Navigating the shopping troubles with insurance exchanges

In In The News by Barbara Jacoby

LLH network pressFrom

One could easily make a case that health care is today’s biggest consumer problem—not unlike those that sparked the consumer movement of the 1960s and 70s. Back then, consumer issues centered on problems with using credit, buying cars and home improvement services, and obtaining the best price for food, appliances, and just about every other new-fangled and expensive product that sprang from the post-war economy.

Like many old consumer problems, health care is complicated. There’s no transparency when it comes to the terms and price of services, advertising can be deceptive and misleading, care can be unsafe—even deadly—and there’s often no place to seek help when you need it.

A recent email from a reader drove home the point that health care is today’s hottest consumer product—and problem. The 59-year-old woman had just received a notice from Aetna, her insurance carrier, advising her of a $100, or 17 percent increase, in her monthly premium for an individual policy covering her and two adult children. The new $704 premium is steep to pay on a freelance proof reader’s income, so she questioned the need for the increase and wanted to complain. But where?

At the start of the consumer movement in the 1960s, consumers faced similar roadblocks. Where could consumers go to register complaints about deceptive and misleading sales practices, exorbitant prices and unsafe products? Mostly they got the run-around until state and local governments set up consumer protection agencies to help buyers in their transactions with unscrupulous sellers.

The woman who emailed me got the run-around too. First she called Aetna to ask about the rate increase. A customer service rep told her she would have to write to Aetna’s grievance and appeals board since they had no phone number. The rep also also explained that the state of Pennsylvania had allowed the premiums to go up. If she had a complaint, she should take it to state insurance regulators.

She called her representative in the Pennsylvania state legislature. “They did everything they could and gave me a complaint form to fill out,” she said. Then she called the office of her Congressman. A staffer said her complaint about high premiums was a legislative issue, and they would have to call her back.

At that point, the woman contacted me.

This woman’s problem and her need for information is the tip of the proverbial iceberg. There will be zillions more like her as newly insured consumers encounter shopping troubles with insurance exchanges and begin to experience the hassles of dealing with insurance. The process will hardly be as simple as buying an airplane ticket through Travelocity, as the Obama administration has promised.

It was the groundswell of complaints like these that prompted the creation of many state and local consumer agencies, many of which are now out of business. Theoretically, state insurance departments have consumer complaint divisions, but the quality of help varies considerably. State attorneys general often look into consumer complaints, but how many consumers think about checking in with the local AG’s office?

The Affordable Care Act calls for navigators—community groups or nonprofit organizations—that would undergo training to help people shop the new insurance exchanges. Will they be able to help resolve complaints or advocate on behalf of the consumers of health care? How good will they be? And will the states even let them do their jobs?

In some 20 other states, a classic legislative fight is brewing that’s reminiscent of the battles fought during the heyday of the consumer movement. Those battles eventually resulted in licensing requirements for businesses like car repair shops and home improvement contractors.

Should states require navigators to be licensed and required to have special training to help consumers? Insurance brokers and agents say yes. Groups that want to be navigators fear some of the requirements might scare them from participating.

While states sort this out, people like the Pennsylvania woman must decide whether to keep her more expensive insurance or buy a new, cheaper policy; she needs help now. “Do you want the devil you know or the devil you don’t know,” she asked. It’s the classic consumer dilemma.

Trudy Lieberman is a journalist and an adjunct associate professor of public health, Hunter College. She blogs regularly on the Prepared Patient blog.