October 24, 2013
If you're not already insured, figuring out the best healthcare plan to buy before the January 2014 start date of the new insurance plans being offered under the Patient Protection and Affordable Care Act (known as the ACA or Obamacare) isn't easy. This is especially true given the ongoing technical problems with HealthCare.gov, the website designed to help people navigate the new marketplace of options.
But for people living with HIV/AIDS and other chronic health conditions, finding the optimal plan for their needs is a lot easier, thanks to a new assessment tool created by Clinical Professor Robert Greenwald and others at the Harvard Law School Center for Health Law & Policy Innovation, a longtime national leader in addressing the healthcare needs of low-income people.
"The feedback we're getting from all over the country is, 'Thank goodness you did this,'" says Greenwald, who has received a number of grants to train people and organizations across the country in how to use the Workbook. The Center is focusing especially on states that have chosen not to expand Medicaid, where comparing private insurance plans becomes even more pressing for low-income, uninsured people living with illness or disability.
The only guide of its kind, the Marketplace Health Plans Assessment Workbook is in particularly high demand by AIDS service organizations, benefits counselors, social workers, and others who work with and advise low-income people, especially since October 1, when enrollment opened for healthcare plans under Obamacare. At least 125,000 people living with HIV/AIDS currently have some of their medical care covered by so-called Ryan White programs but now will be eligible for broader care under Medicaid or subsidized private insurance plans.
While the ACA forbids discrimination by health insurance companies against people living with HIV/AIDS or any other health condition, different companies offer different plans in different states, and there is enormous variety in costs, services provided, and medicines covered. The Workbook, which in addition to HIV also considers healthcare needs related to mental illness, diabetes, and substance use disorders, removes much of the complexity and difficulty of comparing plans so that a person can choose the best option for his or her particular healthcare needs.
Six HLS students in the Center's Health Law and Policy Clinic are working on the project this semester, and will be traveling to Mississippi, Georgia, and other states to help AIDS organizations and others assess and compare the health plans in their region for what they offer. It's an excellent educational experience, says Katherine L. Record HSPH '12, a lawyer and senior clinical fellow in the Center's Health Law and Policy Clinic, and one of the leaders in developing the assessment tool. "They are getting great exposure to the bureaucratic mess we often deal with," she says. "It's good real-world experience for them."
Developed over the past year with input from partner organizations around the country, the Workbook was launched by Greenwald and his team in September at the US Conference on AIDS and the Southern REACH Conference on HIV. Greenwald and Record have also presented a webinar on the Workbook through www.hivhealthreform.org (a website they helped to create) that drew more than 500 participants from around the country. "We had a large audience and it went over well," says Record. "We had some great questions and helped to give advocates the confidence they will need to successfully navigate the health insurance marketplace."
Since the assessment tool requires specific information about any particular plan, it has already highlighted another issue: many plans fail to fully share what they do – and do not – cover. "There's not much transparency there," says Greenwald, and some companies may be offering less coverage for a health condition in one state than in another, a situation the Center will be closely monitoring. "We're going to use all of this information we are gathering by working with all these states to hold the government and insurers accountable," he says, "to make sure they are not discriminating against people with HIV or any other chronic health conditions."