Facilitating State Health Exchange Communication Through the Use of Health Literate Practices Workshop Summary (2012) / Chapter Skim
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2 State Health Insurance Exchanges - Overview
2 State Health Insurance Exchanges - Overview
Pages 5-26
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Other organizations that are focused on state policies work selectively with certain decision makers, such as Medicaid directors, governors, or legislators. NASHP provides opportunities for state health policymakers to meet, learn from one another, and promote best practices.
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NASHP also provides technical assistance to the State Health Reform Assistance Network, a RWJF project that supports a number of organizations as they work intensively with 10 states to implement health reform. ACA Enrollment Reforms The Affordable Care Act (ACA)
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In addition, the characteristics of the new applicants will differ from those who have traditionally accessed public programs. The expanded pool of applicants will include employed and middle-income populations.
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The ACA requires states to adopt technology that allows individuals to apply for health insurance coverage online, in person, by mail, or by telephone. All states have developed an online application for either Medicaid or the Children's Health Insurance Program (CHIP)
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States will need to adapt and develop new policies to manage coverage through the state health insurance exchanges, Weiss said. The existence of different eligibility rules under Medicaid is going to create confusion.
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States will need to consider how to use these technologies in the context of health insurance enrollment. A number of states have adopted a focus on improving the interface between the customer and the health insurance options.
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The ACA includes substantial funding to support independent con sumer assistance/navigator programs. Of the 51 states and jurisdictions that were eligible for consumer assistance programs, 36 states applied for funding.
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Enroll America is working with stakeholder organizations to ensure that Americans know about coverage and are able to navigate systems to gain coverage. Conclusions Weiss concluded her presentations by pointing out that the ACA presents opportunities for transformative change in health insurance eligibil ity and enrollment, and the opportunity for consumers to engage in their health insurance coverage differently.
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The state health insurance exchanges will, in some ways, play a role similar to that played by HR departments. That is, the exchanges will give consumers information about the benefits offered and cost sharing assumed under the plan options, and then empower consumers to make informed choices.
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In contrast, Utah developed its exchange in response to a problem, that of small employers who were struggling to provide coverage to their employees. The goal of the Utah exchange was to make it easier for small employers to provide health insurance coverage.
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For example, in 2010 it provided 146 different plan options for TABLE 2-1 T he Utah Health Exchange: What It Does and Does N ot Do The Utah Health Exchange Does: The Utah Health Exchange Does Not: • over approximately 3,500 enrollees C • S ubsidize the purchase of coverage • rovide enrollees with over 100 plan P • C over individuals or large groups choices • S et minimum benefit levels • llow small employers to make A • S tandardize benefit offerings defined contributions • ary rates based on group experience V and an individual's age, location, and family size SOURCE: Corlette, 2011.
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Unlike the ACA health insurance exchanges and the Massachusetts exchange, people are not getting subsidies to participate, Corlette said. While the carriers have to be licensed, the exchange does not set a minimum benefit standard or require accreditation.
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Since the Georgetown study was completed, both the Massachusetts and Utah exchanges have made changes to try to improve the consumer experience. Massachusetts has added a provider search function so when consumers are comparing different plan options they can search and see whether their doctor is in the plan's network.
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Benard Dreyer, roundtable member, raised the issue of the cognitive load that individuals face as they purchase insurance through health exchanges. He asked if there are ways to decrease this load to make it easier for individuals to make appropriate choices.
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Cindy Brach, roundtable member, asked Weiss for clarification on how an individual interacts with the state health insurance exchange to obtain health insurance coverage. Weiss said that the processes of eli gibility determination and of plan enrollment through an exchange are different but related.
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She asked Weiss if there are lessons learned from the experience of helping Medicaid and Medicare beneficiaries make plan choices that could be applicable to the exchanges. Weiss replied that states have applied different models in providing plan choices to beneficiaries.
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Lessons learned from states as they develop training programs for navigators and materials for consumers would avoid duplication of effort on the part of states. Weiss replied that the National Academy for State Health Policy has developed a tool to help states share resources.
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She pointed out that individuals with low health literacy are often not computer literate. Corlette said the law requires states to set up navigator programs, funded through grants or contracts.
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Brach asked Corlette and Weiss to discuss opportunities, within the navigator programs and elsewhere, to incorporate consideration of health literacy into the state health insurance exchanges. Brach said that states are overwhelmed with the task of launching these exchanges, especially with recruiting the plans and moving forward with exchange implementation.
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The staff at the Center for Consumer Information and Insurance Oversight (CCIIO) could be approached about the need to incorporate health literacy and plain language considerations into the rules and regulations, the subregulatory guidance, and the one-on-one training with states.
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States will have a fair amount of oversight, just as they do under the Medicaid program. Laura Shone, an audience member from the University of Rochester, asked if the state health insurance exchanges would help newly enrolled consumers understand how to use their benefits.
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PowerPoint pre sentation at the Institute of Medicine Workshop on Facilitating State Health Exchange Communication Through the Use of Health Literate Practices. Washington, DC.
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