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New grants totaling $1.5 billion were awarded to 11 states Jan. 17 to establish online exchange markets under the Affordable Care Act that will start enrolling people for health insurance Oct. 1, the Department of Health and Human Services announced.
Delaware, Iowa, Michigan, Minnesota, North Carolina, and Vermont received “Level One” exchange establishment grants, which are one-year grants states will use to build exchanges, HHS said in a release. California, Kentucky, Massachusetts, New York, and Oregon received “Level Two” exchange establishment grants--multiyear awards for further development.
Thirty-four states and the District of Columbia have received grants to build exchanges, HHS said. An HHS spokeswoman told BNA in an email that a total of $3.4 billion in establishment grants have been awarded.
Six states and a multistate consortium led by the University of Massachusetts Medical School have received a total of more than $241 million in “Early Innovator” grants to develop model exchange information technology systems, according to an HHS fact sheet on the exchange grants. Forty-nine states, the district, and four territories received planning grants of up to $1 million each to conduct planning related to the exchanges. Alaska is the only state not to apply for any exchange grants, the fact sheet said.
Getting ready for the Oct. 1 open enrollment starting date, HHS relaunched its HealthCare.gov website Jan. 16 with more of a consumer focus to help people prepare to enroll for health insurance, HHS Secretary Kathleen Sebelius said in a blog post the same day.
In her blog post, “Countdown to Affordable Health Insurance,” Sebelius switched from the term “exchange” to “the new Health Insurance Marketplace.”
“The Marketplace will offer much more than any health insurance website you've used before,” Sebelius told consumers. “Because of these new marketplaces established under the Affordable Care Act, millions of Americans will have new access to affordable health insurance coverage.”
The newly designed website features a sign-up box on the front page through which consumers can receive information on open enrollment closer to the Oct. 1 start date, an HHS spokesman told BNA. “The big new thing is the sign-up,” which will help consumers and small businesses get information for coverage, he said.
A new tab, “Prepare for the Health Insurance Marketplace,” has been added to the website, the spokesman said. Information under that heading includes a description of the new online marketplaces; how consumers can take advantage of them; how they can research them; and how they can check eligibility for subsidies available to low- and moderate-income people, he said.
Once the marketplace is open Oct. 1, consumers will be able to enter information about their income and find out if they are eligible for subsidies or for Medicaid, the spokesman said. Under ACA, people with income between 100 percent and 400 percent of the federal poverty level are eligible for subsidies to buy coverage, and households with income below 133 percent of the poverty level are eligible for Medicaid in states that elect to expand the health care program for the poor.
A HealthCare.gov page titled “About the Marketplace” includes a link inviting consumers to “Learn more about the value of health insurance.” The page has information on health insurance premiums, deductibles, coinsurance or copayments, and out-of-pocket maximum payments, as well as information on health insurance plan contracts with networks of hospitals, doctors, pharmacies, and other health care providers that can limit what is paid for out-of-network services.
Also on Jan. 16, the National Committee for Quality Assurance (NCQA), an organization that accredits health plans and health care organizations, hosted a webinar to discuss findings of a brief issued Dec. 13 by NCQA and the California HealthCare Foundation titled Value Judgment: Helping Health Care Consumers Use Quality and Cost Information.
The two organizations held six focus groups with insured and uninsured California residents in early 2012, before the U.S. Supreme Court decision finding most of ACA to be constitutional, to determine ways to communicate to consumers that high-quality health care does not have to be high-cost health care, said Phyllis Torda, vice president of NCQA's Strategic and Quality Solutions Group. “With a little bit of guidance, consumers … can quickly come to understand that costs and quality are not necessarily equated,” she said.
Previous research has shown that many consumers are concerned that lower cost means lower quality, and it will be important for consumers to understand the concept of insurance value when they are accessing plans through the exchanges, Torda and Jennifer Lenz, NCQA assistant vice president, Quality Solutions Group, said in the webinar. “There was a real teachable moment about health reform,” Lenz said.
In the focus groups, uninsured people were quicker to accept the concept than insured people, Lenz said. “This group seemed to just have a higher level of awareness and be more sensitive to value,” she said.
“These are folks that were previously employed and most recently uninsured or possibly folks who had a pre-existing condition and were unable to access care,” Lenz said. “They were able to understand quickly that unnecessary tests, repeat tests, visits to specialists, things that they felt were a waste of time in their view, they were able to grasp the value concept more quickly,” she said.
In contrast, people with health insurance were somewhat less willing to believe that high-quality care might not be the most expensive care, Lenz said. “Initially participants will associate high quality with high costs,” she said. But once information is presented, “most of them were able to understand value,” and that value in health care did not always mean a trade-off with quality, she said.
“It's helpful if you present it in a way that's relatable to other choices,” Lenz said. She quoted one focus group participant as saying, “'I want to have Nordstrom care at the Target price.'”
One of the conclusions among focus group participants was, “We need to realize that we all pay more when doctors don't pay attention to what's needed,” Lenz said.
By Sara Hansard
A fact sheet on Health Insurance Exchange Establishment Grants is at http://cciio.cms.gov/Archive/Grants/exchanges-map.html. Sebelius's blog post is at http://www.healthcare.gov/blog/2013/01/affordable-insurance-countdown.html. “The Value of Health Insurance” web page is at http://www.healthcare.gov/marketplace/about/value-of-health-insurance/index.html. Value Judgment: Helping Health Care Consumers Use Quality and Cost Information is at http://www.chcf.org/publications/2012/12/value-judgment.
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