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Life Health > Health Insurance > Health Insurance

Lynn Quincy: How you explain PPACA matters

By Allison Bell

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Well-written, well-designed brochures could help ease Patient Protection and Affordable Care Act (PPACA) implementation problems.

Lynn Quincy, a health policy specialist at Consumers Union, makes that case in two written presentations.

The Consumer Liaison Committee, an arm of the National Association of Insurance Commissioners (NAIC), has included the presentations in a packet of materials the committee has developed for the NAIC’s upcoming spring meeting in Houston.

In one presentation, Quincy talks about tests of a model brochures that states could use to explain the new PPACA advanced premium tax credit (APTC) program.

The APTC program — the new PPACA health insurance subsidy program — is supposed to help consumers with incomes of 100 percent to 400 percent of the federal poverty level buy subsidized health coverage through the new PPACA exchanges, or Web-based health insurance supermarkets.

In a second presentation, Quincy gives a short version of the results of a Consumers Union study of the usability of the new PPACA summaries of benefits and coverage (SBCs)

Drafters of PPACA added the SBC provision to require plans to provide consumers with short, standardized health plan summaries, to help consumers and employers shop for coverage on an apples-to-apples basis. SBC notice requirements began to take effect Sept. 23, 2012.

In the APTC presentation, Quincy looked at tests of a model brochure developed with funding from the Robert Wood Johnson Foundation.

Consumers can choose to get the PPACA tax credit in two different ways.

For the 2014 tax year, for example, they can wait until they file their 2014 income tax returns — in early 2015 — to get the tax credit money.

They also can lower their health insurance bills in 2014 by collecting the credit starting in early 2014, while the tax year is still under way, and before they know what their total 2014 income will be.

Under a description of the option for consumers to wait to take the tax credit until they file their taxes in 2015, a hypothetical consumer says, “I can afford the monthly premium. So, I’m taking the tax credit later. I like the idea of getting a bigger refund next April. I’ll use it to get my kids a better computer.”

Under a description of the option for consumers to take the tax credit immediately, while the tax years is still under way, another hypothetical consumer says, “I love my steady job at the print shop, but it’s tough to make ends meet. So I’m taking the tax credit now. It’s just nice to have less going out each month.”

When Consumers Union tested the draft brochure in three communities, it found that the brochure was a success, Quincy said.

“Consumers will take action (like call [an] exchange) after reading [the] brochure,” Quincy said.

Consumers understand that the credit lowers health insurance costs, that there’s a trade-off between taking credit in advance and waiting to get the credit at tax time, and that they must contact the exchange if their income or family changes, Quincy said.

Final test results will be available in May, and a fillable PDF of the brochure draft should be available to state exchanges May 15, Quincy said.

The exchange can put in its contact information, and there are also optional fields for contactor information for other assisters, such as brokers and navigators, Quincy said.

In the presentation on the SBC study, Quincy noted that found signs that compliance with the PPACA SBC notice requirements may be spotty: Only 53 percent of the group plan enrollees who should have received SBCs remembered seeing the forms, and just 35 percent of the purchasers of new individual policies remembered seeing SBCs.
About 90 percent of the consumers who remembered seeing the SBCs described the SBCs as being very or somewhat helpful, Quincy said.

When Consumers Union asked the consumers to rate the health insurers’ own brochure, about 66 percent of the group plan enrollees and 78 percent of the individual policy users described that brochure as being very or somewhat useful.

The SBCs include “scenarios” that show how a plan would cover certain common situations, such as managing Type 2 diabetes or having a baby.

One issuer imposed a $5,000 single deductible and $10,000 family deductible for diabetes care coverage, but the SBC showed that the plan would cover all but $80 of a typical enrollee’s diabetes care, Quincy said.

The same SBC included a correct scenario indicating that the plan would pay nothing for maternity services, but the list of non-covered services left out maternity care, Quincy said.

One way to improve the SBC program would be to enforce PPACA provisions that require insurers toprovide accurate SBCs, Quincy said.

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