Despite the Affordable Care Act’s success in getting 16 million more Americans enrolled in health insurance programs, major hurdles still keep consumers from understanding their coverage, finding a doctor and accessing care, according to a study by RAND Corp.
Many of the newly insured don’t understand the coverage and benefits offered by their plans or such unfamiliar terms as “copays,” “coinsurance,” and “network,” the study found. Many can’t find a provider who accepts their insurance. As a result, these consumers don’t “fully engage in their health care,” including getting the preventive care that can help avoid serious illness.
The research firm, based in Santa Monica, California, based its findings on interviews with consumer organizations, healthcare providers and insurance companies in four states chosen to represent diverse segments of the population: Connecticut, Kentucky, Texas and Washington.
The emphasis during the ACA’s first two open enrollment periods was on getting uninsured people enrolled, RAND notes. But “less attention has been given to the plan selection process and whether consumers are choosing a plan that meets their health and financial needs,” including out-of-pocket costs and provider availability.
Many consumers “struggle with low health literacy,” and insurance information is often presented in dense text rather than simple diagrams. Often plans are selected based only on the cost of premiums, without considering deductibles, copays, and other costs.
Most informational materials are available only in English, with some translated to Spanish. But “little attention has been paid to the many other languages spoken by” consumers.One source estimated that by 2019, 23% of enrollees will speak a language other than English.
Consumers appreciate the in-person support provided by ACA “navigators;” individuals or organizations trained who provide free, unbiased help to consumers as they shop for health coverage through Marketplaces.
This help is especially useful for those with low health literacy and limited English proficiency. But navigators can only help consumers sign up for coverage; they cannot offer guidance in the selection of insurance plans.
RAND said the insurance industry and regulators should consider simplifying plan benefits and cost-sharing provisions, to make it easier for consumers to understand them.
Even with the right coverage, consumers can find it difficult to obtain care. There are shortages of doctors and healthcare facilities, particularly in rural or low-income areas. Because of low reimbursement rates by some plans and by Medicaid, a number of providers are not accepting new patients.
Consumers who select plans with high deductibles or co-pays, or who are not sure what their portion of the cost of a medical procedure or prescription will be, often delay seeking care, RAND notes.
Many of these newly enrolled insured previously visited hospital emergency rooms to obtain care. Even though their coverage now enables them to see a personal physician, they may continue to visit the ER because it is familiar and convenient. Changing this behavior will require education.
Finding a provider and seeing the doctor are important first steps, but real improvements in health also require long-term engagement by consumers, says RAND. This includes getting regular preventive health checks and, if there are problems, taking the prescribed medication and keeping follow-up appointments.
Many consumers fail to appreciate the value of regular doctor visits and preventive care services. Language barriers, lack of transportation, concern about out-of-pocket costs, and cultural or social issues all can present barriers to consumers obtaining care.
