Next big obstacle for Obama's Affordable Care Act? It's not just the Supreme Court.
The success of the new health care law depends on enrolling 30 million people in insurance plans. If officials don't clarify and simplify that enrollment process, the law will amount to a significant waste of time and taxpayer dollars.
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Provisions in the Affordable Care Act require health plans seeking certification in state exchanges to provide information in plain language. This means, according to the ACA, using “language that the intended audience, including individuals with limited English proficiency, can readily understand and use because that language is concise, well-organized, and follows other best practices.” Yet policymakers continue to take action that undermines clear communication.Skip to next paragraph
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In May 2011, for example, Wisconsin’s insurance commissioner made permanent an “emergency rule” to raise the readability scores of insurance policies to a high school reading level. He also overturned a mandate to list what services and procedures are not covered by the insurance in a single place within the policy.
Decisions like that set a detrimental precedent. To be sure, there are up-front costs to create insurance information and enrollment processes using language that is accessible, usable, and actionable to people of all literacy levels. But there are even greater costs to ignoring or downplaying the need to make enrollment materials, and the enrollment process, understandable to everyone.
A system that is difficult to understand and navigate can lead to further delays or failure to enroll in any health plan at all, particularly among healthier individuals who feel less pressure to have insurance coverage. If healthier individuals remain disproportionately unenrolled, the pool of individuals participating in the exchange market will, on average, be sicker. This results in higher health-care costs and ultimately higher premiums in the exchange market.
Efforts are underway to prepare the nation for the implementation of the Affordable Care Act, but it is a field of dreams to assume that just because we build an exchange and mandate participation “they will come.”
We must proactively engage and support individuals through the enrollment process. Trusted community-based organizations and health providers can help consumers navigate the enrollment process and fill out applications, as was shown to be effective in Massachusetts. And performance standards for exchange counselors can include an understanding of and sensitivity to challenges related to low health literacy.
Without considerable attention to this issue, the impact of the new health law may fall well short of expectations.
Laurie T. Martin is a health policy researcher at the nonprofit RAND Corporation and Ruth M. Parker is a professor at the Emory University schools of medicine and public health. This piece is based on an article published by the authors in August in the "Journal of the American Medical Association."