The Enrollment Coalition is a group of organizations across the health care community, including consumer advocates, patient advocates, health plans, health care providers, employers, technology and data organizations, and researchers. The coalition brings together technical expertise, real world experience, regulatory knowledge, and public policy understanding to our work.


Our mission is to collaboratively identify, develop, and advance actionable policy recommendations for federal policymakers aimed at improving enrollment data, systems, and processes to foster the enrollment of uninsured Americans under age 65 into existing health coverage plans and programs for which they are otherwise eligible. Our collective effort respects and builds on the roles of the public and private sector to enable uninsured Americans to enroll into existing coverage sources for which they are eligible, such as Medicaid, CHIP, Marketplace, and employer-sponsored coverage.


The Persistently Uninsured
Private sector and public health care stakeholders, along with federal and state policymakers, have shaped enrollment policies and improved processes across health plans and programs over the last decade. At the same time, there remain millions of uninsured Americans who are not enrolled in health coverage. Even before the COVID-19 pandemic, roughly 30 million Americans lacked health coverage at any point in 2019.[1] The uninsured are also disproportionately likely to be Black or Latino.[2]

Some of the effects of a lack of health coverage for a meaningful portion of the population are well established: less access to and use of preventative care, barriers accessing high-quality health care, high out of pocket costs, delays in accessing care, and worse health outcomes, especially for older, less healthy patients.

Millions Eligible For Coverage, But Not Yet Enrolled
Despite these challenges stemming from lack of insurance, research indicates most such individuals are eligible for, but not enrolled in, a current health care plan or program. According to 2020 analysis by the Congressional Budget Office, “in 2019, about 12 percent of people under 65 were not enrolled in a health insurance plan or a government program that provides financial protection from major medical risks.” CBO noted that “many uninsured people do not enroll in coverage because of the cost; others may not know that they are eligible for subsidized coverage or may be deterred by the complexity of enrolling.” As CBO suggested, the reasons for this gap in coverage are diverse and multi-faceted – ranging from affordability, to personal choice...from changes in jobs to changes in economic status…from linguistic or cultural barriers to missed opportunities to leverage data systems.

Of the individuals uninsured in CBO’s analysis, 67 percent were eligible for subsidized coverage, with 36 percent of individuals being eligible for federally-subsidized health coverage (Medicaid, CHIP, or Marketplace coverage).[3] Roughly the same percentage – about a third of the overall persistently uninsured – were eligible for private coverage through an employer as well.

Enrollment Coalition CBO Graphic

Source: Congressional Budget Office

A Fresh Urgency
In the wake of the COVID-19 public health emergency, many Americans have been displaced from their established source of health coverage. This reality has placed a renewed sense of urgency and focus on helping Americans find and enroll in health coverage.

The pandemic has also focused needed attention on longstanding challenges millions of Americans face in health care –whether due to racial inequities, health disparities, socio-economic differences, or social determinants of health. Thus, coverage efforts also need to acknowledge and help address the real hurdles and challenges many face to receiving equitable access and care. New policies, strategies and tools to improve enrollment must be informed by and appropriately take into account these dynamics.

[1] Congressional Budget Office, Who Went Without Health Insurance in 2019, and Why? September 2020,

[2] ASPE Issue Brief: TRENDS IN THE U.S. UNINSURED POPULATION, 2010-2020, February 11, 2021,

[3] Congressional Budget Office: Who Went Without Health Insurance in 2019, and Why? September 30, 2020,


  • The persistence of millions of Americans forgoing health coverage is not a sustainable status quo for those patients, their families, communities, or our health care system.
  • Enabling millions more uninsured Americans to be enrolled in health coverage for which they are already eligible can help improve the health of those Americans, their communities, and our health care system.
  • Uninsured Americans eligible for current plans and programs would benefit from more streamlined, automated, efficient, effective enrollment processes to gain coverage that meet their needs.
  • New policies to enroll uninsured Americans into existing coverage options should respect consumers’ individual needs and prioritize meaningful, affordable, quality coverage that improves access for targeted populations.


LP Membership - Enrollment Coalition


In May 2022, the Enrollment Coalition submitted a comment to the Federal Communications Commission (FCC) in support of HHS’ request to clarify that the Telephone Consumer Protection Act (TCPA) would not apply to certain eligibility and enrollment communications. The Coalition believes that increasing communication options is a vital tool for improving access to health coverage for which individuals are already eligible.

The FCC’s Public Notice is available here, and the Coalition’s letter may be read here.

In April 2022, the Enrollment Coalition responded to CMS’ request for information (RFI) about access to coverage and care under Medicaid and the Children’s Health Insurance Program. The Coalition’s RFI response suggested improvements to eligibility determination systems for state-operated exchanges, improving outreach to enrollees by using clearer language, removing barriers to enable texting or other preferred forms of communication, metrics to monitor for enrollment success, and methods to improve administrative efficiency. Read the full letter here.

In September 2021, the Enrollment Coalition developed three example enrollment journeys depicting the enrollment process for individuals signing up for Medicaid or Marketplace plans. These enrollment journeys show how the enrollment process can be complicated and points at which it could be difficult for an individual to compete the process to enroll in health coverage.

In August 2021, the Enrollment Coalition sent a letter to CMS requesting the agency provide State Health Officials (Medicaid Directors) updated guidance on planning for the resumption of normal State Medicaid, CHIP, and BHP operations upon the conclusion of the COVID-19 public health emergency. The letter specifically requests updated guidance on planning for and resuming regular eligibility and enrollment operations, expectations or opportunities for assisting individuals who no longer qualify for Medicaid/CHIP to enroll in insurance in the private market, promoting efficiency and integrity in ensuring the right source of coverage at the right time for individuals, and enrollment strategies or flexibilities states adopted during the PHE that may be permanently adopted following the expiration of the PHE, including resources to assist with planning and implementation. Read the full letter here.

In July 2021, the Enrollment Coalition submitted comments in response to OMB’s Request for Information: “Methods and Leading Practices for Advancing Equity and Support for Underserved Communities Through Government.” The Enrollment Coalition’s response focused on reducing barriers and burdens to enrolling in existing health insurance programs in order to promote health equity and reduce racial disparities. Read the full comments from the Enrollment Coalition here.

In June 2021, the Enrollment Coalition sent a letter to Secretary Becerra to request HHS re-issue a previous exception to the cost allocation requirements set forth in the OMB Circular A-87, to allow Federally-funded Health and Human Services programs to benefit from investments in the design and development of State eligibility-determination systems for State-operated Exchanges, Medicaid, and CHIP. Read the full letter here.

In March 2021, the Enrollment Coalition sent letters to Members of Congress to introduce the coalition, its work, and offer to be a resource as Congress works on relevant policies. Read the full letter here.

In January 2021, the Enrollment Coalition sent a letter to the Biden-Harris Team with recommended near-term actions to support health coverage enrollment for eligible individuals. The letter included six recommendations:

  1. Issue an Executive Order on Health Care Enrollment.
  2. Establish a Special Enrollment Period.
  3. Utilize Exchange User Fees to Support Navigators and Other Enrollment Activities.
  4. Support Targeted Enrollment Campaigns in Communities of Color.
  5. Establish “Bridges” to Help People Who Lose Their Jobs Find Alternative Sources of Coverage.
  6. Address Timing of Grace Period and Outstanding Premiums.

Read the full letter here.