Low Income Consumers Give Their Take on Reducing Health Care Costs

The California Healthcare foundation (CHFC) asked consumers what are the most acceptable ways to reduce harmful and wasteful medical care. They interviewed lower- to middle-income health plan members from Covered California and CalPERS and people with Medi-Cal. Participants got background information about the overuse of three common medical services — antibiotics for adult bronchitis, c-sections for first-time normal deliveries, and MRIs for common low back pain. These are their reactions:

  • 57% support oversight of physicians. This approach would change physician behavior through external approval, internal monitoring, or stricter rules about when the intervention will be covered.
  • 21% support patient cost sharing. A minority say that the patients should pay a higher copayment or pay the extra cost of care if they insist on an ineffective medical intervention.
  • 13% support physician payments to encourage appropriate and cost-effective care. A much smaller percentage support penalties or nonpayment to physicians.
  • 9% support taking no action. Fewer than one in 10 agree with leaving the decision entirely to individual doctors and patients.

Fresh Data on ACA Show the Effects of Health Reform

The uninsured rate reached a new low in the first full year of the ACA health insurance marketplace operation. A smaller share of Californians delayed or skipped necessary medical care, according to a survey by the California HealthCare Foundation (CHFC). The survey also found the following:

  • The number of uninsured Californians under 65 dropped 12%, falling from 16% of the population in 2013 to 14% in 2014, a new low.
  • Notable decreases in uninsured rates were found among people living below 138% of the federal poverty level and among African Americans.
  • The share of the population age 18 to 64 enrolled in Medi-Cal rose by 52%.
  • The share of uninsured Californians reporting cost as the reason for lacking coverage dropped from 53% to 43%, although lack of affordability remains the most common reason cited for going without insurance.
  • Most non-elderly adults who went without necessary care said it was because they couldn’t get an appointment.
  • In certain regions, such as Northern/Sierra counties, more people had a hard time finding primary care physicians and specialists who accept new patients or their insurance than in 2013.

Consumers Face Obstacles in Understanding Prescription Coverage

Consumers Face Obstacles in Understanding Prescription Coverage
Consumers find it frustrating and time consuming to get information about their prescription drug benefits, according to a report by the California HealthCare Foundation (CHFC). CHFC surveyed consumers as well as agents and enrollment counselors. Publicly posted formularies are hard to navigate. They often feature arcane terminology, provide incomplete and inaccurate information, and are not available in languages other than English.

Many consumers don’t think of checking whether their medications are covered before selecting a health plan. But those who seek this information have a hard time finding it. Participants say that prescription benefit information is not prominent on plan websites or on the Covered California website. Many participants say that it took multiple clicks to locate a company’s formulary, if they were able to find it. Most were unable to find all the information they wanted, and resorted to calling each plan under consideration to check whether their drugs were covered and get details on their financial responsibility.

In general, consumers are not familiar with many of the terms used routinely in prescription benefit information, such as “formulary,” “prescription drug tier,” “co-insurance,” and “preferred drug” versus “non-preferred” drug. Consumers want materials that are written in more common, accessible language. The following are more key findings:

  • Consumers have little awareness of how to request medications that are not on a plan’s formulary.
  • When shopping for health insurance, drug benefits take a backseat. Consumers base their health plan choices on monthly premiums, physician access, and out-of-pocket costs, such as deductibles and copays for physician office visits.
  • Consumers have often assumed that their drugs would be covered so they didn’t double-check their availability or potential cost.
  • Neither agents nor counselors routinely help clients conduct drug benefit searches. Agents in the study say that it is too time-consuming to be profitable while counselors say they have limited familiarity with the process.
  • Study participants reviewed online formulary search tools. The Colorado Health Plan Finder tool is well-received among consumers and agents because it offers filters to refine plan options. Shoppers can view only plans that cover their drugs. It also displays the copays. Participants said that it allowed them to figure out what they would be spending monthly on prescriptions.
  • Information throughout the Covered California website was consolidated into a table to clarify relationships among prescription coverage and metal tier options. Agents say that having the information presented this way is useful when explaining drug costs to clients. Consumers are split on whether they could understand all elements of the table.

Respondents offered the following suggestions:

  •  Have an online tool with drug cost and coverage information, by plan. An interactive Internet formulary search tool would allow consumers to input drug names. Results would include details, such as cost and tier placement for each plan.
  •  Health plan websites should consolidate drug benefit information under a clearly labeled tab that’s easy to find with a minimum number of clicks.
  • A formulary should specify whether it is for individual or group plans or those included or excluded from Covered California.
  • Consumer education should address the differences among formulary designs. There should be particular attention to educating consumers on how to appeal medication denials and seek redress of other prescription drug coverage issues. Enrollment counselors want additional education on prescription benefits.
  • Use the term “prescription drug list” instead of “formulary.”
  • Drug categories should include understandable terms like “high blood pressure” instead of “hypertension.” Other suggestions are to standardize formulary terms and abbreviations to make comparisons less confusing.
  • Display copay information with tier placement, the cost of monthly prescriptions, the difference between branded drugs and generics, information on step therapy, the appeals process, and a list of pharmacies.

Drug Benefits Vary Greatly in Covered California Plans

In 2014, prescription drug benefits varied greatly among the health plans offered through Covered California. There were also differences in coverage among these plans and California’s most common employer-based health plans. In a project supported by California HealthCare Foundation (CHFC), Avalere Health compared Covered California plans to one another and to employer-sponsored insurance. Researchers examined 2014 pharmacy benefits and how easily consumers could compare their options. The report finds the following:

  • Covered California plans provided affordable, comprehensive access to the most commonly used medications for consumers with relatively limited drug needs.
  • Compared to selected employer plans, the plans offered through Covered California were more aggressive in managing prescription drug use through administrative controls, such as prior authorization and step therapy, a requirement that a less expensive drug be tried before a costlier alternative is approved.
  • Researchers examined drugs used to treat five categories of chronic conditions that rely on medication management — HIV/AIDS, mental health, immunology, asthma/COPD, and diabetes. Formulary coverage, utilization management, and tier placement varied by plan and drug class.
  • Comprehensive information on drug coverage and out-of-pocket costs was hard to find, which could hinder consumers who try to make informed purchasing decisions.

Twitter Reveals Public Reaction to the Exchanges

When it came to top Twitter hashtags last month, Obamacare was right up there with iPhone launch, MLB World Series, Justin Bieber, and The Voice. In fact, Obamacare was among the most tweeted topics in October 2013. Over 13.2 million tweets were related to Obamacare in this first month of pre-enrollment.

The California HealthCare Foundation (CHFC) looked at Twitter to get a read on how public is reacting to the rollout of the federal and state health insurance marketplaces. In the days before federal exchange (HealthCare.gov) launched, tweets containing a link to HealthCare.gov trended positively, with a score of 74/100. But the sentiment dipped significantly to 29/100 five days after the launch, after tens of thousands of people had tried to access HealthCare.gov.

A positive spike occurred on October 20 the day before President Obama’s Rose Garden speech. But the conversation quickly turned negative the next day. The volume of tweets containing search terms related to Obamacare and HealthCare.gov increased as a result of the Rose Garden speech: from 78,012 tweets within 24 hours before the speech; to 35,436 tweets during the hour of the speech itself; and then doubling to 185,184 tweets in the 24 hours after the speech.

Tweets about state-based exchanges were more positive than tweets about the federal exchange. The sentiment score of tweets containing a link to HealthCare.gov was 44 points lower than tweets containing links to the 17 state-based exchange sites combined. Since October 1, the state-based exchange sites had a positive sentiment score of 70/100. Conversely, HealthCare.gov had a negative sentiment score during this period of 26/100.
These five celebrities who were most frequently retweeted when they used #getcovered, the hashtag used by Enroll America and the White House:
Lady Gaga (40 million followers, 14.9K retweets)
Nina Dobrev (4 million followers, 1.4K retweets)
Pharrell Williams (2 million followers, 1.3K retweets)
John Legend (4 million followers, 982 retweets)
Emily VanCamp (320K followers, 499 retweets)

On October 22, the Colorado Consumer Health Initiative (CCHI) launched an irreverent spoof on the “Got Milk?” ads. Its “Got Insurance?” campaign’s message is now popularly known as “Brosurance,” a term used in one of the ads. The campaign, which was aimed at the young invincible demographic,  promoted the hashtag #GotInsurance and the website doyougotinsurance.com. Although #GotInsurance was the promoted hashtag, #brosurance began to dominate the conversation after October 22, and accelerated again when it was raised during HHS Secretary Sebelius’ Congressional testimony on October 30. For more information, visit http://www.chcf.org/programs/healthreform/aca140/october#ixzz2jt6fYDtm

Last Updated 05/25/2022

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