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ACA shifts health insurance questions from affordability to access to care

Center on Health Insurance Reforms: Consumers increasingly have coverage but don't understand it

By expanding access to health insurance, the Affordable Care Act has shifted consumers' questions about coverage from affordability to access, according to a new report from Georgetown University's Center on Health Insurance Reforms.

The report examined the questions that the 13 state-based consumer assistance programs (CAPs) received before, during and after ACA implementation.

Accessibility and affordability were top concerns in 2013, the report found. Many without coverage were turned down because of their health status or received an insurance quote that they could not afford, the report said. Those with coverage reported concerns about high premiums or the high cost of prescription drugs.

In 2014, the topic of conversation turned to the state and federal insurance marketplaces, the report said. Specifically, consumers had questions about the Healthcare.gov glitches, the wait time to receive health plan ID cards and billing problems, according to the report.

Many of those technical problems have since been resolved. As a result, the report said, today's inquiries to CAPs tend to focus less on access to insurance and more on access to care--that is, on a lack of transparency about provider networks, balance billing for out-of-network services and the sheer volume of affordable plans now available on the marketplace. These questions should guide policymakers and payers alike as they continue to pursue healthcare reform efforts.

The report also offered a reminder that many who purchase insurance for the first time possess a low level of health literacy, which the healthcare industry must remember to address. "This lack of understanding limits consumers' ability to select the health plan that meets their financial and coverage needs," the report concluded. "It can also mean they don't use their coverage effectively once enrolled."

The ACA provided $30 million in grant funding to establish new CAPS, or expand preexisting programs, according to the report. Thirty-five states has a CAP as of 2011, but a lack of additional federal funding led 22 states to drop the program. It remains to be seen if the CAPs have boosted overall enrollment figures on the state insurance exchanges, FierceHealthPayer previously reported.

For more:
read the report (.pdf)

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