Engaging AAPIs in Ohio The Ohio Health Insurance Exchange & SHOP

1.Problems in health care today for AAPIs 2.What are the Exchange & SHOP*? 3.Benefits of an Exchange & SHOP for AAPIs 4.Making the Exchange & SHOP Work for AAPIs *Small Business Health Options Program

Problems in Health Care Today for AAPIs Vulnerable AAPIs ‘slip through the cracks’ of the health care system due to: Lack of insurance Underinsurance Health disparities

What are the Exchange & SHOP? The Exchange & SHOP will be “insurance supermarkets” for individuals and small businesses, respectively. They will have an easy-to-use website for comparison shopping of multiple health plans. The PPACA calls on each state to establish an Exchange & SHOP by 2014.

Benefits of an Exchange & SHOP If designed and operated ideally, the Exchange & SHOP would offer AAPIs greater and fairer access to health insurance through: Affordability Transparency Quality An Essential Health Benefits package in every plan sold in the Exchange/SHOP (Qualified Health Plan) Consumer advocacy and guidance Navigators from the communities they serve.

Benefits of an Exchange & SHOP Affordability Lower premiums, higher discounts Exchange & SHOP will also monitor premium increases Bargaining power of many individuals and small businesses

Benefits of an Exchange & SHOP Affordability Tax credits to help buy insurance for middle-class consumers [family of 4 earning up to $90,000 in 2011] Co-pay & deductible assistance for eligible consumers.  Although unlikely to be eligible for Medicaid, legal permanent residents will qualify for tax credits to buy insurance in the Exchange  Would especially benefit low-income AAPI groups (Southeast Asians & NHPIs) Tax credits for small employers to help buy insurance Increase from 35% to 50% of insurance costs in 2014  The majority of AAPI-owned firms will qualify due to low numbers of employees

Benefits of an Exchange & SHOP Transparency Easy comparison of health plans for consumers Easy-to-understand, standardized language describing costs and benefits of all Qualified Health Plans (QHPs) Easy-to-use website built for comparison shopping

Benefits of an Exchange & SHOP Quality Essential Health Benefits package: every QHP sold in the Exchange/SHOP, regardless of price, will cover a standard set of benefits from 10 benefit categories. 1.ambulatory patient services 2.emergency services 3.hospitalization 4.maternity and newborn care 5.mental health and substance use disorder services* 6.prescription drugs 1.rehabilitative and habilitative services and devices 2.laboratory services 3.preventive and wellness services and chronic disease management* 4.pediatric services, including oral and vision care.

Benefits of an Exchange & SHOP Consumer Advocacy & Guidance The Exchange/SHOP will regulate participating insurers Prohibit unethical advertising Monitor and review premium increases Designated or certified “Navigators” Non-profit, third-party organizations Help consumers find, understand and enroll in the Exchange health plan which best suits their needs

Exchange & Shop Making it Work for AAPIs To maximally empower AAPIs, and all health care consumers, the Exchange & SHOP should be designed and operated along these principles: Run by Ohio Pro-consumer governing board Multilingual access Effective regulation

Exchange & SHOP: Making It Work for AAPIs Run by Ohio Ohio should establish and operate the Exchange/SHOP Avoid defaulting to a federal-level Exchange/SHOP unlikely to meet the needs of diverse AAPI groups in Ohio.  Including but not limited to the Burmese, Bhutanese, Hmong, Mon, Karen, and Nepalese refugee communities.

Exchange & SHOP: Making It Work for AAPIs Pro-Consumer Governing Board The board that designs and oversees the Exchange & SHOP must include Consumer, labor, and small business representatives alongside industry experts. An AAPI health expert among other minority health experts. A strong conflict of interest clause that excludes those with financial interests in health care. Hospitals Physicians Insurers Brokers … and any individuals or organizations who may profit from enrollment in a health plan

Exchange & SHOP: Making It Work for AAPIs Multilingual Access The Exchange & SHOP should be accessible to limited English proficient communities: Exchange website should have AAPI language support Navigators for AAPI ethnic groups Based in the communities they serve Ethnically diverse Culturally and linguistically competent

Exchange & SHOP: Making It Work for AAPIs Effective Regulation Ensure quality health plans in the Exchange & SHOP The Exchange/SHOP should be able to accept or reject health plans for sale based on price and quality  Advocacy example: to be sold in the Exchange, a health plan must help reduce health disparities by offering customer service in AAPI languages and covering prevention, treatment, and management of common AAPI conditions Bad example: Utah’s Exchange must accept all health plans Massachusetts: allows its Exchange to select bidding health insurers based on quality and value.

Key Takeaways 1.The Exchange & SHOP give all Ohioans greater control over their health care (easy-to-use, comparison shopping website). 2.The Exchange & SHOP can and should be designed to benefit AAPI health interests.

Sources “Asian Americans continued to suffer the most from long-term unemployment in 2011” (Economic Policy Institute) : asian-american-unemployment-update/ asian-american-unemployment-update/ “Better Health Insurance Options for Ohio” (Ohio Consumers for Health Coverage” “Essential Health Benefits Bulletin” (Center for Consumer Information and Insurance Oversight) Dec. 16, 2011 “Exchanges: Top Ten Priorities for Consumer Advocates” (Community Catalyst) “Summary of Coverage Provisions in the Patient Protection and Affordable Care Act” (Kaiser Family Foundation) “Summary of New Health Reform Law” (Kaiser Family Foundation” “Why We Need a Health Insurance Exchange” (Families USA) “The Health Care Law and You: What’s Changing and When”: