State health insurance “exchanges” are supposed to offer consumers and small businesses quality, affordable health coverage beginning in 2014. But, as these exchanges are being developed, how can we guard against the introduction of policies that would restrict reproductive health coverage, discriminate against LGBTQ people, poorly serve immigrants or fail to adequately address health disparities?
To make this job easier for all of our reproductive justice and health reform colleagues out in the states, Raising Women’s Voices and the National Health Law Program (NHeLP) have partnered to produce a “watch list” of key exchange development issues, policy decisions and procedures. We benefitted from the suggestions of RWV regional coordinators who have been grappling with exchange development issues in their states, and from some of our colleagues at national organizations working on health policy for women, people of color, immigrants, LGBTQ people, low-income communities and people facing end-of-life care decisions.
So, what should you be watching and seeking to influence as a health exchange is created and developed in your state? Here are key categories in our “watch list” for state advocates:
- Exchange Leadership: Who will be making the decisions about your exchange’s policies? How do we guard against undue influence by insurance company representatives and people promoting anti-choice, anti-gay, anti-reform and other regressive policies?
- Governance: Will your exchange operate in a transparent way and engage the public?
- Consumer Assistance: Will a diverse array of consumers really get the help they need in choosing health coverage that meets their needs and fits their budgets?
- Provider Network Adequacy: Will the health plans offered in your state exchange include enough reproductive health providers, community health centers, providers who can serve LGBTQ people and providers who speak languages other than English?
- Coverage Benefits: Which reproductive health services will be covered? Will coverage work to reduce health disparities?
- Refusals/Restrictions: What demands are you likely to encounter that providers, insurers and even people enrolling in plans be allowed to refuse to provide or pay for services that conflict with their moral or religious beliefs?
- Effects on Providers: How will family planning providers accommodate an anticipated increase in patients seeking care? Will provider reimbursements be sufficient?
Yes, we know that not all states are moving forward rapidly in creating state exchanges, and some are outright resisting doing so – essentially betting that health reform will be repealed by a new Congress or struck down by the Supreme Court. But 11 states already have officially created exchanges and more will be moving to do so in 2012. State officials are being spurred by the availability of federal exchange development grants and by worries that they might be caught unprepared and have to let the federal government run their exchange.
Need more advice on anything we’ve covered in this “watch list”? Want to offer a suggestion or an example of how you have handled one of these issues in your state? Contact us at firstname.lastname@example.org.