Access to Care Report/This Week (#4): ACA Health Exchanges Might Consider “Express Enrollment”

August 1, 2013

health-care-lawThis is #4 in a series of Access to Care Reports by Mitchell Law Office

Access to the new Health Exchanges will be strongly affected by the “hassle factor” associated with either filling out an application form on paper or going through a tedious menu online. Even with support from an outreach “helper”, this is going to be a difficult task for applicants as now set up.

Helpers will have many different backgrounds, skill levels, and knowledge bases. Some will be “navigators” deployed by the Department of Health and Human Services (HHS) , while others will be community health workers, local officials, librarians, health care providers and insurance companies, and activist parents—as a sampling.

The original paper application form was quickly derided as excessively long and unworkable. A shorter form has now been developed, but it still presents many complexities.

At this point, perhaps the whole application process should be reconsidered. The model being used now generally follows the application procedure put in place by Medicaid: collect extensive information from an applicant, then analyze and confirm, and finally approve. This model seems to be outdated today.

How about reversing this process, to have an express application option? Applicants could initially provide only name and Social Security number, along with a signed release on a postcard form. The Health Exchanges could then collect information from HHS, the Internal Revenue Service, and other agencies and groups to fill out a draft application as completely as possible.

The application could then be run by the applicant to be corrected, completed signed and returned.

Right now, much of the burden on applying is offloaded to the individual, which is not a service-oriented strategy.

There is a movement afoot to redesign service concepts. The redesign of services is seen by some as a way to help “cope with the twin pressures of limited resources and rising demand…” by having “patients and staff work together to rethink the way health care is delivered….” The same concept could apply quite well to all efforts to collect information from the public.

Such a shift could have a substantial effect on legal practices. Attorneys could shift from trying to help clients break through the barrier of a long application form, or online menu, to helping clients fill out a postcard and then check out a draft form sent by the Exchange.

Of course, clients would then realize how much information is in various data bases, and would no doubt need attorney assistance in going over draft forms and making any corrections.

Perhaps there could be another desirable side effect of such an express application approach: it would automatically give clients an opportunity to check out and correct various data bases. There could also be a short form for these corrections.

The problem is that public agencies are all-too-ready to place paperwork burdens on the public, and have little incentive (except perhaps in the case of ACA implementation) to minimize the public burden.

Previous installments of “Access to Care Reports” address the various ways in which access to care issues are affecting legal practices:

Report #1   Report #2  Report #3