The report details first year enrollment figures; makes recommendations on improvements to the enrollment process; and cites a need for more data to identify gaps in the Louisville health care workforce to meet the needs of the newly insured.
In August 2013, two months prior to the first open enrollment period under the ACA, the Board of Health convened a wide-ranging group of community stakeholders to evaluate the opportunities to expand access to health care under the ACA in Louisville and improve the health of the community. The group included hospital health care systems and providers, state and local government agencies, local nonprofit organizations and insurance providers and insurance agents. The Board of Health divided its work into four committees – Enrollment, Health Literacy & Education, Workforce Capacity and Outcomes & Evaluation.
“Louisville is uniquely positioned for ACA implementation. Our governor has recognized Kentucky as a state with consistently poor rankings in health outcome measures, and has fully embraced the controversial provisions of the ACA in an attempt to change this,” Blakely said. “As the largest urban center, Louisville is the most diverse city within Kentucky, with diverse needs. Outreach and education has required a collaborative effort to be resourceful and comprehensive. We are not aware of similar efforts to convene work groups around ACA implementation.”
Key findings and recommendations:
- The first year of the implementation of the ACA in Louisville was viewed as a success by all stakeholder groups. Actions of the Board of Health committees were viewed as a critical component of successful ACA implementation in Louisville and a model for future collaboration on public health issues.
- Before the ACA there were an estimated 101,000 uninsured Louisville residents. As a result of local efforts, more than 82,000 – 81% of those formerly uninsured – had gained health coverage.
- More than 70,000 of those formerly uninsured were enrolled under Medicaid. Enrollment numbers under private Qualified Health Plans (QHPs) were lower.
- The report recommends the Commonwealth Institute of Kentucky, an entity of the UofL School of Public Health and Information Sciences, complete research to inform the continued outreach process by evaluating consumers’ experiences of acquiring and using health insurance, and exploring why uninsured individuals did not enroll or dropped their coverage.
- The report recommends the Kentucky Office of Health Policy establish reliable mechanisms for collecting workforce data to ensure understanding of Kentucky’s health care workforce capacity to accommodate newly insured consumers.
“The enrollment numbers did not match the forecasted numbers; specifically, many more consumers enrolled in Medicaid than predicted eligible, and not even one-fourth of predicted eligible consumers enrolled in QHPs,” Buchino said. “We must understand who remains uninsured, explore consumers’ hesitancy to enroll in QHPs and their perceptions of affordability, and analyze strategies for outreach to the uninsured population.”
“I commend the Board of Health for their fine work. Improving the health of Louisville residents is one of the top priorities of my administration, and thanks to the efforts of the Board of Health and other community partners, many more residents now have access to healthcare – which is one of the key goals of Healthy Louisville 2020, our plan to improve our city’s health,” said Louisville Mayor Greg Fischer. “My administration has also adopted a ‘health in all policies approach’ that considers the health impact of all local government policy decisions. This coupled with a significantly increased access to health care will assist in our goal of making Louisville one of the healthiest places in America.”