Study investigates public perceptions of administrative barriers affecting health insurance access

Reviewed by Lily Ramsey, LLMJul 27 2023

During the COVID-19 pandemic, governments changed rules and procedures related to Medicaid enrollment. These changes decreased many of the burdens eligible people face when signing up for programs and contributed to a 30 percent increase in Medicaid enrollment. However, the end of public health emergency declarations brings an end to these pandemic policies, which many fear could lead to eligible people losing public health insurance simply because they are unable to fulfill administrative requirements such as accurately filling out and submitting forms, renewing their enrollment and communicating with Medicaid agencies.

A new study investigates public perceptions of administrative barriers affecting health insurance access. Publishing soon in the journal Health Affairs Scholar, it was conducted by Simon Haeder, PhD, associate professor in the Department of Health Policy & Management at the Texas A&M University School of Public Health, with his co-author Don Moynihan, PhD, from the McCourt School of Public Policy at Georgetown University. The study uses a nationally representative survey of American adults to measure attitudes about policies meant to reduce administrative burdens and explore how these attitudes vary among different populations.

The survey, conducted in late 2022 and early 2023, asked respondents about nine policies aimed at reducing administrative burdens for individuals currently enrolled in the Medicaid program related to the nation's transition out of the public health emergency. These include automatic renewals, the use of prefilled forms, plain language and alternate communications like text messaging, ensuring states have enough resources to handle enrollment, and increased outreach and enrollment efforts. Haeder measured levels of general support for such administrative changes and how experience with Medicaid, political ideology and ability to handle administrative tasks affect support of these policies.

Administrative burdens are something people face when dealing with public services. These can include learning about procedures, keeping track of enrollment and renewal dates and filling out and submitting forms. Administrative procedures are a necessary part of providing services and some play a key role in reducing waste and fraud. However, in some cases these procedures can be difficult to understand, especially for people without experience managing administrative tasks. In some cases, procedures can even be used to limit access to programs in a way that is less visible to the public. Additionally, such burdens can have a disproportionate impact on groups that are already facing inequalities.

Haeder's analysis found notable support for policies that reduce administrative burdens across the whole survey sample. However, some groups showed greater support than others. For example, politically liberal respondents, people with experience with Medicaid and those who have difficulty with administrative tasks were more supportive of reducing burdens. In contrast, politically conservative people and those without experience with Medicaid were still supportive but to a lesser degree.

Haeder noted a few limitations with the study, such as the use of an internet-based survey and the fact that the one-time sample cannot measure changes in public perception. Additionally, the survey's nine policy changes have a minimal chance of increasing enrollment fraud. People may be less likely to support changes to policies aimed at preventing fraud. Future research into other policies and attitudes toward other public assistance programs will be valuable.

Despite these limitations, the findings of this study point to substantial public support of efforts to shift administrative burdens away from individuals and improve communication and outreach about Medicaid enrollment procedures. Pandemic policies showed the potential success of reducing administrative burdens, and public support of such changes could lead to changes in how governments handle assistance programs in the future.