Individuals with chronic diseases who shop for health insurance online under the Affordable Care Act need better tools to help them figure out if their doctors and their drugs are covered by the plans they’re considering buying, according to a new survey that also ranked states on how well they address consumer needs.The study was released Friday by the National Health Council, an umbrella group of organizations that advocates for people with chronic diseases.
New Jersey ranked about average among the 32 states analyzed in the report. New Jersey is among 34 states where residents purchase their ACA health plan on the federal health insurance website, HealthCare.gov. More than 250,000 New Jerseyans have enrolled in 2015 health plans on HealthCare.gov, up from about 162,000 in 2014, the first year of Obamacare. More than 80 percent of New Jerseyans who used HealthCare.gov have received federal subsidies to defray the cost of coverage.
For New Jerseyans, the online insurance shopping experience is largely under the purview of the federal Department of Health and Human Services, which runs HealthCare.gov. However, New Jersey, like other states, continues to regulate health insurance.
Marc Boutin, NHC chief executive officer, told reporters during a conference call that HHS has been responsive to its requests to improve HealthCare.gov.
“At the end of the day, people want tools,” he said. “They want to be able to put in basic information (and then receive) information to help them make decisions. Simply making information transparent isn’t enough. If it’s not uniform, you can’t compare it.”
He said website technology is evolving in ways that will make it easier for consumers to find the health plan they need. Eventually, he said: “People will put in their information and be told what plans are appropriate for them. We’re moving in that direction, and we still have some work to go.”
He praised HHS for “taking us a long way down that road.”
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Kelly Brantley is senior manager of Avalere Health, which worked with the NHC on the state-by-state review. She said that, while today on HealthCare.gov, consumers will find links to the doctor and hospital networks associated with each health insurance plan, and links to lists of prescription drugs covered by those plans, “There are not integrated tools where a person can put in their drugs and put in their doctors and have a sort of meta-analysis of the plans available (in their state) that will help them figure out if their doctors, drugs or procedures are covered by any of the plans.”
Boutin said, “We would love to see over the course of the next year to three years that every state has an Expedia.com-like tool that will allow you to search for a plan on your own terms in a very accessible way and give you the kind of information that is required to be an informed consumer.”
The study found that patients shopping on exchanges often have difficulty accessing the information they need to make an informed decision about their insurance. Specifically, the survey found that more than one-third of exchange consumers with chronic conditions had a hard time finding information about covered providers and medications.
Yet, of state exchanges analyzed by the NHC, only seven have additional website resources and tools beyond the federal minimum requirements, and only one state has passed contracting requirements to enhance plan information transparency.
The national survey, conducted for NHC by the by public opinion research firm Lake Research Partners, found many patients with chronic conditions did not find critical plan features easy to access on exchange websites:
- 36 percent of respondents said a list of participating providers was hard or very hard to find;
- 38 percent said a list of prescription drugs was hard or very hard to find.
Joel Cantor, director of the Rutgers Center for State Health Policy, said the report “classifies New Jersey as about average, which is fair on many dimensions. But in some respects, the report understates how well New Jersey is doing. For example, it notes that New Jersey has not acted to standardize plans, but we have had plan standardization in our individual market since 1993, so no action was needed. New Jersey has had strong regulation of its individual market for many years that required less change to accommodate ACA rules than many other states.”
Ray Castro, senior policy analyst for New Jersey Policy Perspective, said: “This study clearly shows that more standardization of plans, transparency and simplicity is needed in New Jersey’s exchange. The many new plans that are now in the exchange provide more choices, but this also makes the decision process more complex. Both the state and federal government need to work better together to improve the consumer experience.”
And John Sarno, president of the Employers Association of New Jersey, said: “The report shows that New Jersey has done a good job enrolling eligible individuals, but suggests that, with a state-run exchange, the enrollment would be higher. Having said that, I do not think that having a federally run exchange has compromised consumer protections or transparency.”
Castro added: “While the federal government in New Jersey administers the exchange, the ACA maintains the authority of the state to regulate all insurance plans. The federal government at a minimum needs to maintain its funding for consumer assistance and outreach and the state needs to improve its enforcement and standards for plans.”
“The study finds that patients want to pick a plan that meets their needs. But we need to ensure exchanges provide them the tools to make it possible,” Boutin said “In particular, transparency standards and easy-to-use decision support can help patients make an informed decision about their insurance.”
The research found that an overwhelming majority of patients would find added consumer support helpful when choosing coverage. Only 37 percent of patients enrolled in silver-level plans reported they had all the information they needed when making a decision. When presented with a list of possible web-based tools:
- 88 percent of all respondents said having a standardized list of covered providers would be helpful when selecting a plan;
- 85 percent said a standardized list of covered drugs would be helpful; and
- 83 percent said a calculator to help them estimate their out-of-pocket health costs would be helpful.
With the assistance of Avalere Health, the NHC evaluated 32 states on 15 metrics identified as important to the patient community and spread across five principles: non-discrimination, transparency, state oversight, uniformity and continuity of care.
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