Health disparities and affordability in the debate on improving health insurance

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WASHINGTON — The nation’s capital may be politically divided, but lawmakers are finding room to at least discuss several health insurance issues, including reducing ethnic disparities in coverage and making it easier to compare plans insurance, several health policy experts said on Friday.

One issue Congress will face is the expanded subsidies included in the U.S. bailout for people purchasing health insurance coverage through the Affordable Care Act insurance marketplaces, said Elizabeth Wroe, JD, director of the consulting firm Leavitt Partners. “What happens when that ends at the end of this year? Does that create a moment for Congress to potentially step in and expand those grants, or pass other policies on top of that, to try process registrations?

Unfortunately, though, “sometimes there’s not a very good understanding at the congressional level that you can’t just push a number of policies, and particularly, when we’re talking about insurance markets, the that states have timelines, and health plans have a process that they go through to set rates, premiums, and plans,” she continued. “It’s really important for a number of these problems of not waiting for the 11th hour to talk about it.”

Another growing issue is health disparities — and which insurers collect information about them, Wroe said. “You make sure the plans are actually collecting the information that will be really useful and measuring whether or not the benefit design is helping to address health disparities and move towards health equity.”

Annette James, president of the American Academy of Actuaries’ Health Equity Work Group, said her organization is also working on this issue as part of a four-phase project. “We have just completed the first phase: identifying and monitoring actuarial data sources and methods that may contribute to health disparities,” she said. “We will now begin the second phase of analysis to see what research exists and where there may be gaps.”

The organization is also studying whether the design of insurance benefits “may actually create or perpetuate barriers” to health insurance access for disadvantaged communities, and may lead to underutilization, James said. For example, “Are high-deductible plans so expensive that they inadvertently discourage appropriate use by certain populations? Can pre-authorization and pre-certification processes increase reluctance to seek needed services in certain communities due to the invasive nature of this protocol? And can a tiered network design really discourage appropriate utilization of medical services and lead to further underutilization, particularly if first-tier providers are not easily accessible to disadvantaged communities?

Insurance agents and brokers are another area of ​​focus, Wroe said. “There is a definite consensus that agents and brokers have a role to play in listing,” she said. “But I think there’s also a recognition that one of the different players has to work to certain standards. So I think there’s a place where you can see an increased role for agents and brokers with monitoring, and making sure everything is done in a way that helps improve enrollment in qualified health plans.”

Auto-enrollment is another important goal, according to Wroe. “Whether it’s a federal program or federal standards with state enforcement, or fully state automatic enrollment options, there are a number of policies that are definitely worth considering. be considered.”

While these discussions are taking place, market listing continues. JoAnn Volk, MA, research professor at the Center on Health Insurance Reforms at Georgetown University, noted that to date, for the current open enrollment, 14.2 million people have signed up for market coverage. , including 10 million through the federal market and 4.2 million through the 18 state-based markets. Most of them are repeat customers, not new registrants, she added.

Some states, such as Maryland, contact residents during tax filing season, asking if they would like to share their insurance status, income, and other information relevant to determining whether they might be eligible for Medicaid or to a market insurance plan, Volk mentioned. “In the first year of this program – 2020 – 60,000 people shared their data and most of them – 53,000 – were found eligible for market subsidies or Medicaid.” Although only 4,000 of these people signed up for coverage, the program began before market-enhanced subsidies became available, which may have played a role in low uptake. “But it can be an effective strategy for reaching those who have proven harder to reach,” she said.

Lawmakers are also considering the issue of standardizing health plans to make it easier for people to choose. Although health markets have divided their plans into “gold”, “silver” and “bronze” plans which differ in cost and benefit levels, “it goes a step further to really lock in cost sharing for particular services and in many cases makes more services available without having to pay the deductible,” including primary care and behavioral health, Volk said.

Standardized plans also offer fixed copayments rather than “coinsurance” because “it’s easier for consumers to understand what their outgoings are when they look at a dollar amount instead of 20% of a cost. invisible that may appear on their bill one day,” she said. federal healthcare.gov starting in 2023. Additionally, Volk noted, eight states plus the District of Columbia already have standardized plans, and Colorado will use them starting in 2023.

  • Joyce Frieden oversees MedPage Today’s coverage in Washington, including stories about Congress, the White House, the Supreme Court, professional health associations and federal agencies. She has 35 years of experience in health policy. To follow

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