Barriers to Enrollment in Health Coverage in Colorado

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Resolution Research recently assisted RAND Corporation with a new study on health care in Colorado. To view all of the findings, please visit:

Here is a summary of their findings:

As part of the implementation of the Affordable Care Act, Colorado has expanded Medicaid and also now operates its own health insurance exchange for individuals (called Connect for Health Colorado). As of early 2014, more than 300,000 Coloradans have newly enrolled in Medicaid or health insurance through Connect for Health Colorado, but there also continues to be a diverse mix of individuals in Colorado who remain eligible for but not enrolled in either private insurance or Medicaid. The Colorado Health Foundation commissioned the RAND Corporation to conduct a study to better understand why these individuals are not enrolled in health insurance coverage and to develop recommendations for how Colorado can strengthen its outreach and enrollment efforts during the next open enrollment period, which starts in November 2014.

RAND conducted focus groups with uninsured and newly insured individuals across the state and interviews with local stakeholders responsible for enrollment efforts in their regions. The authors identified 11 commonly cited barriers, as well as several that were specific to certain regions or populations (such as young adults and seasonal workers). Collectively, these barriers point to a set of four priority recommendations that stakeholders in Colorado may wish to consider: (1) Support and expand localized outreach and tailored messaging; (2) Strengthen marketing and messaging to be clear, focused on health benefits of insurance (rather than politics and mandates), and actionable; (3) Improve the clarity and transparency of insurance and health care costs and enrollment procedures, and (4) Revisit the two-stage enrollment process and improve Connect for Health Colorado website navigation and technical support.

Key Findings

Barriers Affecting Outreach and Awareness

  • There is significant confusion and little understanding about Medicaid and private insurance subsidies through Connect for Health Colorado.
  • Messaging about insurance was not compelling and did not discuss the health benefits of insurance.
  • There are not enough funds or data to support local outreach and education.

Barriers Affecting the Decision to Enroll

  • Many Coloradans have unfavorable attitudes toward the individual mandate.
  • There is significant mistrust of the system.
  • Messaging was often not tailored or actionable.
  • Health insurance coverage is not affordable for many Coloradans.

Barriers Affecting the Enrollment Process

  • The complexity of plan materials makes plan selection difficult.
  • There were lag times and poor communication about eligibility-related decisions.
  • There was misinformation across stakeholders.
  • Individuals in Colorado must apply for Medicaid and be denied before applying for private insurance.
  • The Connect for Health Colorado website was not user-friendly.


  • Support and expanding localized outreach and tailored messaging.
  • Strengthen marketing and messaging to be (1) clear, (2) actionable, and (3) focused on the health benefits of insurance (to overcome negative or politicized messaging consumers are hearing).
  • Improve the clarity and transparency of insurance and health care costs and enrollment procedures.
  • Revisit the two-stage enrollment process and improve Connect for Health Colorado website navigation and technical support.



There are several individuals whom we wish to thank for their support in this study. First, we are grateful to Amy Kerr, Kelci Price, Amy Latham, and Kyle Sargent from the Colorado Health Foundation for inviting RAND to conduct this study and for providing helpful feedback throughout the project. Also, this work could not have been completed without the input from the uninsured and newly insured individuals in Colorado with whom we spoke, who shared their stories, perspectives, and recommendations for strengthening outreach and enrollment efforts in Colorado. We would also like to show our appreciation to the local stakeholders who provided their perspective and, in many cases, provided a space for us to conduct our focus groups. We learned a great deal from each of these individuals over the course of the project. We would also like to thank Resolution Research for their assistance with recruitment for the focus groups.

We acknowledge the support of RAND colleagues in carrying out our activities: Karen Florez and Christian Lopez, whose assistance enabled us to conduct two of the focus groups in Spanish, and Teague Ruder, who created the maps of Colorado used throughout this report. We also thank our peer reviewers, Anita Chandra, Carole Gresenz, and Jeanne Ringel, for their constructive feedback that helped to strengthen this report. We are also grateful to our communications analyst, David Adamson, and production editor, Steve Oshiro, for their contributions and care in helping us to complete this report.

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