Will Health Insurance Reform Reach Those Who Really Need It?

Issues that affect our lives don’t happen in a vacuum. Everything affects everything else, and there’s no area where that’s truer than health and access to care. So I’m going to take a slight detour from the financial and economic issues I write about most of the time to say a bit about the Affordable Care Act, which marks a historic expansion of access to health care.

Thanks to the law, an estimated 32 million previously uninsured Americans will be able to purchase health insurance in 2014. But right now there are real questions about whether this historic expansion of coverage will reach those Americans who need it most.

My colleagues on The Greenlining Institute‘s health team have been looking into this, and just published their findings in the form of a new report. They focused on the new Health Benefit Exchanges, which will allow consumers to compare the price, quality, and benefits of competing health insurance plans. Maybe most important, Americans will be able to purchase coverage through their state’s Exchange with federal subsidies that will help low and middle-income families cover the cost.

The bottom line is that getting the word out about these new options may be more complicated than it seems, and state Exchanges should get communities involved in the process sooner rather than later.

Current plans call for Web portals to serve as the main route through which consumers will access the Exchanges, but these websites won’t be able to do the job by themselves. States will need to pursue a variety of outreach and enrollment strategies, strategies that must be based on the populations they must reach.

Nationally, roughly one-third of currently uninsured individuals who would qualify for Exchange subsidies are between ages 18 and 29, and one in three are Latino. Both of these figures are far greater than for the population as a whole. In some places, such as my home state of California, the proportions will be even greater. Most Californians newly eligible for health insurance through the Exchange will be from communities of color, many living in households where English is not the primary language.

These demographics present some challenges.

It may seem counter-intuitive, but young people, and particularly young people of color, may have a difficult time enrolling online. For one thing, communities of color have less reliable Internet access than whites. Only 49% of Latino homes have broadband access compared to 59% of black households and 69% of white households. Research by the Public Policy Institute of California found that Asian American, African American and Latino households were markedly less likely than whites to use the Internet to access government services.

Getting healthy young adults into the expanded health insurance pool is critical to making the whole system work. And young people, and particularly young people of color, are more likely than other groups to use smartphones rather than computers to access the Internet. Nationally, 40% of smartphone owners ages 18-29 use their phone as their primary Internet access point, while 38% of black and Latino smartphone owners access the Internet primarily through their phone.

But mobile devices may not sync well with Exchange web portals, presenting an additional barrier to access for many uninsured Americans. Removing that hurdle is vital, and likely will require specialized apps designed for use with iPhones, Blackberries and Android phones.

But that’s just the beginning. The state Exchanges will need to use a variety of tools to reach the people they need to enroll, including social networking sites, kiosks in key public places, and telephone and in-person assistance in a variety of languages.

It’s important to remember that the above ideas aren’t a laundry list of items that officials can just check off one by one. Each state is different, with varying demographic, geographic and cultural characteristics. Each state Exchange will have to figure out a strategy that works for their communities, and that means reaching out to those communities and listening to what they have to say.

With full implementation of the Affordable Care Act just a little over a year away, the time to start that listening process is now.

Preeti Vissa is the Director of Greenlining’s Community Reinvestment Program that focuses on building wealth and economic sustainability in communities of color. This post originally appeared at The Huffington Post.

10 replies »

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  2. What a great article, Craig. Thanks. I ralely cannot understand why it is so hard to reform health care (or banking or intelligence or foreign policy or )Don’t elections matter in America? Maybe there IS a shadow government we don’t know about.

  3. Are you unaware that Medicare is roughly 40 trillion in the red. Do you have a logical explanation how a system that far in the negative when expaned to cover more people, and thus lose more money would actualy solve anything?

    The 10% lost to fraud alone makes the argumkent non starter

  4. This is a great discussion about the Affordable Care Act, but it’s missing a key component. In my recent blog post (http://bit.ly/sV59da) I write about how Medicare Plan E would solve the problem.

    And to the point of education, nothing less than a strategically implemented public awareness campaign to get the word out to American is all me need. Simplicity, folks.

    I encourage you to read my blog http://bit.ly/sV59da and add your comments there too.

  5. Hello preeti,
    I am fully agreed with your mentioned plans & services towards Health care insurance. I think , you should share your plans and services over some healthcare sites, so that people who need health care insurance services, they can find you easily and serve you provided services.

    we also provide Old Age healthcare service across USA .Please visit : (http://www.attentivehomecare.com) to get more information about complete health care services.

  6. I very much appreciate the issues, concerns, and suggested solutions that Preeti has brought to light about implementation of the Affordable Care Act.

    In a state like California, with a very diverse population, it is certainly expected that there will need to be extensive outreach strategies so that everyone can access the new coverage benefits.

    In Massachusetts, the roll out of the insurance exchange (known as the Health Connector) was supported by grants to organizations throughout the state to provide outreach and education. The support for outreach was very successful, and we found through doing focus groups with newly insured individuals in the state that there was no substitute to one-on-one personal education.

    Even with good websites, individuals who have insurance for the first time can be easily daunted by the choices offered through an exchange, and may have difficulty staying covered over time without support during the coverage renewal period.

    Natalie Truesdell, JSI Research & Training Institute, Inc.

  7. I’m all for easier access and wider awareness of new health care implementations. However, the argument is a bit wack: people who can afford a smartphone should not have trouble accessing a computer. If you are fiscally responsible (which I’m aware, much of the population is not), then you should be thinking to yourself, “maybe right now is not the time for a smartphone.”

  8. so we shoud spend tens of millions of dollars on top of billions in subsidies becuase asking someone to go to the library once a year to enroll in insurance is asking to much?

    Maybe we should stop holding their hand and start demanding some personal responsibility out of them? How many billions do we waste a year worrying about people that can’t be bothered to worry about themselves.

    If you want free insurance or heavily subsidized insurance get off your ass, go down town, wait in line and sign up. If you want it handed to you via an app or pesonal assistant then be successful and pay for it yourself.

  9. To start with. Let’s cut out all those lunches the drug reps are buying for the entire clinic staff. My wife works for a cardiology group and her entire clinic (about 25 people) have catered lunch every day. We all end up paying higher costs for medications because of these lunches.