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New State Health Insurance Exchange Rules Must Be Strengthened

Earlier this summer, the Department of Health and Human Services (HHS) released a preliminary set of regulations that instruct states in the development of their new health insurance marketplaces, also called exchanges. These rules govern all aspects of how the exchanges are run and are a key mechanism for reigning in health insurance company profiteering.

There are a few key aspects of the rules that could be strengthened to ensure that the exchanges function for the benefit of people, not health insurance companies. Right now, HHS is accepting comments to help them revise the rules. This is our opportunity to set a high bar for states to meet or exceed – click here to sign a petition telling HHS that they must ensure that state exchanges:

Speak our language

The proposed rules contain references to cultural and linguistic sensitivity on the part of insurers, navigators, and the exchanges themselves. However, these references usually suggest that participants are “encouraged” to show such sensitivity but are not required to meet any standard that will guarantee that they actually do so.

Recommendation: HHS rules should provide that insurers, navigators, agents and brokers, and the exchanges themselves be required to communicate with consumers in the consumer’s primary language whenever five percent of a state’s population or 500 residents are literate in the same non-English language.

Make health care better

The HHS rules require that insurance companies seeking to do business in the exchanges be required, among other things, to have a quality improvement plan before they can participate. There is insufficient guidance to ensure that insurance companies will actually create meaningful plans.

Recommendation: HHS rules should provide that any insurance plan certified to participate in an exchange include in its quality improvement plan provisions to overcome health disparities including language services, community outreach, cultural competency training, health education, wellness promotion, and evidence-based approaches to manage chronic conditions.

Prevent the fox from guarding the henhouse

State legislation creating exchanges usually establish an appointed governing board. HHS proposed exchange rules permit insurance company representative to be appointed to these boards so long as the majority of representatives come from consumer and small business backgrounds. These boards exist to regulate insurance companies and purchase meaningful, affordable insurance for consumers – and insurance companies, who stand to profit greatly from the decisions of the board, should play no role in them at all.

Recommendation: HHS must establish rules that prevent insurance companies from having representation on health insurance exchange boards. Consumers will suffer if insurance companies are allowed to make their own rules.

Make sure there are doctors in communities of color

Research shows that one of the primary causes of health disparities is lack of access to medical services in underserved communities and neighborhoods. The HHS rules require insurance companies to develop networks of health care providers to reach underserved areas, utilize critical care organizations such as clinics, and make provisions to guard against “red lining.” However, the proposed rules are unclear about how these networks will be built in communities with no health care infrastructure.

Recommendation: HHS rules should require, as a part of provider network development, that exchanges and insurance companies develop and implement plans to increase access to medical care in underserved communities. These plans should show how health care training institutions, providers, clinics, hospitals, and public health systems will be used to increase access. The implementation of these plans should be monitored by the exchanges and by HHS.

Cut down on red tape

The reporting requirements for small businesses go beyond the requirements set in the Affordable Care Act. Small businesses already have to verify that their employees are who they say they are. Adding additional verification requirements is duplicative, time consuming, and expensive for small businesses.

Recommendation: In order to minimize cost and paperwork burdens for small businesses, HHS rules prohibit exchanges from requiring small businesses to re-verify the identity of their employees.

The Affordable Care Act was passed so that all people in America would have access to quality, affordable health coverage and care. Insurance companies are doing their best to undermine this goal and to make sure the rules of the game don’t change for them. Click here to send your comments to HHS and tell them to make health care reform work for people, not insurance companies!

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