How Geographic Distance from Application Counselor Sites Impacts Marketplace Enrollment

Background/Purpose: The fourth year of the Health Insurance Marketplaces (HIMs) showed people’s continued interest in enrolling into Qualified Health Plans (QHPs). Comparing options that are available to individuals and their families can be challenging to navigate, however. Individuals need to not only consider the costs associated with monthly premium payments but also deductibles, co-insurance and co-payment structures, prescription formularies, predicted usage of services, provider and hospital access, and cultural and linguistic competency of health systems. This can be overwhelming to individuals who may not be used to selecting and purchasing health insurance based upon their families’ needs.

Navigators and Certified Application Counselors (CACs) are trained to assist people in comparing and selecting health insurance plans that best meets their needs and circumstances Navigators and CACs are trusted community organizations such as social service organizations, and health centers. They hire enrollment assisters that are culturally and linguistically competent based upon the needs of their communities.

The objective of this study is to see if the location of the enrollment sites had an impact on the enrollment numbers for the nearby zip codes in New Jersey, either by maintaining previous enrollment numbers or increasing the number of enrollments. This has not been previously studied to determine assisters’ role in enrollment changes from year to year. A secondary aim of this study was to determine if there were areas with decreases in enrollment that could benefit from new enrollment sites being established.

Methods: Data and samples: Geographical data from the Census and coordinates of all enrollment sites in New Jersey from CMS were used. The most recent QHP enrollment data from CMS was also used.

Measures: I first created geographic maps of the zip codes and counties in New Jersey in ArcMap. Changes in enrollment by zip code between the last two enrollment periods was calculated and mapped. The coordinates of enrollment sites were then layered in. A spatial join was created between the enrollment site centroids and the zip code enrollment rates. Buffers were created at 10 miles from each enrollment site to create a catchment area.

Results: A total of 266,325 individuals enrolled in QHPs in New Jersey. Zip code enrollment changes ranged from a 46 percent increase to a 30 percent decrease. New Jersey had 144 distinct enrollment sites, with the majority concentrated in Northern New Jersey. A spatial analysis showed that there is a relationship between enrollment rates and presence of enrollment sites. The most important finding was the zip codes with the greatest decreases in enrollment did not appear to have easy access to an enrollment site.

Conclusions and Implications: My findings indicate that there is a relationship between enrollment sites and enrollment patterns. This indicates that areas of lower enrollment could benefit from the establishment of additional enrollment sites. Understanding this relationship better would help health policy planners better understand enrollment patters across insurance types.