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Literacy, language barriers, confusion call for combined efforts to raise awareness
Build it, and they will come. That is what health insurance exchanges (HIXs) are anticipating, but as the Oct. 1, 2013, go-live date looms, many consumers remain unfamiliar with health reform in general and exchanges in particular.
A recent Enroll America survey found that 78% of uninsured people did not know they would have access to “a quality health insurance plan.” Avalere Health estimates that 8.2 million people are expected to enroll in health insurance exchanges in 2014, and the task of getting them onboard could be daunting.
The Department of Health and Human Services (HHS) requires that exchanges conduct consumer assistance and outreach programs that are culturally and linguistically appropriate, including a toll-free call center, a website for comparing qualified health plans and a Navigator Program to provide enrollment assistance.
HHS recently announced $150 million to support health centers in every state with outreach and enrollment efforts.
A new issue brief from the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured offers guidelines for outreach efforts: create peace of mind; provide a combination of broad and targeted outreach strategies in clear and culturally appropriate language; offer an accessible enrollment application with multiple enrollment avenues and one-on-one enrollment assistance; and prevent gaps in Medicaid and CHIP coverage.
The advice seems to be resonating with stakeholders.
Jenny Sullivan, director, Best Practices Institute for Enroll America, a not-for-profit, non-partisan organization, says that many of the uninsured are confused by the concept of the HIX, the financial assistance that will be offered and the concept of preexisting conditions. Education will be key before enrollment begins.
“They prefer language they can understand, along with an apple-to-apple comparison of options and enrollment information,” she says. “Their primary concerns are realizing value and feeling financial security and peace of mind.”
A national survey of 1,814 adults ages 18 to 64 at or below 400% of the Federal Poverty Level, conducted by Lake Research Partners, indicates that nearly two-thirds would accept the premium amount if they thought they were getting comprehensive coverage, could avoid the emergency room, felt protected from thousands of dollars of medical debt, and could get care when they needed it.
Sullivan says that many plans in the exchange are building out their consumer websites, but cautions that too much information can also be a liability.
Websites will require a complicated communication system with the IRS, state Medicaid systems and insurance companies.
Covered California, California’s state HIX, has a total marketing budget of $187.5 million for 2013 and 2014, 75% of which is dedicated to paid media and community mobilization efforts. According to exchange officials, more than 1 million Californians will enroll during the first year.
In mid-May, the HIX awarded $37 million in outreach grants to 48 community-based organizations to assist consumers in understanding plan choices and how to enroll.
“All of our efforts are focused on eliminating barriers to enrollment,” says Sarah Soto-Taylor, deputy director of community relations for Covered California. “Our first priority is raising awareness about what Covered California is and how it can help people.”
Covered California has a consumer-friendly web portal to help visitors understand the exchange and its available health plans. It also is working with community partners to explain benefits, mobilizing bilingual-trained counselors all over the state to provide one-on-one assistance and launching a call center with multiple language capabilities.
Soto-Taylor sees the major challenges as getting the word out to California’s large and culturally diverse population, explaining a new kind of affordable healthcare, and in many cases, reaching a previously underserved segment of the population.
Leveraging its success in enrolling members in its Medicaid managed care plans, Hudson Health Plan headquartered in Tarrytown, N.Y., will transfer the expertise to targeting eligible beneficiaries for participation in the state insurance exchange.
“It can be a mine field for people enrolling,” says Georganne Chapin, president and CEO of Hudson, “especially for those with language and literacy barriers.”
Hudson will not participate in the New York Health Benefit Exchange but is facilitating the transition of newly eligibles. The health plan is educating beneficiaries at schools, health centers and other community sites to seek coverage.
The exchange expects to enroll 1.1 million New Yorkers, and must be able to funnel the eligible to Medicaid under the “no wrong door” concept for exchanges.
Chapin says the many plan choices and different levels of benefits, copayments, premiums and actuarial values are even mystifying to those who know something about healthcare-including navigators.
She shares key lessons learned: Do not wait until the last minute to enroll those eligible for the exchange; facilitate enrollment before beneficiaries are taken off Medicaid rolls; and avoid using technical language in consumer-facing communications.
Twila Brase, president, Citizens’ Council for Health Freedom, a national healthcare organization based in St. Paul, says she is opposed to the exchanges especially the $530 million-to be spent over 15 months-designated by the federal government to set up information call centers in 14 states.
She questions why so many federal dollars need to be used to “cajole” Americans to join an exchange.
“The exchanges are not providing insurance but rather second-tier Medicaid for the middle class,” she says.
She blames managed care for part of the problem, saying it took away people’s freedom to make health insurance choices.
Insurers’ announcements regarding state health insurance exchange participation
Aetna: 14 exchanges
Cigna: 5 exchanges
Humana: 14 exchanges
UnitedHealthcare: 10 to 25 exchanges
WellPoint: 14 exchanges
Insurers not participating by state:
Cigna: Vermont and California
Vermont Health Co-op: Vermont
Insurers that operate or own private exchanges:
Horizon Blue Cross Blue Shield of New Jersey: operates a private exchange
Health Care Service Corp: part owner of Bloom Health
Blue Cross Blue Shield of Michigan: part owner of Bloom Health
WellPoint: part owner of Bloom Health
BCBS Kansas City: operates a private exchange
Highmark: operates a private exchange
Medica: operates a private exchange
Network Health (Massachusetts): operates a private exchange
Sources: Booz & Co.; VTdigger.org; Los Angeles Times; Deloitte