Maintaining Reliable Provider Directories for Health Plan Shoppers

A new report by the California HealthCare Foundation examines how Colorado, Maryland, New York, and Washington overcame obstacles to develop well-functioning provider directories. The goal of the report is to inform California policymakers and stakeholders as they seek to improve consumer access to accurate provider network information. The following are key findings:

  • An environment for shared accountability can be fostered through incentives, policy alignment, and enforcement of regulatory and contractual requirements.
  • Uniform data standards and accompanying guidance ensures that data are usable, especially when they come from disparate sources.
  • Provider directories should engage and inform consumers with diverse language needs and educational levels as they enroll in coverage and seek care.

Reactions to Supreme Court Subsidy Ruling

The U.S. Supreme Court ruled that nationwide subsidies called for in the Affordable Care Act are legal. The following are reactions from stakeholders:

  • Patrick Burns, president of the California Association of Health Underwriters: The Supreme Court got it right. California has a state-based exchange (Covered California), so nothing will really change here, but the clarification was very important to residents in the 34 states that utilize the federally facilitated health insurance marketplace in some form…Our hope is that state and federal policymakers will now turn their attention on efforts to truly reduce the cost of providing health care, something that the ACA has not fully addressed. Lawmakers and regulators need to look at and improve the portions of our health care system that work well and keep a variety of health insurance product options available to all. The employer-based system has reliably and effectively delivered quality health coverage to generations of Americans. And we as a nation need to work to preserve it.
  • Covered California Executive Director Peter V. Lee: Although Covered California enrollees were not at risk of losing their subsidies as a result of the Supreme Court decision, a ruling invalidating subsidies offered through the federal health exchange could have resulted in changes to the federal law, which could have affected California…The subsidies have helped millions of Americans, including individuals I have met whose lives were saved as a result of the care they received. With the support of federal subsidies, the majority of consumers enrolled with Covered California pay less than $150 per month for their premiums, with many tens of thousands of consumers paying less than $10 per month for coverage.
  • California HealthCare Foundation president and CEO Dr. Sandra Hernández: We hope that this ruling will hasten the conclusion of the seemingly endless political debate about the law. After the ACA was enacted in 2010, California government and industry leaders had the foresight to swiftly establish Covered California. That was a wise decision not only because the exchange now has 1.3 million enrollees, but also because the state exchange insulated Californians from the financial and health risks posed by this legal challenge.
  • The American Academy of Actuaries Academy Senior Health Fellow Cori Uccello: The…ruling upholding…preserved an integral component of the Affordable Care Act and averted significant disruptions to the individual health insurance market. In the loss-of-subsidy scenario, adverse selection would have been a serious concern, as relatively higher-cost individuals would have retained coverage, increasing average costs and premiums. While the legal challenge to subsidies has been decided, the Academy urges policymakers to assess any proposals that may be offered to modify or replace the ACA against these important market reform principles.

Guide to Tracking ACA Implementation in California

The California HealthCare Foundation has created a guide to track progress toward the January 2014 launch of the central provisions of the Act. “With California hard at work creating new private and public insurance options, among other ACA requirements, this guide will help the public, members of the media, and stakeholders keep a close eye on implementation activities,” said Marian Mulkey, director of CHCF’s Health Reform and Public Programs Initiative. To get the guide, visit chfc.org.

Last Updated 01/19/2022

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