By Jocelyn Guyer
It used to be that late August in Washington, D.C. was the perfect time to clean the junk out of your office, delete old emails, and go to the dentist. Now, though, the high energy folks in the Obama Administration charged with implementing health reform are bringing yet more change to Washington, D.C.. Yesterday, they sponsored an all-day listening session with stakeholders to gather thoughts and insights on the new Exchanges that are so central to health reform. They brought together employers, labor leaders, consumer advocates, insurers, and a host of other experts to cover exchange issues such as how to communicate with consumers; small businesses and exchanges; governance issues; promoting delivery system reform; and the role of exchanges in determining eligibility for premium and cost-sharing subsidies and coordinating with Medicaid.
The discussion was incredibly rich, but one theme that emerged over the course of the day – and that also was very much in keeping with HHS’s vision for the meeting – is the importance of securing consumer input into health reform implementation and using a transparent decision-making process. Glen Schor with the Massachusetts’ Connector was particularly eloquent on this point, calling transparency a “hallmark” of how Massachusetts has succeeded in implementing health reform. He and others noted it can be time consuming and cumbersome to solicit consumer input and to share all sorts of details about policymaking, but it is ultimately vital to helping people feel comfortable with major changes.
From a consumer perspective, there also was a fascinating discussion about the kinds of information that people will need to make decisions about their health care coverage under reform. Of particular note, I thought, were comments by DeAnn Friedholm of Consumers Union about the importance of recognizing that people make decisions in different ways. Drawing on Consumers Union’s experience with publishing Consumer Reports, she pointed out that not everyone is likely to want a detailed chart comparing a health plan along a zillion different dimensions. Instead, some people may want a much simpler set of information, such as three good health plan options from which they can choose. While I personally am a huge fan of multi-dimensional charts and love a good spreadsheet, I’m guessing that much of America will want dramatically simplified information about how to secure coverage and enroll in subsidies.
I participated in a panel headed by Director of the Center for Medicaid and State Operations Cindy Mann on coordinating Medicaid and Exchange coverage. Many of the ideas will be deeply familiar to long-time Medicaid and CHIP experts and advocates, including the need for unified and simplified application and retention procedures for Medicaid and the Exchange; the importance of building a strong information technology infrastructure for eligibility determinations that allows linkages between the Exchanges, Medicaid and CHIP and databases that can be used to verify eligibility; and the value of providing people with multiple ways to apply for (renew) coverage, such as the option to submit applications on-line and/or to secure help from a community-based organization. At the same time, we discussed that the tax credits for premium assistance and cost-sharing subsidies pose some unprecedented challenges, including that the tax system is based on annualized income and is not designed to respond when incomes fluctuate over the course of a year.
As intended, the day raised more questions than answers, but, all-in-all, was much better than a trip to the dentist. Seriously, it was impressive to the extent to which people are beginning to roll up their sleeves and work on turning the health reform law into a practical reality.
