Health Insurance and Insights from Health Literacy Helping Consumers Understand: Proceedings of a Workshop (2017) / Chapter Skim
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3 Challenges Faced in Helping the Uninsured Get and Use Health Insurance
3 Challenges Faced in Helping the Uninsured Get and Use Health Insurance
Pages 15-30
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From page 15... ...
"A cookiecutter approach to national health insurance enrollment and helping people once they are enrolled will not work," said Davis. She also noted that states vary widely in how they implement marketplaces, just as insurance 1 This chapter is based on responses of Elisabeth Benjamin, vice president of health initia tives at the Consumer Service Society in New York; Janette Robinson Flint, executive director of Black Women for Wellness; and Janet Mentesane, executive director of the Martin Luther King Health Center and Pharmacy in Shreveport, Louisiana, to questions posed by Terry Davis, professor of medicine and pediatrics at Louisiana State University Health Sciences Center in Shreveport, and the statements have not been endorsed or verified by the National Academies of Sciences, Engineering, and Medicine.
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From page 16... ...
WHAT IS YOUR ROLE IN ENROLLING PEOPLE AND WHAT IS UNIQUE ABOUT YOUR STATE? As a prelude to her answer, Benjamin said, in many ways, New York has the most extraordinary marketplace in the nation in that it does simultaneous enrollment for every possible form of coverage, including commercial qualified health plans, subsidized plans with a tax credit, cost-sharing plans, Medicaid, Child Health Plus, and the new basic plan for those who are lower income but not Medicaid-eligible.
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From page 17... ...
She noted that this type of intense, multivisit process was not factored into the equation on how community-based organizations and navigators would get paid. Mentesane explained that the Martin Luther King Health Center and Pharmacy is a free clinic and free pharmacy serving mostly chronically ill patients in northwestern Louisiana.
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From page 18... ...
"I am not the expert and that is why we partner with good on-the-ground community organizations." One problem she has faced is the program's inflexibility with regard to what she called the boomerang problem -- when clients have problems and they come back. "Our navigators are not trained to deal with postenrollment issues, which are quite complicated," said Benjamin.
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From page 19... ...
"These are not the people who can go on to a website and enroll by themselves," she said. Her biggest worry is that federal and state governments are going to start cutting funds from navigator programs at the same time the problem is growing more difficult.
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From page 20... ...
In particular, she noted how important federally qualified health centers are today because they treat the individuals who have given up trying to navigate the health system, both public and private. "They are still very much needed in terms of the critical care that they provide that is essential to folks who are newly insured or folks who even want something close to where they live," said Flint.
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From page 21... ...
"I think that helps lead to long-term retention," said Benjamin. She also said the person who oversees the navigator contracts in New York holds a weekly hour-long conference call in which representatives from all 50 navigator program talk about every problem and system glitch they encounter.
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From page 22... ...
Picking up on the panelists' comments that more education of the public was needed, and noting that using health insurance is a learned behavior, Rosof asked the panelists for ideas on what could be done to educate the health care provider and other members of the health care team about the issues the panelists raised to facilitate understanding. "Education has to be not only on the person and patient side, but on the provider team side, too," said Rosof.
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From page 23... ...
In addition, navigator training was minimal, she said, and some of the navigators themselves had never had insurance. Brach then restated her question to focus less on the substantive knowledge about insurance plans and more on how the navigators were trained in health literacy principles to ensure their clients understood what they were being told.
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From page 24... ...
Pollitz said the federal online training course's module on health insurance is too basic, though that module is being revised to incorporate more information. Ruth Parker, professor of medicine and public health from Emory University School of Medicine, noted that Pollitz and the three panelists all spoke about the complexity of health insurance and the challenges in producing something that is simple enough to understand so that people trust the information and will use it to enroll in a health insurance plan and use the services afforded by that plan.
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From page 25... ...
Davis added that, whatever the means of communication, health literacy principles have to be used in a way that does not overwhelm people. Teach-back is an essential component of any educational effort, said Davis.
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From page 26... ...
A solution, she said, would be to help consumers connect with experts so they know who to call for good explanations. Lindsey Robinson, a pediatric dentist from rural Northern California and a representative of the American Dental Association, said the California exchange has decided that all health plans sold through the exchange must include a pediatric dental benefit, though in her opinion it was a glaring omission to not require adult dental coverage in all exchange plans.
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From page 27... ...
"This should be, and I think it was intended to be, a profession," said Pollitz. "These were supposed to be professionals who knew what they were doing, who could develop relationships and help people year after year, and provide valuable feedback to the policy makers so that they could fix the program." She said that of the 5,000 navigator programs, a couple hundred help more than a thousand clients during each open enrollment period.
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From page 28... ...
Pow, said she works with many insurance companies and they are aware of how complex health insurance is and how hard it is to explain concepts such as co-insurance, deductibles, and co-pays in language the public can understand. Most people, she added, cannot visualize how these concepts apply in real life and affect their finances.
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From page 29... ...
Flint replied that her organization, Black Women for Wellness, is part of a 14-agency coalition put together by the California Black Health Leadership Network, which received $1.2 million to do education and outreach to cover the entire state. Of that $1.2 million, her organization received approximately $80,000 to serve the 1 million people in her office's catchment area.
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