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April 8, 2014
Viewpoints: What needs to be fixed with health care reform

Covered_California_pamphlet.JPG(April 8 - By Micah Weinberg, Special to The Bee)

It seems that all we hear about health reform these days is hatred or hype. As usual, the truth is more complicated. We've laid a solid foundation for a much-needed national reform, but the challenges to date run deeper than the issues with the website. Successfully creating a functional, universal health care system for our country will require being entirely clear-eyed about what has worked and what needs to be fixed with the Affordable Care Act.

As we reach the end of the first period for individuals to enroll in health coverage, the number of people who have selected a health plan through the public exchanges may top 7 million nationally, more than 1 million in California.

This was no mean feat. Health plans, insurance brokers, community groups, government agencies and celebrities such as LeBron James have all been working around the clock to get people to sign up. They've done so in an environment where opponents of reform have been spreading misinformation that has been quickly debunked by fact-checkers.

But reformers also created many of their own challenges by passing a law that is overly complex. This leads to the first one we must acknowledge and work to fix: It is significantly more complicated to enroll in health coverage than it was before the passage of Obamacare.

Before health care reform, millions of Americans were at risk of being excluded from coverage because they had pre-existing conditions. This was inhumane and dysfunctional, and it had to change. But the amount of information now needed to enroll - from projected family income for the year to whether a family member has an offer of "affordable" coverage through an employer - is an order of magnitude greater.

One result of this complexity is that the customer service experience of many people attempting to enroll in a plan, switch to another plan or figure out how to use their coverage has fallen short of expectations. Hundreds of thousands have spent many hours on the phone bouncing around between public exchanges and insurance plans attempting to sign up for coverage, pay for their selected plan or figure out which doctors are in their plan's networks.

This leads to the second critical thing reformers must acknowledge. People's challenges in figuring out how to access health care may threaten the development of high-value networks. And this is the aspect of reform that holds the most promise for controlling health care costs.

Most of the networks developed for individual market coverage have more selective rosters of doctors and hospitals than the network plans typically offered in that market prior to the Affordable Care Act. And thank goodness. These more selective networks spur greater price competition among providers, which is crucial for reining in rising costs.

To date, though, there have been too many challenges in making sure that consumers have good information about which providers actually are in the networks. Most exchanges, including California, had to pull down their provider directories if they ever even attempted in the first place to provide this information. Further, insurers' own directories are often difficult to navigate, and a few doctors and hospitals have misinformed consumers, saying that they are not in reform networks when they in fact are.

We've all got to work together to get this right. Insurers have to develop adequate and transparent networks and exchanges, and providers have to give consumers better information. Otherwise, we'll see a dramatic, as well as entirely understandable, backlash that will force these networks to broaden and cause health costs to skyrocket again. This is probably the most critical thing to get right in health care reform, and we have not gotten it right yet, even in states such as California that are held up as models for the rest of the nation.

So what's going on with health care reform? Largely what those that crafted the law hoped would happen. But both sides need to ditch the political spin and be entirely honest about the trade-offs inherent in any broad-ranging policy change. And we need to keep working hard to fix the parts of the process that are fixable, especially simplifying the enrollment experience and ensuring that consumers have the accurate information about which doctors and hospitals they can access.

Micah Weinberg is senior policy adviser to the Bay Area Council, a business-backed nonprofit, public policy organization.



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