Even with health insurance, challenges remain

IOWA CITY - Many Iowa consumers purchasing health insurance through the state's marketplace are among the sickest and the least prepared to use that insurance effectively, according to a pair of University of Iowa Public Policy Center studies out earlier this month.

The studies, funded by a grant from the Commonwealth Fund, also suggest that a high proportion of eligible consumers need post-enrollment help to better understand their new insurance plans, provider availability and billing.

The Affordable Care Act's open enrollment period for the insurance marketplaces began on Nov. 15 and lasts until Feb. 15, 2015.

One study surveyed 500 Iowans about their knowledge and attitudes about the ACA as well as their potential need for assistance. The second study evaluated the IowaCare program, a health care program for low-income adults not eligible for Medicaid.

That program ended in December 2013 and was replaced by the Iowa Health and Wellness Program.

'We wanted to see who these people are that are gaining insurance,” said Pete Damiano, director of the Public Policy Center and one of the study's authors. 'They have the least experience, the least knowledge, are more sick and have greater health needs.”

The consumers who are most likely to take advantage of the Health Insurance Marketplace and Medicaid Expansion started with a disadvantage, the studies found - including having limited experience with insurance, less knowledge about the ACA and less comfort with selecting a plan. They also were more likely to choose a plan based on cost alone and a had multiple chronic conditions.

According to the study, 89 percent of IowaCare enrollees surveyed had at least one chronic condition, and 60 percent had three or more chronic conditions. Another 40 percent of respondents reported their health as fair or poor, and one-third said their mental health was fair or poor.

The combination of these factors means that some consumers may not choose the correct coverage plan for their needs, such as selecting a plan with a narrow network, or a policy that limits the doctors and hospitals customers can see.

Challenges

Iowans who select the wrong insurance plans could create serious hurdles for themselves, including limitations to access and health care providers. For Iowans with chronic health problems, a narrow network plan may mean continuity of care is interrupted.

Damiano said these plans may not include coverage for the correct doctors, prescriptions or hospitals and therefore may not meet consumers' needs.

In addition, even with the new availability of health insurance, there still is a large unmet health care need. The study found that 39 percent of survey respondents self-reported chronic oral health problems - making it the most common chronic illness.

But dental insurance is not always available.

Only a handful of states - including Iowa - offer stand-alone dental insurance plans. The Iowa Dental Wellness Plan offers coverage to low-income Iowans, providing access to core services such as exams and cleaning.

The plan incentivizes more complex work, such as restorative services, root canal care and gum treatment.

'Adults in states with Medicaid expansion will benefit greatly if their state provides dental care as a covered benefit,” the study said.

Because of the complexity of consumer needs and challenges, the study said post-plan selection assistance is critical.

Safety net providers, such as Rural Health Clinics and Federally Qualified Health Centers, are well positioned to help consumers because many of these organizations served as health care navigators during open enrollment.

'Especially for the high cost, high utlilzers, the development of health homes and community care teams that incorporate safety net providers will be critically important for providing the most appropriate patient-centered care once consumers have insurance,” the study said.

Damiano said it's important to understand the consumer needs in a post-ACA world so health care groups can prepare to deal with the challenges.

'We wanted to raise awareness so organizations can be ready for this,” he said.