One of the Affordable Care Act’s (ACA) major provisions is the creation of insurance exchanges or state-based marketplaces for small businesses and people without employer health coverage. Although these exchanges, designed to offer choices of affordable health plans, are not mandated until 2014, Minnesota officials are now meeting to decide how to set them up.
Will these insurance exchanges, which must be in place beginning in 2014, address health disparities? This was the oft-asked topic at the January 17 state health insurance exchange advisory task force meeting at Shiloh International Temple in North Minneapolis.
Health disparities “are a high-priority issue,” says Task Force Chair and State Commerce Commissioner Mike Rothman at the four-hour meeting at Shiloh Temple. It “was a huge and terrific opportunity for us to come and be directly in the community…to have an open dialogue to ensure that we understand what the needs are.”
“We have been meeting two or three times a month” since November of last year, says Stairstep Foundation CEO Alfred Babington-Johnson, one of two Blacks on the task force. The current healthcare system “is ill prepared” to serve all people, especially Blacks and other people of color who are disapportionately affected by health disparities, he added.
The other Black task force member, Open Cities Health Center CEO Dorii Gbolo, pointed out that the new state insurance exchanges must help reduce current barriers for Blacks and low-income people from getting quality affordable health care.
Blacks tend to get “different” care than Whites when it comes to health concerns, stated State Health Commissioner Edward Ehlinger. “I don’t think people realize that health care is a social determinant. It’s not just access to care but continuing of care. We need to encourage prevention” to keep everyone healthy and keep healthcare costs down, he surmises.
“We have a moral obligation to address” rising healthcare costs, adds State Human Services Commissioner Lucinda Jesson. As a result, the task force presented the following list of recommendations:
- Establish an effective “navigators” program: persons who are trained to identify those at risk and minimize “churning,” which Ehlinger defines as persons who “keep going from plan to plan, on and off.” They should be located in community-based organizations, and be structured to support different navigator roles designed to address the specific needs of diverse populations.
- Keep people covered despite incarceration: Allow people to enroll even if they have not been convicted or are in jail pending charges, including charges of parole or probation violations.
- Set up outreach and marketing campaigns to reach the “newly covered” and the “covered but not enrolled,” and design culturally specific outreach strategies along with community organizations.
- Simplify eligibility determination and enrollment procedures.
- Adopt statewide data-collection standards to better understand and document health disparities, and to hold insurers and providers accountable for their performances on health equity measures.
- Do not adopt unnecessary and burdensome citizenship documentation requirements for individuals and small businesses enrolling through the exchange.
- Collaborate with community organizations in creating care models that reward health outcomes and bring benefits from any innovations and savings back to the communities hardest hit by disparities.
- Allow the exchange negotiate with insurers to push for lower premiums and better benefits.
- Ensure that the yet-to-be-established Exchange Board has designated seats for individuals with expertise in particular areas, including at least one member with expertise in public health and health disparities, and one member with expertise in mental health.
Babington-Johnson made a motion that the task force “consider the impact of health disparities on all policy decisions,” which the group unanimously approved on a voice vote. Afterwards he applauded their action, “but we got to go forward and make that meaningful,” he noted.
The January 17 meeting, however, was not well attended. “I’d wish more people, more of our community had been here,” observed Makeda Norris, who was among several persons who offered public comment at the meeting. Norris added that she saw it as “a great start to having input to the health system exchange. It gave me more information.”
“We had an opportunity to speak on the issue,” said Mitchell Davis of the Minneapolis Urban League.
“I thought it was very informative, but I’m about the bottom line,” added Health Empowerment Resource (HER) Clinic Executive Director Pam White. “We know that there are health disparities and we know that there are gaps in services, but we believe now it’s about [putting] those [recommendations] into action. I’m hoping that the new process will offer something affordable.”
When asked would have the health disparities issue been discussed if he, Gbolo, or both were not on the task force, “I think perhaps not,” responded Babington-Johnson. “But there are people like [fellow member] Phillip Cryan [SEIU Organizing Director] and Commissioner Ehlinger who are involved that have a deep commitment to better health outcomes.”
Nonetheless, community members should be involved in setting up the state insurance exchange, Babington-Johnson strongly suggests.
“I thought there were some very interesting suggestions made both from members of the community as well as from some of the task force members,” surmised Jesson. “I thought it was a great conversation.”
When asked why wasn’t the meeting more publicized, which may explained such a low turnout from community residents, “We’ll work on making sure [the public is better informed],” promised Rothman. “We’ll do that.”