Objective 1.1: Increase choice, affordability, and enrollment in high-quality healthcare coverage

HHS supports strategies to increase choice, affordability, and enrollment in high-quality healthcare coverage.  HHS promotes available and affordable healthcare coverage to improve health outcomes in our communities and empowers consumers with high quality healthcare coverage choices.  The Department also leverages knowledge and partnerships to increase enrollment in health insurance coverage.  

Objectives are the changes, outcomes and impact the HHS Strategic Plan is trying to achieve.  This objective is informed by data and evidence, including the information below.

• Based on enrollment data from late 2020 and early 2021, approximately 31 million people were enrolled in Marketplace or Medicaid expansion coverage related to provisions of the Affordable Care Act (ACA) , the highest total on record.  (Source: Health Coverage Under the Affordable Care Act: Enrollment Trends and State Estimates)  As of January 2022, 14.5 million consumers had enrolled and effectuated health insurance coverage through the Marketplaces.  (Source: Biden-Harris Administration Announces 14.5 Million Americans Signed Up for Affordable Health Care During Historic Open Enrollment Period)
• In May 2021, 82,761,078 individuals were enrolled in Medicaid and Children’s Health Insurance Program (CHIP), an increase of 459,367 compared to April 2021.  75,888,651 individuals were enrolled in Medicaid, an increase of 441,109 compared to April 2021.  6,872,427 individuals were enrolled in CHIP, an increase of 18,258 compared to April 2021.  Since February 2020, enrollment in Medicaid and CHIP has increased by 12,073,218 individuals (17.1 percent).  Medicaid enrollment increased by 11,860,914 individuals (18.5 percent).  CHIP enrollment increased by 212,304 individuals (3.2 percent).  The Medicaid enrollment increases are likely driven by COVID and the continuous enrollment requirement in the Families First Coronavirus Response Act (FFCRA).  (Source: May 2021 Medicaid and CHIP Enrollment Trends)
• Studies show that people without health insurance coverage are less likely to receive necessary preventive care and screening services, have less access to care, and experience worse health outcomes than those with health insurance coverage.  (Source: The Remaining Uninsured: Geographic and Demographic Variation)  All 50 states and the District of Columbia have experienced substantial reductions in the uninsured rate since 2013, the last year before full implementation of the Affordable Care Act.  (Source: Health Coverage Under the Affordable Care Act: Enrollment Trends and State Estimates)  Before the coronavirus disease 2019 (COVID-19) pandemic, an estimated 11million nonelderly Americans were uninsured despite potentially being eligible for free or reduced-cost coverage through the Affordable Care Act Marketplace.  (Source: The Remaining Uninsured: Geographic and Demographic Variation)
• Uninsured rates continue to be higher in certain populations, including Latinos (18.3 percent) and Blacks (10.4 percent), people with incomes below the poverty level (17.2 percent), and residents of states that have not expanded Medicaid (17.6 percent).  (Source: Tracking Health Insurance Coverage in 2020-2021)
• Four in 10 (43 percent) new consumers and three in 10 (30 percent) returning consumers and more than one third (34 percent) of all consumers have selected a Health Insurance Marketplace plan of $10 or less per month following the implementation of American Rescue Plan Tax Credits.  (Source: Four in Ten New Consumers Spend $10 or Less Per Month for HealthCare.Gov Coverage Following Implementation of American Rescue Plan Tax Credits)
• Medicare is expected to see the fastest spending growth (7.6 percent per year) due to projected enrollment growth.  (Source: National Health Expenditure Projections 2019–2028)
• For 2021–2023, private health insurance spending is expected to slow to 4.6 percent per year on average.  Over 2024–2028, private health insurance spending is projected to grow 5.0 percent on average.  (Source: National Health Expenditure Projections 2019–2028)

Contributing OpDivs and StaffDivs

ACL, AHRQ, ASPE, CMS, HRSA, and OASH work to achieve this objective.

HHS OpDivs and StaffDivs engage and work with a broad range of partners and stakeholders to implement the strategies and achieve this Objective.

Strategies

Promote available and affordable healthcare coverage to improve health outcomes in all communities, particularly those that are underserved

• Enhance and support outreach efforts to inform eligible individuals, of available affordable healthcare insurance options and related cost-saving opportunities, including premium and cost-sharing assistance programs.
• Improve continuation of coverage and process for coverage transitions across Medicaid, the Children’s Health Insurance Program (CHIP), Medicare, and Marketplace plans.
• Provide support and assistance to the five U.S. Territories—American Samoa, the Commonwealth of the Northern Mariana Islands, Guam, Puerto Rico, and the U.S. Virgin Islands—to comply with federal requirements of the Affordable Care Act and Medicaid to meet the healthcare needs of their populations.

Empower consumers with choices for high quality healthcare coverage

• Improve transparency of choice and access to available health coverage options, including Medicare, Medicaid, and Marketplace plans, for all consumers seeking or exploring coverage options.
• Promote partnerships and collaborations with states to provide and monitor equitable and timely access to Medicaid and CHIP providers and services.
• Facilitate enhanced understanding of eligibility, improved screening, and health insurance literacy to bolster enrollment and coverage of underserved populations.

Leverage knowledge and partnerships to increase health coverage enrollment 

• Support states, tribes, territories, grantees, faith-based organizations, and other federal award recipients through technical assistance and capacity building to expand pathways to high-quality healthcare coverage for all populations.
• Build the capacity of organizations to navigate the changing healthcare landscape to better support their clients to access and use their health coverage to improve health outcomes.
• Monitor enrollment and retention of eligible individuals in Medicaid, CHIP, Qualified Health Plans through the Marketplace, and the individual and small group market broadly to improve enrollment in high-quality comprehensive coverage and reduce health disparities.
• Support research, including the application of findings and lessons learned, related to the cost effectiveness and affordability of insurance coverage for diverse populations.

Performance Goals

The HHS Annual Performance Plan provides information on the Department’s measures of progress towards achieving the goals and objectives described in the HHS Strategic Plan for FY 2022–2026.  Below are the related performance measures for this Objective. 

• Improve availability and accessibility of health insurance coverage by increasing enrollment of eligible children in CHIP and Medicaid
• Increase the number of tables per year added to the MEPS table series
• Number of patients served by health centers
• Percentage of Health Center patients who are at or below 200 percent of poverty

Learn More About HHS Work in this Objective

• Coverage to Care Initiative: The CMS Office of Minority Health leads the Coverage to Care initiative to assist all consumers in understanding their health coverage in order to use it to connect to primary care and the preventive services that are right for them, so consumers can live a long and healthy life.
• Health Center Program: Health centers are community-based and patient-directed organizations that deliver comprehensive, culturally competent, high-quality primary healthcare services to the nation’s most vulnerable individuals and families, including people experiencing homelessness, agricultural workers, residents of public housing, and veterans.  Health centers serve one in 11 people across the country, and they lead the nation in driving quality improvement and reducing healthcare costs for America’s taxpayers.
• Health Equity Technical Assistance Program: The CMS Office of Minority Health offers health equity technical assistance resources, aimed to help health care organizations take action against health disparities.  This may include: personalized coaching and resources to help an organization and providers embed health equity into their strategic plan; resources on improving care for racial and ethnic minorities, people with disabilities, individuals with limited English proficiency, LGBTQ+ people, and rural populations; best practices on data collection and analysis; and assistance with developing a language access plan.
• State, County, and Local Estimates of the Uninsured Population: Prevalence and Key Demographic Features: This public-use dataset created by ASPE enables stakeholders to analyze the demographics of the remaining uninsured population at the state, county, or local area.  An accompanying report from ASPE highlights some of the key findings from this dataset.
• The Connecting Kids to Coverage National Campaign: A national outreach and enrollment initiative, the Campaign reaches out to families with children and teens eligible for Medicaid and CHIP to (1) Raise awareness about health coverage available under these programs; (2) create opportunities for families to get their eligible children and teens signed up for coverage; (3) motivate parents to enroll their children and teens and renew their coverage; and (4) provide outreach guides and toolkits that can be used to help states, community organizations, schools, health care providers and others organize and conduct successful outreach activities
• State Health Insurance Assistance Program: SHIP is a national program that offers one-on-one assistance, counseling, and education to Medicare beneficiaries, their families, and caregivers to help them make informed decisions about their care and benefits. SHIP services support people with limited incomes, Medicare beneficiaries under the age of 65 with disabilities, and individuals who are dually eligible for Medicare and Medicaid.