Beyond Obamacare: 5 opinions on health care reform

Health care reform remains a contentious issue in the United States. The Supreme Court upheld the constitutionality of President Obama's health care law, the Affordable Care Act, known as Obamacare. But some Republicans, like presidential hopeful Mitt Romney, hope to repeal the law under the next Congress. Here, writers explore five key aspects of health-care reform.

3. Next big obstacle for Obama’s Affordable Care Act? It’s not just the Supreme Court.

RAND health policy researcher Laurie T. Martin and Emory professor Ruth M. Parker point out another obstacle for the successful implementation of the health-care law:

Over the next three years, as the Patient Protection and Affordable Care Act (ACA) goes into effect, America’s state and local officials will be responsible for reaching out to more than 30 million individuals and enrolling them in publicly funded or subsidized health plans offered through state insurance exchanges. The majority of those individuals have low health literacy and will have difficulty finding, understanding, and using insurance information critical to getting them properly enrolled.

Failure to meet the enrollment goals of new health care law, however, will not only undermine the success of the new health law, but more importantly, will do little to expand health insurance coverage. Unless steps are taken to clarify the language and procedures surrounding the enrollment process, individuals are not likely to enroll, resulting in a significant waste of time, energy, and taxpayer dollars.

They explain that “[p]roperly enrolling in a health insurance plan, particularly a government funded or subsidized plan (such as Medicare or Meicaid), is a complex task.” It requires individuals to “navigate the system” and requires them to understand complex terms and requirements, complete forms, and provide documentation.

Martin's and Parker’s recent estimates suggest that “over half of currently uninsured adults – those who will become newly insured under the ACA – have difficulty finding, understanding, and using even the most basic health information.”

They urge:

The success of the Affordable Care Act to enroll those newly eligible in an appropriate insurance plan therefore depends on clear communication to individuals who have limited health literacy. It is not realistic to expect that a website and assistance from insurance exchange navigators (counselors) can do this.... Provisions in the Affordable Care Act require health plans seeking certification in state exchanges to provide information in plain language.... Yet policymakers continue to take action that undermines clear communication.

 Martin and Parker suggest some solutions:

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.

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.”

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