Applying a health equity report card to measure and monitor state marketplace progress in outreach and enrollment

Given nearly half of those eligible for coverage through health insurance marketplaces will be individuals of diverse racial/ethnic heritage, monitoring how marketplaces work to educate, reach, and enroll these populations is critical to assuring success. Early enrollment data suggest that states are already facing significant challenges. For example, in California, whereas half of Hispanics are eligible for marketplace insurance, by December 2013, approximately 20% enrolled. With support from the W.K. Kellogg Foundation we are developing a Health Insurance Marketplace and Health Equity Report Card prototype intended to document state progress in meeting marketplace requirements around equity, diversity, and cultural/linguistic competency to effectively reach diverse communities and achieve enrollment targets. The study design involves the development of structure, process, and outcome indicators to measure the extent to which equity is addressed or integrated across five functions: leadership and governance; exchange mission and design; navigator and assister program; outreach and enrollment; and evaluation. The prototype will be tailored to state-run, partnership, and federal marketplaces and its administration will be pilot-tested in at least one state. This session will present the report card prototype, offering explicit examples of measures for evaluating state health equity progress in the marketplace. It will also discuss preliminary findings from a pilot administration of the report card, offering initial guidance and lessons for states interested in carrying out such an assessment. The session will close with next steps in report card application and dissemination and related discussion of emerging models for advancing equity through the marketplace.