The latest word(s) on healthcare insurance

There are six more weeks for Californians to enroll in the healthcare insurance marketplace during thisinitial open enrollment period. Now seems a good checkup time for public libraries to evaluate how well we have provided information and technology access to this Affordable Care Act program.

Have you and your staff been keeping up to date on changes, including regulations and scheduled online enrollment site down periods?  The quickest and most efficient way to do that is by subscribing to and following Covered California’s Twitter feed.

An announcement made there (and via other social media routes) last week alerts us all to the SHOP portal on the Covered California website coming down for the next several months. The explanatory news release includes the important detail that paper applications made for small business employer coverage will continue to be accepted and moved through the enrollment process during this period. Does your small business community know about this change?

In the first two months of the open enrollment period, public library staffs were reporting a generalized lack of inquiries from their communities regarding ACA. Interestingly, they also reported doing little in terms of public education–including such activities as hosting insurance education and health and wellness programs.  Changes in the demographics of who can and does have health insurance points to new insurance users who may have little understanding of health insurance speak (for instance, the difference between co-pay and out of pocket costs) and need some basic math skill-building (to calculate and compare percentages). Many who previously relied on emergency rooms to provide any medical attention they identified for themselves as needing aren’t experienced in how to discuss–and understand clearly–health information with a personal physician (for instance, the difference between a diagnostic test and a test related to a medical procedure). Has your adult literacy partner developed curriculum that addresses these needs to find educational help?

Six weeks ago, other components of the Affordable Care Act went into effect. As of January 1, very specific patient rights and protections  must be recognized, including an end to yearly and lifetime dollar limits an insurer will pay; free preventive care; mental health and substance abuse services coverage; and other details that can change how long-time insured people, as well as those new to health insurance coverage, when and how reliance on insurance provides new areas of care access.  Do your communtiy members know about these changes already in effect?

While roll out of the health insurance enrollment regulations related to the Affordable Care Act has received lots of popular media coverage, digging below that surface of opinion to lay bare the information that still needs to reach your community is an ongoing project.

More for your healthcare info hungry community

Covered California consumers can now use a quality rating system when choosing a health care plan is the latest big news about the state’s Affordable Care Act insurance market site. Reading the full story shows there is some real substance behnd the headline:

  • The scoring comes from the Consumer Assessment of Healthcare Providers and Systems
  • Input for the scoring derives from consumers of each healthcare plan, who were asked about features ranging from ease of getting doctor appointments to medical care and customer service
  • The availability of such a scoring system is a requirement of ACA’s rollout, but this one isn’t a required accomplishment at the state level until 2016, so California is actually way ahead of schedule and plans to continue to tweak it as more data becomes available
  • Each healthcare plan offered through Covered California is assessed and rated according to how it stacks up against all such plans offered throughout the Western United States, so comparison evaluation outstrips the in-state options
  • And the rating is expressed with a four-star shorthand, with four stars indicating the plan is in the top quartile of the plans evaluated, three stars indicating the plan is as good as those ranking between 50% and 75% on the scale of 100% satisfaction, two stars for the third quartile (25%-50%) and one star for those with the bottom quartile ranking

This kind of information can also serve as a reminder that healthcare and health insurance are huge areas of literacy need. Using the Affordable Care Act’s requirements to design both adult and family literacy directions and programming can provide high value to your community. Learning to understand the “insurance speak” of co-pyay and deductibles, and the math understanding required to make judicious use of aligning this quality rating system with affordability are just two literacy training areas to consider. Like other aspects of the laws and regulations around ACA, the public library’s potential to demystify and educate can be parlayed into demonstrating the high value of the library itself to your community.

(Almost) everybody’s doin’ it

With the initial (but only initial, folks!) deadline for Covered California health insurance marketplace registration upon us next week, there has been much ado about information gathering, the Affordble Care Act, and public libraries. Thanks to the 82 who responded to Infopeople’s own survey of California public library activities related to the Affordable Care Act, we can see ourselves in the national context. During the same brief window we asked for library administrators and staff to respond to our survey, a national survey of state libraries, conducted by WebJunction, yielded responses from 40 states.  Here’s how things stack up:

  • 67% of responding California libraries reported receiving 0-4 questions related to ACA during the first two months of health insurance marketplace registration, while 55% of thos in Illinois responding to a survey reported receiving no questions related to ACA during the same period.
  • 73% of responding California libraries found Infopeople’s distribution of registration-focused posters and booksmarks useful. In contrast, it is interesting to note that Missouri law prohibits the use of any resources to support or educate on ACA.
  • California, through Infopeople, provides public library staff with a Resources page dedicated to ACA information, an archived webinar with library and Covered California speakers on the topic (which 46% of California responders reported viewing) and a free online independent learning series on ACA and public libraries (which 11% of California responders have taken and another 34% plan to take). Other states are also providing their public libraries with helpful resources on the topic, including Ohio’s [Federal] Health Insurance Marketplace Do’s and Don’ts for staff. Louisiana, another state with no state-level marketplace and thus reliant on the Federal insurance exchange, also provides its library staff members with an online course on working with community members to utilize The Montana State Library gives ready access to public library staff on Affordable Care Act Resources. Washington, a state like California where there is a health insurance exchange separate from the Federal one, provides library staff, through its State Library, with a resource page on the Affordable Care Act, linking them to state-level resources as well as federal law.

Other state libraries attending a call-in meeting yesterday, organized by WebJunction, included Maryland, New York, Colorado, Indiana, and Iowa, providing us with a mix of viewpoints and approaches from most regions of the country and representing both those states with their own marketplaces and those using the Federal one. In our discussion of initial difficulties reaching Latino populations, a national resource bubbled up that may help California public library staff clarify community concerns. The National Immigration Law Center has an excellent and accessible Frequently Asked Questions document will be added to Infopeople’s Resources on the Affordable Care Act.

One more resource of note, available under the Publications and Articles tab of the Centers for Medicare and Medicaid Services Resources portal, is titled “Protect Yourself from Fraud in the Health Insurance Marketplace.” This brochure is available for bulk order on that page.

Getting so many public libraries connected to whatever resources can lighten their loads as this massive national initiative continues is like learning any new language: we seem to have the vocabulary down well enough now to practice our conversational skills. And by talking about what we know and what we need with librarians both in California and in other states, we can continue to boost our effectiveness in responding to information needs.

How your library may be missing a great advocacy opportunity

Earlier this week, I met with representatives of WebJunction and ZeroDivide to discuss how public libraries both in California and around the nation are responding to the element of the Affordable Care Act that legislates the initial enrollment period in health insurance marketplaces. Among the details we learned from each other is that the California library pattern, to date, mirrors the national one: there has been a clear tendency to leave the heavy lifting of informing communities about registration to non-library agencies. A majority of public libraries with developed reference services have, to date, opted for a passive role, awaiting formulated questions related to health insurance–including registration, but extending to health insurance literacy–to be addressed to staff at a reference desk.

Popular media reports about registration (national television as well as regional California news sites) have, overwhelmingly, reported on the national online insurance exchange and its myriad problems. Even sophisticated news consumers, including librarians, express surprise to learn that not only has California’s exchange (which is not limited to online registration) been significantly trouble free in matters of technology, but that state law and regulations don’t mirror President Obama’s rollback of the due date for demonstrated coverage. If sophisticated news consumers have missed these facts, how can we presume that communities don’t need active information leadership from their public libraries?

No, we aren’t men (or women) in uniform, but there is a similarity here between our stand-back approach and that of the old fashioned fire department, where the long gaps between extingishing fires held no other publicly visible duties and tasks. Now we see fire fighters providing safety education sessions, evaluating community members’ ready access to emergency equipment and responses, and working with other agencies–police, schools, businesses, and, yes, libraries–to effect better community safety practices. And, with the registration and health insurance exchange, we as information and referral facilitiators, are perfectly tuned to effect better community health practices. Let’s not sit back and wait for invitations to perform a concert.

Then there is the somewhat cynical angle: here we have a golden opportunity to build our advocacy forces by showing how our services make a difference between ignorance and confusion and our infusion of clarity, fact and culturally competent communication.

Here are some places to find more details:

Important news releases from California’s health insurance exchange

Three announcements today from the state’s Affordable Care Act-mandated health insurance exchange, Covered California ( require the attention of all library staff providing accurate and authoritative information to their communities: 1. When the website for the exchange comes back online Monday morning, November 25 (It was previously announced and noted here that the site will be down for an upgrade from Friday night, November 22, until early Monday morning), the agency will also have a new phone hotline to help with complicated consumer questions. The number will be 885-857-0445, and will be staffed Monday through Friday, 8 am to 8 pm. 2. The Covered California Board of Directors made a regulatory decision at today’s meeting that, unlike the federal marketplace, Covered California will abide by the original decision to find non-compliant health insurance plans to fail to meet the standard for coverage criteria as originally decided, that is, as of December 31. You can read that press release here. In yet another press release today, a detailed report of enrollments since October 1 has been published. This report supplies not only week to week figures since October 1, but informative breakdowns by subsidy eligibility status, language use for enrollment, and enrollment by geographical area and insurance provider within the state. The uptick in enrollment numbers across the past couple of weeks suggest that inquiries at libraries will also be increasing. Especially with the news that non-compliant plans will not meet the state standard, it may well be time to evaluate your library’s approach to disseminating information about the law and consider active partnerships to address community enrollment needs.

All of this newsbreaking serves as a reminder that California libraries must ensure that they keep abreast of authoritative breaking news from the state’s health insurance exchange. Who on staff is monitoring Covered California’s Twitter feed? How is news that comes via emailed press releases distributed in a timely manner to staff so that the public can be correctly informed? Has your library’s homepage included a link to Covered California’s News feed?