This will be my third year as a Certified Application Counselor (CAC) for the health insurance marketplace in Virginia. By far, this will be the hardest open enrollment season I’ve had so far.

Open Enrollment: Already a Tall Order

CACs are volunteers who help people enroll in marketplace coverage.  Here’s what I’ve learned so far: Enrolling in marketplace health insurance is already a tall order for many consumers because of the time and effort involved to sign up. For many families, signing up for coverage is an all-day affair that requires taking time off from work or using a valuable weekend day. While most of my appointments are scheduled for 90 minutes, they often run over and many of my clients have long wait times before the appointment. Consumers must also remember to bring several important documents like social security cards or visas, copies of previous tax returns, W-2s, and paychecks in order to verify their identity, immigration status, and to project income for financial assistance eligibility. Returning consumers also have to remember their account information for healthcare.gov.

That’s all before the appointment starts. The appointment itself is not easy. I’m a stranger to the families I assist, but I ask them personal questions about their immigration status and financial information like their household income and what kind of jobs they have. I also ask about current and future medical needs and any doctors or hospitals they want to see under a health plan. Establishing this kind of trust in a 90-minute timeframe is often straining, particularly for those concerned about revealing personal information. For consumers that have limited English proficiency, the process can be twice as long and difficult.

Why this Enrollment Season will be My Toughest Yet

This year, just getting consumers to come in at all for enrollment assistance is one of our biggest challenges. For the last six months, consumers have been inundated with messages that “Obamacare is dead,” premiums are spiking, and cost-sharing subsidies are ending. The Trump Administration also cut 90 percent of the budget for open enrollment advertising and 40 percent for the marketplace Navigator program, which funds enrollment activities and in-person assistance. This confusion and cut in outreach likely will have significant impact on enrollment. By one estimate, we’ll have 1.1 million fewer people signing up this year. Another study finds that only 15 percent of the uninsured and 40 percent of Marketplace enrollees know when Open Enrollment begins.

Throughout the existing and new turmoil, however, assisters are motivated to continue. Assister programs are responsible for more than half of signups through healthcare.gov in past years. Because these programs are so important to enrollment, many non-profit organizations and foundations have responded to support and promote Open Enrollment in the wake of federal inaction. Grassroots organizations like Get America Covered are leading the charge to get the word out and enroll as many people as possible. Get America Covered has created resources for CACs and navigators, talking points, fact sheets, as well as social media campaigns. Another grassroots organization, Indivisible, is using Facebook through its Indivisible ACA Sign Up Project to share outreach ideas, create locally organized volunteer groups for on-the-ground outreach, and push out Open Enrollment information through targeted social media campaigns. At Georgetown CHIR, we’re pitching in with a new and updated Navigator Resource Guide. It has over 300 answers to frequently asked questions about Open Enrollment and the marketplaces. Local groups are also organizing; Enroll Virginia is gathering interested organizations and individual CACs to brainstorm about outreach in local communities, host potluck trainings, and put on enrollment events throughout Open Enrollment.

Volunteers are united in the effort to enroll as many people into coverage knowing how important health insurance is to people’s financial stability or ability to access lifesaving preventive care. As a CAC, it’s easy for me to maintain my motivation to help people sign up for coverage, even in the face of consistent efforts to make it more difficult. The appointment that begins with strangers often ends with relief and joy on the faces of newly insured families. As trying as this upcoming Open Enrollment may be, I take comfort in knowing that I’m helping people enroll in the coverage they need.

Open Enrollment in most states runs from November 1 through December 15. You can find local navigators and assisters by going to localhelp.healthcare.gov. As this Open Enrollment unfolds, I will check back with the CHIRblog to report on significant challenges or changes consumers experience with the enrollment process.