3/19/2013 The Affordable Care Act & Opportunity for Advancing Racial & Ethnic Health Equity Taking Vision and Promise to Reality Presenters : Dennis P. Andrulis, PhD, MPH, Senior Research Scientist Nadia J. Siddiqui, MPH, Senior Health Policy Analyst Maria R. Cooper, MA, Health Policy Analyst Texas Health Institute Lauren R. Jahnke, MPAff, Consultant LRJ Research & Consulting 8 th National Conference on Quality Healthcare for Culturally Diverse Populations March 7, 2013 | Oakland, California Funded by: W.K. Kellogg Foundation, The California Endowment, and Kaiser Permanente Community Benefit National Program Office Overview • ACA’s Vision, Promise, and Background • Design to Monitor ACA through an Equity Lens • Implementation Progress of Equity Provisions – Health Insurance Exchanges – Health Care Safety Net – Workforce Support and Diversity – Data, Research, and Quality – Public Health and Prevention • Where Do We Go from Here? 1
3/19/2013 ACA’s Vision and Promise • Working to eliminate health disparities and advance health equity is central to the Affordable Care Act (ACA) of 2010 • Over three dozen provisions directly advance racial and ethnic health equity, diversity, and cultural and linguistic competence • Dozens of other general provisions with major implications for racially and ethnically diverse populations History & Scope of Work • Obama vs. McCain Health Care Proposal Analysis 2008 • House & Senate Health Reform Bills Analysis • Joint Center Report: Advancing Health Equity for • Joint Center Report: Advancing Health Equity for Racially and Ethnically Diverse Populations Racially and Ethnically Diverse Populations 2010 • Federal agency progress on ACA & Equity • Federal agency progress on ACA & Equity • Health Affairs article on ACA & Safety Net • Health Affairs article on ACA & Safety Net 2011 • ACA & Racial and Ethnic Health Equity Series: • ACA & Racial and Ethnic Health Equity Series: Comprehensive Tracking of implementation Comprehensive Tracking of implementation 2012- progress, emerging guidance & programs progress, emerging guidance & programs 2014 2
3/19/2013 Design • Utilized a “health equity lens” to monitor implementation of 60+ provisions in the ACA with mention of or implications for racially and ethnically diverse populations across five areas: – Health Insurance Exchanges – Health Care Safety Net – Workforce Support and Diversity – Data, Research, and Quality – Public Health and Prevention Methodology • Extensive review of peer-reviewed research and Literature Review national/state policy reports for each provision • Federal rules and guidance Federal Policy and • Funding opportunity announcements Actions • Workgroups, collaborative opportunities • State and local progress and programs State and Local • Related legislative actions Actions • Emerging opportunities and challenges • Federal and state government Interviews with • Hospitals, health centers, health plans nearly 70 • Community organizations, advocates individuals • Academia and experts 3
3/19/2013 Cultural and Linguistic Requirements in Health Insurance Exchanges Project Objectives • To track the progress of ACA provisions we identified on exchanges and health plans in an exchange • To identify and synthesize related resources • To highlight model activities that we found in selected states • To develop recommendations for states, health plans, federal agencies, and others to ensure effective implementation of cultural and linguistic requirements of the ACA 4
3/19/2013 ACA Provisions Examined 1. Section 1311(b): Establishment of State Exchanges 2. Section 1311(i): Culturally, Linguistically Appropriate Information in Exchanges 3. Section 1311(e): Plain Language Requirement for Health Plans 4. Section 1001: Culturally, Linguistically Appropriate Summary of Benefits and Uniform Glossary 5. Section 1001: Culturally, Linguistically Appropriate Claims Appeals Process 6. Section 1311(g): Incentive Payments in Health Plans for Reducing Disparities 7. Section 2901: Remove Cost Sharing for Indians below 300 Percent of the Federal Poverty Level 8. Section 1557: Non-Discrimination in Federal Programs and Exchanges Exchange-Related Provisions 1. Section 1311(b): Establishment of State Exchanges � All states will have exchanges to facilitate the purchase of qualified health plans for individuals and small businesses by January 1, 2014 � States can operate their own exchanges, have the federal government do it, or have a state-federal partnership exchange 2. Section 1311(i): Culturally, Linguistically Appropriate Information in Exchanges � ACA and subsequent regulations require the navigator programs, applications, forms, notices from exchanges and health plans, outreach and education, and other information from exchanges to be accessible to limited English proficient people and be culturally and linguistically appropriate 5
3/19/2013 State Exchange Decisions State Case Studies • Reviewed exchange planning activities for states that stood out in considering C/L competence and ones that were most often cited for their progress • Other considerations: states in different regions of the country, relatively higher percentages of non-white and LEP populations • Seven states chosen: California, Colorado, Connecticut, Maryland, New York, Oregon, Washington – all have state-based exchanges due to federal and partnership exchanges being less developed at this time • Purpose is to provide a snapshot of selected states’ progress in implementing the exchange provisions, and to offer experiences and models that may be useful to other states 6
3/19/2013 Summary of Case Studies - 1 Progress Related to Racial & Health Equity Actions in Exchange Development & Planning by Case Study State CA CO MD NY OR WA CT Diversity in board composition mentioned Y Y Ni Y Y Ni (1) in the exchange legislation Vision, mission, or values statements specifically cite diversity and disparity Y Ni Y Ni Ni Y Y objectives or needs Diversity specified for stakeholder advisory Y Ni Ni Y Ni Y Ni groups Community meetings or focus groups held that target or consider racial, ethnic, and Y Y Y Y Y Y Y language needs *Tribal consultation policy and consulting Y Y Y Y Y Y (2) with federally recognized tribes Input from advocacy groups representing Y Y Y Y Y Y Y communities and patients of color Summary of Case Studies - 2 Progress Related to Racial & Health Equity Actions in Exchange Outreach, Education, and Enrollment by Case Study State CO MD OR WA CA CT NY *Targeted outreach and education planned for limited English proficient and specific Y Y Y Y Y Y Y racial and ethnic groups *Navigator/assisters program will focus on specific racial, ethnic, and language needs Y Y Y Y Y Y Y in enrollment *Training materials to be developed for cultural and linguistic competency of S S S Y Y S S navigators/assisters 7
3/19/2013 Summary of Case Studies - 3 Progress Related to Racial & Health Equity Actions in Exchange Website, QHPs, and Evaluation by Case Study State CO MD OR WA CA CT NY *Planning for Internet web portal to provide access for limited English proficient people Y Y Y Y Y Y Y (such as taglines indicating availability of languages services) Planning to take cultural and linguistic competency measures into account in Y (3) Ni (3) Ni Ni (3) selecting qualified health plans for the exchange Planning to evaluate the success of measures addressing diversity and Y S Ni S Ni Ni Ni disparities in the exchange after operational and use the assessment for improvement Summary of State Progress • The case study states have made steady progress in incorporating C/L competency in their exchanges as required by the ACA, and in additional areas • Many other states have been slower to get started due to factors such as the Supreme Court cases and the elections causing delays in state government planning • All case study states have had multiple meetings with consumers and stakeholders, input from advocacy groups representing communities of color, are planning for targeted outreach, are planning for C/L competent navigators and other assisters, and are planning for accessible web portals 8
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