Supporting Health Plan Oversight: Consumer Organization Directory for State Regulators

Last year, the AIDS Institute and the National Health Law Program filed a complaint with the U.S. Department of Health and Human Services (HHS) Office for Civil Rights, alleging that four insurers operating in Florida violated the Affordable Care Act’s provisions prohibiting discrimination on the basis of disability. The AIDS Institute analyzed the prescription drug formularies of all 36 silver-level Qualified Health Plans (QHPs) operating in Florida and found that the plans offered by four issuers had exceptionally high cost-sharing for prescription drugs used in the treatment of HIV/AIDS.

Based on that case, it occurred to us that other advocacy organizations might be interested in assisting state insurance regulators in efforts to discover discriminatory benefit design or perhaps with other projects that impact consumers and patients. Our discussions with state regulators indicated a desire to analyze benefit designs and formularies more completely, but a lack of time and manpower necessary to do so. They further indicated a willingness to partner with independent outside groups to help with such analyses. Therefore, as part of our work supporting state departments of insurance through the Robert Wood Johnson Foundation’s State Health Reform Assistance Network (the State Network), we created a directory to connect states that are interested in looking deeper into discriminatory benefit design with advocacy organizations that would view such work as part of their mission on behalf of consumers and patients.

We began by emailing each of the 333 patient organizations that signed a letter to HHS entitled “I Am (Still) Essential.” The letter raises concerns about continuing discriminatory benefit design even after the implementation of the Affordable Care Act and suggests ways HHS could protect more vulnerable consumers. We asked each organization if they would be willing to serve as a resource for states or to help identify potentially discriminatory benefit designs. At initial publication, the directory includes 28 organizations that are willing to assist all states and 37 organizations willing to assist particular states. The directory will continue to be updated. We hope regulators take advantage of this resource while reviewing health insurance plans in the coming years. The directory is available at Robert Wood Johnson Foundation’s State Network website.

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