In ACA year two, a clearer vision of signup targets

In one clip, a young man wearing a cap and gown tumbles down the stairs at his graduation ceremony. Another shows a guy who face-plants after dunking a basketball.

"Reality is - you can't prevent the unexpected," a narrator says. "But you can prepare for it with affordable health coverage."

The commercial, which presents an "America's Funniest Home Videos"-style compilation of laughable accidents, has begun circulating online as part of BlueCross BlueShield's latest efforts to reach a much-coveted demographic - millennials.

Insurers and advocacy groups alike are approaching Round Two of Affordable Care Act marketplace enrollment with a much clearer idea of the holes unfilled during last year's enrollment and the demographics they need to target this year.

"There are definitely certain tactics and best practices we learned from the first open enrollment period that we're utilizing to reach those target populations this time," said Jacob Flowers, Tennessee state director of Enroll America, a national nonprofit that works to sign people up for ACA coverage.

For insurers, millennials are the ones wearing the big bulls-eyes. Having young, healthy people on insurance plans will be crucial to balance costs incurred by the older, sicker people who readily signed up for plans last year.

That lopsided dynamic is one of the reasons why BlueCross officials said they had to raise premiums an average of 19 percent on its exchange plans this year.

"We just did not see as many Gen Y consumers as we had hoped during the last enrollment," said Carla Raynor, BlueCross vice president of strategic marketing.

BlueCross has purchased heavy ad rotation on video streaming sites like YouTube and Hulu, along with cable programming like Adult Swim or shows like "Jimmy Kimmel Live" and "King of the Hill" - shows young people will watch live or record for later.

The insurer also is reaching out to Latinos, hiring bilingual agents and buying ads on Univision and Hispanic TV programming. Reaching that demographic, which did not show strong sign-ups last year, is an important component of the company's revamped strategy, Raynor said.

"Last year we were just trying to survive," said Raynor. "This year we are more brave and trying new things."

Enroll America also is aiming at Latino and black communities, said Flowers, and focusing on offering personal assistance to help people in those groups shop for coverage.

Howard Roddy, center, a vice president at CHI Memorial Hospital, joins other attendees Wednesday at the Chattanooga-Hamilton County Health Department during a community forum about the Affordable Care Act.

"We found that the principal way that African-American and Latino communities and the youth are enrolling is through in-person assistance," said Flowers. "We've found that those groups are twice as likely to enroll if they have an assister."

BlueCross also recognized the need for in-person assistance. Of the Tennessee customers who signed up for BlueCross plans last year, most did so on their own through HealthCare.gov. BlueCross officials see a potentially large untapped market among the uninsured who did not take such initiative.

This year, the company plans to boost its number of customer service representatives, and it has activated a mobile team to help with sign-ups across the state. The mobile is booked for every day through the next year, said Raynor.

The gap between English and Spanish speakers is not the only communication divide that navigators and brokers saw last year. Across the board, Enroll America found many people signing up for exchange plans last year didn't understand the language of insurance.

Katherlyn Geter of Erlanger Health System speaks to attendees, most of them Affordable Care Act navigators at the Chattanooga-Hamilton County Health Department in Chattanooga during a community forum about the Affordable Care Act.

Many people's history with insurance is limited to an employer plan. Understanding the nuances of premiums, deductibles and co-payments is a new experience.

To fill the gap, the group is launching a statewide hotline and website where people can make an appointment with an assister.

The hotline will be especially helpful in rural areas, where outreach events are fewer and resources are scarce.

"There is a tremendous amount of interest in rural areas," said Nancy Ridge, who oversees navigator efforts for the Chattanooga Medical Foundation. "There just was not much of an [outreach] presence in those areas last year."

The foundation has received federal grant money from the national nonprofit Seedco to expand its navigation efforts to 10 outlying counties.

Ridge and others say they expect fewer uninsured people will stay on the fence this year. The HealthCare.gov website should work better, they say. The penalty for being uninsured will more than triple. And this year, the noisy political rhetoric surrounding the issue has mostly quieted.

"We heard from a lot of young people that they didn't know if the law would even be around next year," said Raynor.

A measure of that uncertainty remains. Republicans are preparing to take control of the U.S. Senate and the Supreme Court is to hear arguments in a case that challenges whether tax subsidies for premiums are lawful in 36 states - including Tennessee and Georgia - where the exchanges are run by the federal government.

BlueCross officials say the controversy does not affect their strategy moving forward.

"This is the law of the land," said BlueCross spokeswoman Mary Danielson. "We're doing everything we can to ensure it's successfully implemented for our members. Until we hear otherwise, it's full steam ahead."

Contact staff writer Kate Harrison Belz at kbelz@timesfreepress.com or 423-757-6673.

Story corrected at 3:05 p.m. Nov. 17. The story misstated the name of Jacob Flowers as Jason Flowers.