By Hannah Ellison and Sabrina Corlette

It’s the dog days of August and many of us are in beach mode, but we at CHIR are getting geared up. We’re just 12 weeks away from the start of the third open enrollment period (OE3) for the Affordable Care Act’s health insurance marketplaces. And just three weeks away from the expected announcement of federal grants awards to the marketplace’s Navigator organizations. We’ve been privileged to work for the last two years to provide technical and policy support to health insurance Navigators, certified application counselors and other consumer assisters (collectively, assisters) through a generous grant from the Robert Wood Johnson Foundation.

It was with great interest then that we pored over the Kaiser Family Foundation’s latest survey of health insurance marketplace assister programs and brokers. The results help us understand what worked and didn’t work during last year’s enrollment season, and help guide us on ways to improve consumer outreach and enrollment for OE3. We share below some key highlights from the survey:

• Enrollment assisters were busy. They helped an estimated 5.9 million consumers this year.  More than 4,600 Assister Programs served Marketplace consumers, deploying 30,400 staff and volunteers.
• They came back! Even though many assister programs had to lay off workers after the first open enrollment period, more than three-quarters of returning Programs said most or almost all of their staff from year one returned to help consumers in year two.
• State-based marketplaces offered more consumer assistance. Federally facilitated and partnership marketplaces had fewer than half the number of assisters per 10,000 uninsured than their state-based counterparts.
• They helped consumers not just with enrollment but also post-enrollment problems. Nearly 80% assisted consumers with post-enrollment questions and problems.
• Assisters were much more likely than brokers to enroll the harder –to-reach uninsured. Brokers were less likely than assisters to serve Latinos, consumers with English as a second language, consumers who lacked access to the Internet, or low-income consumers who might be eligible for Medicaid. Brokers were also less likely than Assister Programs to serve people who were uninsured.
• Assisters work year-round. Returning Assister Programs helped an estimated 630,000 consumers apply for coverage through special enrollment periods, 290,000 consumers report mid-year changes to the Marketplace, and nearly 800,000 consumers resolve post-enrollment problems.
• There are not enough of them. Consumer demand for help exceeded what some Programs could provide this year, though not by as much as last year. About one-in-five Assister Programs reported having to turn away at least some consumers this year.
• They could use more support from the marketplaces. Eight-six percent of Assister Programs indicated they would like additional training on a range of complex issues.  Programs also report that marketplace websites and call centers need improvement.
• Those that coordinated with other programs did better. Returning Programs that coordinated often with other Assister Programs were more likely to increase the number of people they helped this year.  In some states, “Super Navigators” have been designated (formally by the Marketplace or informally) to promote coordination, centralize training and mentor new Assisters, facilitate scheduling and referrals, and help on complex cases.
• They are worried about sustainable funding. Only 27% of Assister Programs say they are very certain that funding will be available to support them next year and 39% are not certain at all.

For the federally facilitated marketplace (FFM), grants to Navigator organizations are expected to be announced September 2, 2015. $67 million will be available for Navigators in FFM and Partnership states; the same amount awarded in 2013 and a 12% increase over year two funding levels. The FFM has further announced that they will enter three-year contracts with their grantees, which we lauded here as helping to provide greater stability for assister organizations. Many state-based Marketplaces, however, have yet to decide the level of consumer assistance resources they will fund in year three. In research we recently published on state-based marketplace renewals, one-on-one help for both current and prospective enrollees will be critical to the marketplaces’ long-term sustainability.