Consumer Assistance and Health Reform: Bridging the Gap

By Allison Johnson

With open enrollment under the Affordable Care Act (ACA) set to begin in October 2013, one of the most significant challenges to providing assistance to people seeking coverage may be the fact that many consumers lack a fundamental understanding of what health insurance is and how it works. A Consumers Union report published in January 2012 found that even among consumers that have coverage, knowledge of their plan coverage and financial obligations is poor. Moreover, consumer testing suggested that many people “dread shopping for health insurance,” and find the terminology of health coverage confusing. Important for consumer assistance efforts is the finding that many people don’t necessarily want the cheapest plan, but consumers are instead concerned about value and what benefits their health insurance dollars go towards. And a recent poll from the Kaiser Family Foundation (KFF) showed that many Americans—including two-thirds of the uninsured—are unaware of how the ACA will affect them.

To discuss critical issues on consumer assistance measures in the ACA, the Kaiser Family Foundation and the Robert Wood Johnson Foundation (RWJF) co-hosted a panel discussion on Thursday, April 18. Panelists included Elisabeth Benjamin of the Community Services Society in New York, Kathleen Gmeiner of Ohio Consumers for Health Coverage, Nancy Metcalf of Consumer Reports Magazine, and Janet Trautwein of the National Association of Health Underwriters. The discussion was moderated by Lori Grubstein of RWJF and Karen Pollitz of KFF. Several interesting themes came out of the discussion, including:

  • An ongoing need to educate consumers about what health insurance is and how it will change under the ACA;
  • Consumer and employer anxiety over changes to coverage and affordability;
  • Uneven development and funding of consumer assistance programs among states;
  • The challenge of building the workforce capacity to provide consumer assistance;
  • The absence of materials directed towards employees about changes to employer-sponsored coverage under health reform; and
  • The importance of finding new and existing avenues to educate consumers about the exchanges.

Three of the panelists noted that many consumers are under the impression that under health reform they might have free coverage or no cost sharing obligations. And many are just simply uninformed. The panelists hit on a recurrent message to remember that for most Americans, the changes under the ACA only add to the complexity (and their confusion) over health insurance in the United States. Nancy Metcalf, the health editor for Consumer Reports magazine, gave examples of letters she has received about health plans and coverage: a recent letter from a 66 year-old still in the workforce, who also has children under the age of 26; individuals with complex health conditions who feel their $200/month premium is too high and want a different plan; or lingering questions about asset tests for subsidies and Medicaid.  These types of questions are common, and according to the panelists, demonstrate the information gap many consumers have.

Consumer assistance programs are tasked with not only with helping consumers understand what coverage they may be eligible for and facilitating  enrollment, but also educating consumers about the fundamentals of health insurance and the ACA reforms. States vary in their approaches to these programs—for example, some are well-funded while others have only a few employees—and this variation could result in uneven assistance across the country. However, states also have an opportunity to learn from each other to improve their own consumer assistance programs. For example, every interaction with a government entity—the DMV, Social Security office, or even public schools—could extend the outreach effort and encourage the uninsured to look into their coverage options in the exchanges. Other communities will need more than just casual contact and will instead require navigators and assisters to go “door-to-door” and “store-to-store” to engage the uninsured across cultural and geographic barriers.

Consumer assistance programs face a number of challenges heading towards the start of open enrollment October 1, 2013, (many of which are addressed in two new KFF issue briefs, here and here). At a minimum, consumers will need considerable help assessing and understanding their different health plan options and which plans are optimal for their financial situation and health status. By necessity, this will involve navigators, in-person assisters, the broker/agent/producer community and non-profit consumer advocacy organizations.  Educating consumers about their options and responsibilities under a health plan was difficult before the ACA and it will continue to be a challenge as implementation moves forward.

Stay tuned to CHIRblog for further updates on consumer assistance and the launch of the new health insurance marketplaces under the ACA.

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The opinions expressed here are solely those of the individual blog post authors and do not represent the views of Georgetown University, the Center on Health Insurance Reforms, any organization that the author is affiliated with, or the opinions of any other author who publishes on this blog.