The Kaiser Family Foundation released a report last week showing that 47 percent of the nation’s uninsured report lacking coverage for five or more years, and 18 percent report never being covered.
Colorado is not immune to a persistent lack of health coverage among its uninsured. The 2013 Colorado Health Access Survey indicates that 51 percent of the uninsured in Colorado have been without coverage for more than three years, 37 percent for more than five years, and 10 percent have never been insured. Together, these account for more than 420,000 Coloradans.
While the percentage of uninsured lacking insurance for five or more years is 10 percentage points lower than the national numbers reported by Kaiser, Colorado is trending upwards. Colorado saw an increase of eight percentage points for uninsured Coloradans who lacked insurance for five or more years between 2011 and 2013, a statistically significant increase of more than 35,000 Coloradans.
The chronically uninsured may potentially require specialized outreach to help them re-enter the health care system, as the Kaiser report points out. Because they have been uninsured for such an extended period, their ties to the health care system are likely minimal. And for those who have had insurance coverage in the past, much has changed under the Affordable Care Act. Targeted education and outreach efforts may be required to reintroduce, or in many cases introduce, the chronically uninsured to the health care system.
One outreach strategy is to target this population using public assistance programs, such as Child Health Plan Plus (CHP+), Medicaid, the Supplemental Nutrition Assistance Program (SNAP), disability or cash assistance programs. Kaiser found that among uninsured adults eligible for Medicaid under the eligibility expansion in the Affordable Care Act (up to 138 percent of the federal poverty line), 62 percent reported someone in their immediate family receiving public assistance benefits. This provides an avenue for which the states can quickly and easily identify those who are likely eligible for Medicaid.
Some states, such as Oregon, have had success “fast tracking” enrollment through programs such as SNAP. Because there is significant overlap between SNAP and Medicaid eligibility, 97 percent by some estimates, states have been able to substantially streamline the application process, making enrollment less burdensome on both the consumer and the government.
Colorado has begun a rollout of this strategy, although details are limited. The states and the federal government ascribe a lot of potential to these “fast track” approaches, and hope it can be one means of addressing the chronic-uninsured problem.