DeAnn Friedholm says lawmakers and others who are working on the new health insurance distribution exchanges should understand just how lost many consumers will be.
Friedholm, the Austin, Texas-based health care reform director at Consumers Union, talked about health exchange enrollment assistance features in November 2011 at a health reform implementation conference organized by the National Conference of State Legislatures (NCSL), Denver.
The NCSL posted a copy of an exchange enrollment assistance presentation she developed on the conference website.
From a policymaker's point of view, one benefit of the new system is that exchanges could help hold down health coverage costs, Friedholm says in the presentation.
But, on ther other hand, "it is going to be a pain in the neck to implement this thing," Friedholm warns.
The first lesson Friedholm gives is, "Abandon the image of a careful shopper capable of weighing the myriad costs and benefits of their health insurance options."
In the real world, Friedholm says, "consumers dread shopping for health care."
Consumers also have a hard time understanding co-payments, coinsurance rates and other cost-sharing provisions, Friedholm says.
The secret to enrolling consumers successfully will be to simplify the options available as much as is practical, giving consumers online comparison tools, and providing live assistance from brokers, navigators and others, Friedholm says.
Policymakers also should find ways to create acceptable, understandable substitutes for difficult-to-understand terms such as "benefit limit" and "preferred."
Policymakers should develop compensation disclosure rules for brokers, navigators and others and ban compensation structures that encourage helpers to steer consumers to plans that pay better commissions, Friedholm says.
Navigators – ombudsmen — need not be licensed, but any brokers or navigators who participate in the program should get training to help them understand the needs of lower-income applicants, Friedholm says.
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