There’s NOT an app for that – but there probably should be.

California has until 2014 to create a system for enrolling its 4.7 million uninsured and underinsured citizens who are eligible for new benefits under the federal Affordable Healthcare Act. The state’s powerful Health Benefit Exchange Board is working to create a web portal with some ambitious goals: allowing Californians to check their healthcare eligibility, compare cost options, and enroll in an insurance plan, all in real time over the Internet.

But there’s a problem.

“We’ve been looking at the digital divide for some years now,” said Carla Saporta, health policy director at the  Greenlining Institute. “Digital inequality is affecting communities of color in that they don’t have the same access to broadband at home as other communities.”

According to a new report from the Greenlining Institute, many of the people the Health Exchange is trying to reach get Internet access only through smart phones.

In fact, the proportion of people who connect only through smart phones is highest among a key set of demographics the healthcare law is trying to bring into the system  — younger people and communities of color.

And reaching this group may be crucial to the program’s success, due to another of their key characteristics: They’re healthy.

The Health Benefit Exchange works by pooling consumers together, creating the kind of negotiating leverage enjoyed by corporations and agencies like CalPERS. But having a good number of healthy individuals participating will also play a role in keeping the costs of insurance down.

Unfortunately the cell phone-government program relationship is largely uncharted territory. Examples of public health campaigns using text messages for educating and reminding patients exist, though many are too new to gauge their success.

On the bright side: Text4baby, the nation’s first free, cell phone-driven health-education program launched in 2010, is turning out positive results.

Preliminary research released this month revealed the program helped these women remember critical appointments, inform them of warning signs, and engage their doctors. Its success has green lighted other messaging services targeting diabetes prevention and quitting smoking, and the creation of an HHS task force, text4health.

Even in this nascent stage, the importance of mobile devices for public health campaigns is gaining wide recognition, including within the national design effort behind the health exchange.

The project, known as User Experience 2014 (UX2014), is a public/private partnership of federal agencies, states, healthcare providers, insurance companies, and the design firm IDEO (known, amongst other impressive feats, for designing the first mouse for MAC).

UX2014 has undertaken extensive consumer research, actually visiting people in their homes in several states, and designing a simple and inclusive system for states, to be released in spring 2012.

A list of mobile features in the works include applications locating nearby assistance, tracking status of enrollment, or sending reminders to renew insurance and complete payments.
A particularly neat design would allow someone to use their phone’s camera to upload missing documents, like wage stubs, into the system.

But actual enrollment through a smart phone application may not be on the table because of limits within the Affordable Healthcare Act itself.

The federal law requires a uniform enrollment process across all platforms: online, mail, over the phone, or in person.

“We think mobile is really important because there has been a huge penetration of the use of cell phones and smart phones,” said Sam Karp, VP of Programs at the California Healthcare Foundation on the design side of the project, “But we don’t see a smart phone as having a large enough display for doing the complete application.”

But enrollment is also only half the battle, and not even the first half.

As noted by Saporta, “Outreach and education needs to start yesterday. Just because you build a system, doesn’t mean people are going to utilize it.”

Issues that affect our lives don’t happen in a vacuum. Everything affects everything else, and there’s no area where that’s truer than health and access to care. So I’m going to take a slight detour from the financial and economic issues I write about most of the time to say a bit about the Affordable Care Act, which marks a historic expansion of access to health care.

Thanks to the law, an estimated 32 million previously uninsured Americans will be able to purchase health insurance in 2014. But right now there are real questions about whether this historic expansion of coverage will reach those Americans who need it most.

My colleagues on The Greenlining Institute’s health team have been looking into this, and just published their findings in the form of a new report. They focused on the new Health Benefit Exchanges, which will allow consumers to compare the price, quality, and benefits of competing health insurance plans. Maybe most important, Americans will be able to purchase coverage through their state’s Exchange with federal subsidies that will help low and middle-income families cover the cost.

The bottom line is that getting the word out about these new options may be more complicated than it seems, and state Exchanges should get communities involved in the process sooner rather than later.

Current plans call for Web portals to serve as the main route through which consumers will access the Exchanges, but these websites won’t be able to do the job by themselves. States will need to pursue a variety of outreach and enrollment strategies, strategies that must be based on the populations they must reach.

Nationally, roughly one-third of currently uninsured individuals who would qualify for Exchange subsidies are between ages 18 and 29, and one in three are Latino. Both of these figures are far greater than for the population as a whole. In some places, such as my home state of California, the proportions will be even greater. Most Californians newly eligible for health insurance through the Exchange will be from communities of color, many living in households where English is not the primary language.

These demographics present some challenges.

It may seem counter-intuitive, but young people, and particularly young people of color, may have a difficult time enrolling online. For one thing, communities of color have less reliable Internet access than whites. Only 49% of Latino homes have broadband access compared to 59% of black households and 69% of white households. Research by the Public Policy Institute of California found that Asian American, African American and Latino households were markedly less likely than whites to use the Internet to access government services.

Getting healthy young adults into the expanded health insurance pool is critical to making the whole system work. And young people, and particularly young people of color, are more likely than other groups to use smartphones rather than computers to access the Internet. Nationally, 40% of smartphone owners ages 18-29 use their phone as their primary Internet access point, while 38% of black and Latino smartphone owners access the Internet primarily through their phone.

But mobile devices may not sync well with Exchange web portals, presenting an additional barrier to access for many uninsured Americans. Removing that hurdle is vital, and likely will require specialized apps designed for use with iPhones, Blackberries and Android phones.

But that’s just the beginning. The state Exchanges will need to use a variety of tools to reach the people they need to enroll, including social networking sites, kiosks in key public places, and telephone and in-person assistance in a variety of languages.

It’s important to remember that the above ideas aren’t a laundry list of items that officials can just check off one by one. Each state is different, with varying demographic, geographic and cultural characteristics. Each state Exchange will have to figure out a strategy that works for their communities, and that means reaching out to those communities and listening to what they have to say.

With full implementation of the Affordable Care Act just a little over a year away, the time to start that listening process is now.

Maria Sencion has been feeling dizzy. Not all the time, but for a few minutes each week — just enough to make her wonder if she should see a doctor.

With that nagging worry in the back of her mind, the 47-year-old mother of four went on Saturday to the healthcare enrollment fair staged by Building Health Communities South Los Angeles.

Inside the Fremont High School gymnasium, orange-shirted volunteers offered guidance on the type of health insurance available to Sencion, her husband and three of her children, none of whom currently has coverage.

Sencion was one of roughly 70 who showed up at the event, staged to inform residents about the patchwork of healthcare programs provided by the county, the state and the Affordable Care Act, President Obama‘s healthcare reform law. That tepid response discouraged organizers, who said South Los Angeles has more than 231,000 uninsured.

Coordinators of the health fair had 150 breakfasts, 200 lunches and 300 bags of healthful groceries available to attendees. Had the event been focused on finding employment, or addressing an urgent crime issue, it probably would have attracted a larger number of people from the neighborhood, said Sonya Vasquez, policy director for Community Health Councils, which advocates for expanded coverage.

“Even though they know healthcare is important, they don’t always understand how to talk about it, or the importance of talking about it,” said Vasquez, whose group participates in the South L.A. initiative.

Vasquez said federal healthcare reform is designed to ultimately streamline the array of programs available to the public, particularly those with low incomes. Under the current arrangement, insurance programs for California children don’t necessarily apply to their parents. Coverage available at the county level isn’t always provided by the state.

State officials created a temporary program for residents with preexisting conditions, such as asthma, until a similar measure takes effect under the federal healthcare law in 2014. Illegal immigrants, who make up more than 40% of the uninsured in South L.A, aren’t covered under Obama’s healthcare initiative, Vasquez said.

Of those who did show up, one man hoped to find healthcare coverage for his 45-year-old brother, who just got out of prison and is out of work. An unemployed woman in her 60s wanted information on treatment for diabetes but said she had little money to contribute toward her coverage.

Tanesiha Johnson, 39, took in a two-hour PowerPoint presentation from the Greenlining Institute, looking for insurance information that could help her 22-year-old daughter, who she said is in dire need of dental work, and her 17-year-old daughter, who is pregnant. Johnson has health insurance but wasn’t aware that the new federal law allows her children to remain on her policy until they are 26.

“That makes me feel a lot better,” she said.

Building Healthy Communities is a creation of the California Endowment, which is focusing on South L.A. and 13 other communities around the state. The California Endowment is working with a number of other nonprofits to look at the way public safety, insurance coverage, development decisions and other issues make a section of South L.A. healthy or unhealthy.

Tamu Jones, a program manager with the California Endowment, voiced hope that future events for the South L.A. initiative would draw more participants. “As we build relationships with this community over time, our ability to connect will increase,” she said.

Despite the light turnout, Saturday’s event was a success for Maria Alvarado, a 48-year-old parent volunteer at Fremont High School. Alvarado said her family, which lacks insurance, spent more than $2,200 on medical care two years ago after her youngest son was bitten by a snake while camping.

After a consultation with volunteers, Alvarado found state coverage for her two youngest sons, as well as a separate program for herself. In Spanish, she said she planned to get her paperwork together so that she can schedule a doctor’s appointment.

“It’s been two years since I’ve had a checkup,” she said.

4.7 million uninsured or underinsured Californians are expected to become eligible for healthcare under the Affordable Care Act (ACA). And according to a report published by the Greenlining Institute today, most of the newly eligible will be from communities of color.
However, without an effective outreach campaign catered to the needs of ethnic communities, the benefits of the ACA may not reach those most in need.

The report, “How to Ensure the Health Benefit Exchange Reaches all Californians,” outlines the challenges inherent to enrolling people of color in the Health Benefit Exchange (Exchange), a virtual marketplace where consumers will be able to compare the benefits, costs, and services of one insurance option to another. The intention is to, “reduce costs by pooling consumers together in order to increase market leverage.”

The Exchange will take effect in January of 2014.

However, the primary access point for this resource will be online – a cause for concern because access to Internet is less prevalent amongst communities of color.

According to the Public Policy Institute of California, 81 percent of whites have broadband access at home, as opposed to 76 percent of Asians, 74 percent of Blacks, and only 55 percent of Latinos. Additionally, only 35 percent of Latinos and 39 percent of Blacks use the Internet to access government resources, as opposed to 64 percent of whites.

The disparity in access to digital technology makes the need for customized outreach to communities of color that much more urgent. This is especially critical because according to the UCLA Center for Health Policy Research, 57 percent of those who benefit from the Exchange will be from communities of color.

One of the Greenlining Institute’s suggestions to the Exchange board involves the use of smartphones.

Arguing that smartphones are, “the primary means of Internet access for 38 percent of African Americans and Hispanics,” the report suggests that the Exchange board conduct outreach through text messaging, with reminders for users to renew their insurance, complete their applications, or make payments.

But while smartphone campaigns may reach young people of color, elders and immigrants must be reached out to as well.

Carla Saporta, Health Policy Director at Greenlining and co-author of the report, emphasized the importance of involving ethnic media in outreach. “The Exchange needs to utilize community based organizations,” she said.

Another responsibility of the Exchange board is to establish a “navigator” program, to conduct outreach and provide information to consumers. Saporta spoke of the need to include established community members in this program: “We need to hear from the community [because] at this point community voice is not really [being] heard.”

Anthony Wright, Executive Director at Health Access, commented on the importance of the Greenlining report: “It’s important to take lessons from previous efforts. If this is going to work in California, it’s got to work for the diversity in California.”

The report is being sent to the Exchange board and other policy makers in California. Saporta will also be presenting Greenlining Institute’s findings on Friday and Saturday to the National Association of Insurance Commissioners.

“At this point, the Exchange board has been slow to want to do any type of outreach and education in the community,” said Saporta. “We needed to start doing this outreach yesterday.”

Recent healthcare reforms could leave millions of Californians behind unless the state’s new Health Benefit Exchange board moves aggressively to reach them, according to a new report from a Berekely-based advocacy group.

The Greenlining Institute, which advocates for communities of color and other disadvantaged groups, will present its report to the National Association of Insurance Commissioners’ fall meeting on Friday in National Harbor, Md., just outside of Washington, D.C.

“The Health Benefit Exchange simply can’t operate on the principle of, ‘If you build it, they will come,’” said report co-author Carla Saporta, Greenlining’s health policy director. “If the populations most in need don’t know about it, they won’t come. Putting up a website where people can enroll is a good start, but the Exchange must reach people where they are – whether that’s in community centers or on their smartphones.”

Among the report’s key findings are that most of the 4.7 million Californians newly eligible for health insurance will be from communities of color, and many live in households where English is not the primary language. People of color and low-income communities are less likely to have Internet access, less likely to use the Internet to connect to government services, and more likely to use smartphones rather than computers as their primary online access.

The report says smartphone and social networking site usage is particularly prevalent among adults aged 18-29, which is exactly the young and healthy population whose enrollment is critical to successful implementation of the exchange. So, the Exchange must use a variety of strategies to reach these populations, including smartphone apps, kiosks in key public sites, and telephone and in-person assistance in a variety of languages, the report says.

Populations most in need of health insurance — and critical to successful implementation of the Affordable Care Act — could be left out unless California’s Health Benefit exchange board moves aggressively to reach them, according to a report released by The Greenlining Institute.

“The Health Benefit Exchange simply can’t operate on the principle of, ‘If you build it, they will come,’ ” said report co-author Carla Saporta, Greenlining Institute Health Policy Director.

The report finds that 4.7 million Californians newly eligible for health insurance will be from communities of color, and many live in households where English is not the primary language. It also finds that people of color and low-income communities are less likely to have Internet access, and more likely to use smartphones rather than computers as they primary online access.

Health Benefit Exchange Board Must Aggressively Target Underserved Communities

BERKELEY, CALIFORNIA – Populations most in need of health insurance and critical to successful implementation of the Affordable Care Act could be left behind unless California’s Health Benefit Exchange board moves aggressively to reach them, The Greenlining Institute argues in a report to be released this Thursday and presented at the National Association of Insurance Commissioners’ fall meeting on Friday.

“The Health Benefit Exchange simply can’t operate on the principle of, ‘If you build it, they will come,’” said report co-author Carla Saporta, Greenlining Institute Health Policy Director. “If the populations most in need don’t know about it, they won’t come. Putting up a website where people can enroll is a good start, but the Exchange must reach people where they are – whether that’s in community centers or on their smartphones.”

iHealth: How to Ensure the Health Benefit Exchange Reaches all Californians, can be previewed online here. Key findings include:

• Most of the 4.7 million Californians newly eligible for health insurance will be from communities of color, and many live in households where English is not the primary language.
• People of color and low-income communities are less likely to have Internet access, less likely to use the Internet to connect to government services, and more likely to use smartphones rather than computers as their primary online access.
• Smartphone and social networking site usage is particularly prevalent among adults aged 18-29, the young and healthy population whose enrollment is critical to successful implementation of the Exchange.
• The Exchange must use a variety of strategies to reach these populations, including smartphone apps, kiosks in key public sites, and telephone and in-person assistance in a variety of languages.

The implementation of federal health care reform – officially known as the Patient Protection and Affordable Care Act, or ACA for short – is underway. This represents a huge opportunity for communities of color, who are disproportionately uninsured – but only if we get it right.

The ACA is expected to make it possible for two thirds of California’s seven million uninsured to obtain health insurance. The majority of these newly eligible for insurance will be people of color, who right now are disproportionately lacking in coverage: Compared to white Californians, Asian Americans are 40 percent more likely to be uninsured, African Americans are 70 percent more likely to be uninsured, and Latinos are nearly three times as likely to be uninsured.

It’s critical that everyone in our communities understand the new options that will be available, and that those implementing these reforms in California aggressively reach out to all who need access to coverage.

Some of this new coverage will be accomplished by expanding Medi-Cal, and some will be through a new system of tax credits to encourage small businesses to provide health insurance for their workers. Those who can’t obtain health insurance through one of those channels – potentially millions of Californians – will be able to get coverage through the newly created Health Benefit Exchange.

The Exchange will be a competitive, transparent marketplace where consumers have the opportunity to compare the benefits, costs, and services of various insurance options.The Exchange is intended to reduce costs by pooling consumers together in order to increase their market leverage, pool risk, and increase efficiency – in short, to give individual consumers the same advantages that very large companies have when purchasing health coverage for their workers. In addition, the federal government will use the Exchange to provide subsidies to help make insurance affordable for those who haven’t been able to handle the cost.

California, in keeping with our state’s forward-looking tradition, was the first to start setting up its Exchange. A board has been selected, and that board has begun laying the groundwork to put this new marketplace in operation by its scheduled start date of 2014. Decisions the Exchange board makes in the coming months will be crucial to ensuring that all of our state’s communities know about the Exchange and are able to take advantage of these new health coverage options.

And that’s where we – and you – come in. At The Greenlining Institute, we’re worried that communities of color do not have a very strong voice in the process of implementing the ACA, including the Health Benefit Exchange, in California. Unfortunately, the board does not represent the diversity of our population, and many in our communities don’t even know it exists. While there will be some opportunities for input during the implementation process, those opportunities will be limited, so we need to make the most of them.

To do that, we need your help. We want to develop a set of ideas to present to the board and other policymakers to ensure that the ACA implementation process includes and involves all racial and ethnic communities.  To help develop this agenda, we are collaborating with community partners in 6 regions of California (Orange County, greater Los Angeles, the San Joaquin Valley, the Inland Empire, South Sacramento and San Diego) to hold town hall forums in each of these regions.

These forums aim to both provide information about the ACA and to hear concerns and ideas from the community: What challenges do you face in obtaining or providing health insurance? What do you need from the Exchange to make this new program work for you?

We plan to take what we learn at these meetings and put the information into a briefing paper for policymakers. We will also hold a legislative briefing in Sacramento to ensure our concerns reach state legislators and their staffs.

The first town hall will be October 24 in Santa Ana. Then in early November we’ll go to south Los Angeles and the east Coachella Valley, followed by several other locations later in the month.

Whether or not you can come to a meeting, we need your input. To share your thoughts or get information about ACA implementation and the town hall forums, email Carla Saporta at carlas@greenlining.org. Let’s make the most of this opportunity to improve the health of our communities.

Imagine walking into your corner drugstore to pick up aspirin, toothpaste and individual health insurance.

That day might not be so far away. Walgreens reportedly may enter the health insurance marketplace this fall, selling a variety of health plans at a variety of price points, although the company has not confirmed such reports.

Walgreens’ possible entrance into the health insurance market is a result of a health care reform legislation mandate that will establish health insurance exchanges to offer coverage options. The exchanges must be in place by Jan. 1, 2014.

If your employer doesn’t offer health insurance, you’ll be able to buy it directly for you and your family through an exchange. And if you’re a small business owner, the exchanges are designed to give you a broader choice of health plans, at a lower price.

Companies such as retailers, financial services providers and others may now consider jumping into the health insurance business.

Ankeny Minoux, president of the nonprofit Foundation for Health Coverage Education, speculates that companies are holding off making announcements about plans to enter the health insurance arena because the formal rules under which they would operate haven’t been established yet.

Health insurance exchange rules

Under health reform guidelines, each state will be able to establish its own health insurance exchanges, or have the federal government do it for them.

Consumers will see some big changes when the exchanges roll out. One of them is that insurers won’t be able to deny you coverage if you have a pre-existing condition.

That means people with a pre-existing condition “can shop the market and not just the high-risk [insurance] pool,” Minoux says.

Another benefit will be tax credits to help you pay for insurance if your income is between 100 percent and 400 percent of the federal poverty line.

50 sets of rules

Because each state can set up its own exchange, it has certain powers to decide what it wants its exchange to look like, says Carla Saporta, health policy director at the Greenlining Institute, a public policy research and advocacy organization.

Companies that decide to sell health insurance nationwide theoretically could face 50 different sets of rules.

Saporta is based in California, which was the first state to adopt legislation creating a health exchange. Its board members are negotiating with health insurance providers “to keep costs down for consumers,” she says.

The California exchange also will set up a website to provide consumers with comparison information on health plan options.

Jeff Gitlin, principal of PwC’s U.S. health care payer practice, says insurers that participate in the exchanges must be consumer-friendly, because many insurance companies are accustomed to selling their plans to businesses rather than individuals.

Education is going to be crucial to make consumers “better informed decision-makers,” Gitlin says.

Consumer Advocates Applaud Critical Protection for Small Businesses, Individuals

AB 52, which would allow state regulators to reject excessive health insurance rate increases, passed the Senate Health Committee today by a vote of 5 to 3.

The support of Sen. Ed Hernandez (D- West Covina) was considered crucial by the bill’s supporters.

“We appreciate Senator Hernandez’s commitment to working with us to create a bill that establishes much needed consumer protections, and look forward to working with him to pass a strong bill that protects Californians from excessive rate increases,” said Carla Saporta, health program director at The Greenlining Institute. “California health insurance premiums have gone up at five times the overall inflation rate, bleeding consumers and small businesses dry. With AB 52, California will join 35 other states with this sort of common-sense protection against rate gouging.”

Introduced by Assemblymember Mike Feuer (D-Los Angeles) and supported by a wide variety of health, consumer and small business organizations, AB 52 would require health plans and insurers to seek approval from state regulators prior to raising premiums, copayments, or deductibles.  It would build upon newly-implemented federal and state law improving the health insurance rate filing and review process.

Groups endorsing AB 52 include Small Business Majority, the Asian Business Association, Black Business Association, Black Economic Council, California Hispanic Chamber of Commerce, California Black Chamber of Commerce, Latino Business Chamber of Greater Los Angeles, Council of Asian American Business Associations, American Diabetes Association, Consumers Union and many others.