­reach groups, whose fund­ing is not in­cluded in these tal­lies.

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