By Ferd H. and Cheryl C. Mitchell
During 2014, a variety of administrative issues will face those groups and individuals charged with getting the Affordable Care Act (ACA) “up and running.”
From a positive perspective, as more individuals become aware of the improved health insurance coverage to be provided by “Qualified Health Plans (QHPs),” there will be an increasing opportunity to “spread the word.” Public administrators and private managers are both being given new opportunities for verbal and written networking—to point out how QHP insurance coverage has replaced earlier plans with marginal and restrictive coverage.
There is also an opportunity for administrators to promote the fact that, under the ACA, pre-existing conditions cannot be used to deny coverage.
The availability of better insurance coverage—that is available to all citizens and legal residents, often with subsidies—can serve as the foundation for efforts to encourage more individuals to enroll and obtain protection.
Even young adults can be encouraged to sign up, if advocates can prepare reasonable explanations of how health insurance fits into the real-world circumstances of those who are only beginning to build lives and careers. The multiple demands on young adults must be recognized if the purchase of health insurance is to be put forward as being of sufficient value to make compromises elsewhere. It is difficult for people of all ages to evaluate the value of protection against events that are of low probability, but can have a large impact on life when they occur.
However, on a negative note, enrollees in health plans may develop complaints over the limited number of policies available due to insurance-company caution; narrow provider networks that can limit choice; and substantial deductibles that can lead to major out-of-pocket expenses when care is needed.
Administrators will need to deal with such challenges openly and directly. One strategy may be to help individuals understand why the positive features of the ACA are available only because of these negative aspects of the Act.
In some situations, and in some states, it may also be important for administrators to explain the options available under the new “adult” category introduced for Medicaid, for individuals with income under 138 percent of the Federal Poverty Level (FPL). Both older and younger individuals may find this to be an important message.
There are also some other difficult issues for administrators to face with respect to the ACA.
The Health Care System is now more complex, with expanded linkages among governmental agencies, providers, employers and individuals. Many individuals may experience “social pain” when trying to cope with these linkages, and administrators may have to look for ways to reduce this pain and improve coping skills. Classes in “how to get care under the ACA” may have a place.
There may also be significant “reality conflicts” between advocates for the ACA and young adults who are living in a very different world, trying to build lives and careers under financial pressures. Administrators will need to explore ways to bridge into this “reality space,” to make the case that limited resources should be used for health insurance instead of for other pressing demands, and that coverage through the ACA can help improve overall “life plans.”
Finally, many individuals may react to the ACA with some alienation due to the regimentation associated with the Act. Standard forms and procedures often seem to be impersonal and unpleasant intrusions on the feeling of personal “self-identity.”
It may be difficult for administrators to help individuals learn to make use of the best features of the ACA. Support will be needed to help potential applicants deal with long and complex forms and with ACA sign-up and service procedures that seem burdensome.
This is installment #16 in the “Affordable Care Act and Public Administration” series.
Previous installments of this series have considered impact of the ACA on the field of public administration from a variety of perspectives. Refer to the archived postings for this blog to review all of these installments and obtain an overview of the combined commentary. (Or search for “health care”, “ACA” or “Mitchell” in the search box somewhat below the top of the home page).
More on these and related ACA topics, including coverage of how organizational reactions affect implementation efforts, may be found in a recent book by the authors that describes evolution of the ACA, and in a new Practice Guide by the authors that addresses funding and access issues in health care.