It’s no secret that the passage of the Affordable Care Act means lots of new opportunities for health care coverage and access – and that most Americans are confused about what the law actually means for them. Here at Community Catalyst, we have seen health reform as an opportunity to improve consumers’ ability to get clear information in lay terms from trusted sources to help them understand their health care options. And consumer assistance programs (CAPs) are a critical way to make this happen.
The Affordable Care Act included $30 million in 2010 to fund state ombudsman offices and CAPs (Section 1002). The grant guidelines for those funds are slated to come out in the next few weeks, and the grants will likely go to states, who will decide how to best use the funds.
While we’re not quite sure how the guidelines will read or play out in implementation, we have some core criteria we think are necessary to providing consumers accurate, understandable information and helping them navigate the new world of health care.
1. Be truly independent. Consumers should be able to trust that the information and enrollment assistance they get is unbiased – not informed by state budget problems or politics. Especially as 20 states’ attorneys general actively oppose health reform, consumer assistance programs should ensure there’s a wall between state and political issues and helping consumers. 2. States need to do more than they already do. Many states are currently overwhelmed and understaffed because of budget woes. Consumer assistance programs need to be separate and robust from current activities in state Administrations – and actually have the capacity to provide necessary help, navigation and information. 3. Meet the needs of the community. Consumer assistance needs to be culturally and linguistically competent, and provided by people who understand working with vulnerable populations. A well-trained staff should be trusted by members of the community, including people at different levels of income and insurance options (from Medicaid to private insurance). 4. Allow for feedback to policymakers. A critical reason for consumer assistance is the ability to get real-time, on-the-ground information about what’s working and what’s not. Regular feedback to state and local policymakers can help improve health reform implementation 5. Ensure every state has a consumer assistance program. Even if a state does not set up a program, the federal government should be able to contract directly with an organization to carry out these important duties.
Based on these elements, we think that the best option for CAPs in most states is often non-profit community advocacy organizations. Examples like Health Care for All Massachusetts’s Helpline, New York’s Community Health Advocates, and Health Assist Tennessee have shown us that strong consumer assistance programs can mean the difference between a failed attempt and successful reforms. The Helpline in Massachusetts saw their call volume increase from 500 to 4000 per month after the passage of that state’s health reforms in 2006. People call with questions from enrollment assistance to help with paperwork to navigating the health system. We hope that the grant guidelines will explicitly permit states to contract or partner with community organizations to provide consumer assistance. We have seen these models work, and know that they are trusted sources of health care information for communities and families looking for help in understanding a system that’s about to get bigger and more complex.
— Christine Barber, senior policy analyst