We Must Keep Our Promise if the Affordable Care Act is to Work
This article was written by Patricia Baker, president & CEO of the Connecticut Health Foundation.
Connecticut has every reason to be proud of itself. Access Health CT (AHCT), the state’s insurance marketplace, anticipates exceeding its goal by enrolling more than 185,000 residents in health insurance since enrollment. The Connecticut Health Foundation (CT Health) applauds everyone that came together to make this work. Navigators, in-person assisters, health care providers, community-based organizations, policymakers, brokers, friends, family and others made a tremendous effort to get us to that 185,000 number. Connecticut is rightfully recognized as a leader in implementing the Affordable Care Act (ACA).
- Today, the percentage of those enrolled in public vs. private insurance is 38/62– the best in the country.
- Connecticut is the only state that operates retail stores. Seventy percent of the 300 to 400 daily visitors purchase insurance.
- Access Health CT is so successful that they are attempting to franchise their model for purchase by other states.
- At last count, the Department of Social Services (DSS) processes 72 percent of its Medicaid applications in four days, and decreased Medicaid determination from 45 days to 1 day.
Although Connecticut is a leader in health reform implementation, it is not keeping its promise to all Connecticut residents. Having health insurance is not the same as having access to care. For example, what about the 28 percent of consumers, determined eligible for Medicaid, who cannot access care because their applications haven’t been processed? In other words, is 72 percent good enough? We’ve promoted these great new insurance benefits on radio, television, online and in newspapers, encouraging residents to apply for health insurance. Unfortunately, many enrolled residents cannot yet access these benefits.
At the Root of the Issue
At the root of the problem is the process for enrollment, coupled with technology. AHCT and the Department of Social Services (DSS) systems currently do not communicate and interface – requiring a manual hand-off of forms. Also, DSS is working with a 25-year old legacy computer systems that is woefully inadequate, as validated in the Mercer Report. DSS spent $20 million to modernize the system. In order to leverage the systems available, The Centers for Medicaid & Medicare Services (CMS) approved the creation of a manual system between DSS and AHCT. A paper file (PDF) comes out of one system (DSS), and is handed off to Xerox to enter data, which is then linked up to AHCT’s system. Also, incomplete applications get caught up in the system—needing human intervention—often delaying the process for some applicants. Delays can also be attributed to technical problems, and system sweeps in the Federal health exchange hub, which also links up to the Connecticut system. Connecticut must prioritize fixing the system to ensure accuracy and expediency in securing Medicaid enrollment.
The No Wrong Door Approach Can Solve the Problem
Connecticut committed to implementing the No Wrong Door (NWD) approach (infographic) by the end of 2015. With NWD in place, that 72 percent could grow to 100 percent. However, the gap between the two systems leads to wrong doors.
Under the current system, individuals and families may knock on different doors for health insurance coverage, many of which may not open, preventing them from getting covered. Under NWD, every door is the right door. Consumers can apply online, telephone, storefronts, and more, and be routed smoothly to the right place. State officials envision the AHCT and DSS websites will eventually be consolidated into a single portal. Robust technology alone, however, is not enough. A strong navigator and in-person assister network is essential to building trust and designing culturally-specific outreach strategies to reach hidden, uninsured populations in their communities.
Helping More People of Color Gain Better Access to Quality Health Care
The implications for NWD are significant for people of color who, prior to the ACA, made up 65 percent of the state’s uninsured residents.
According to policy research from the Urban Institute (commissioned in 2013), NWD is critical for achieving the goals of the ACA in terms of covering, and keeping covered, people who are currently uninsured. In Connecticut, NWD would result in:
- Health insurance coverage gains 13% above what the ACA alone could be expected to achieve.
- A 50 percent reduction in uninsured rates for African Americans, Hispanics, and Asian-Americans, expanding health equity.
- Improved consumer experience – less frustration and lost coverage opportunities from knocking on wrong doors.
- Administrative efficiencies for the state through automation and reduced duplication between agencies that must work together limiting the opportunities for errors and mistakes.
Short-term and Long-term Recommendations for Keeping the Promise for Everyone
Connecticut needs to stop thinking in terms of privately insured vs. publicly insured when it comes to our residents. Instead, there needs to be a change in perspective so that residents are seen as the same membership. DSS and AHCT are charged with enrolling all residents. How do we achieve this vision?
To keep the promise, Connecticut must commit to:
- Transparency – “Shine a light on something, and we’ll do it.” Let the public know what is really happening in terms of advancements and challenges. Transparency builds trust in the process, and sets realistic expectations about goals, progress and timing.
- Full implementation of the NWD approach. Enroll everyone eligible for coverage whenever and wherever they enter the system.
- Cooperation between all stakeholders, including DSS and AHCT. Everyone must work together so all customers are served and able to access care. Collaborative problem-solving will help address challenges as they arise, and scale up solutions that work.
The ACA promises coverage that can lead to longer, healthier lives for Connecticut families. The goal of Connecticut is to be a leader in the good health and well-being of its residents, not in having the best numbers.
Connecticut can keep the promise of good health through full implementation of NWD. NWD won’t be in place until 2015. For now, the philosophy of NWD should guide how the state provides immediate assistance and problem solving to diverse consumers as it continues to enroll people.
 Levin Becker, Arielle. “Access Health CT marketing Obamacare “exchange in a box.” The CTMirror.org. April 1, 2014. http://ctmirror.org/access-health-developing-a-new-ct-export-insurance-exchanges/