Accessibility of the Affordable Care Act (ACA) marketplace websites

BackgroundThe Affordable Care Act (ACA) mandated that creation of online health insurance websites to ease the complex process of shopping for and enrolling into coverage. Ensuring that these sites are not only available but also meet digital accessibility standards is important so that individuals with disabilities are able to access healthcare services and efficiently obtain insurance coverage.MethodWe evaluated each of the marketplace sites in 2020 to assess whether they are digitally accessible. We employed a custom audit tool based on a subset of the Web Content Accessibility Guidelines (WCAG) 1.0 and 2.0 AA and used content analysis to compare the site's accessibility statements with best practices.ResultsNearly all of the ACA marketplace websites have significant room to improve their digital accessibility. Notable technical problem areas include lack of text equivalents for images, difficult site navigation, and lack of optimization for mobile use, particularly on those pages that provide instructions on how to get in-person help.ConclusionsGiven that access to health insurance is a primary predictor of access to health care - sites must be easy to use and accessible to all individuals regardless of ability. Barriers to online enrollment, such as those identified in this work, may exacerbate disparities in quality of care, treatment continuity and affordability for individuals with mental and physical disabilities. Entities providing health-related online information & engagement should be aware of actionable opportunities to improve digital accessibility to optimize the enrollment process for both maintaining coverage and assisting those that remain uninsured.