Emergency Regulations proposed for Covered California Is It ? Jones Releases Emergency Rule Over Narrow Provider Networks

Are you one of the hundreds of thousands who accepted the incompetent design of 'The Affordable Care Act ?  You are not alone.

It has taken more than one year of operation for state health officials to recognize this current disaster. 

The affordable care act has delivered an empty promise, deception, and a boiler plate plan that gives  you a health insurance card...Good luck after that.

Sick patients require help and assistance. Those who are well and especially those who have an acute or chronic illness have many challenges in life, should not and cannot negotiate the web sites, and even when they do, much of it is incomprehensible.  

Haste in signing up due to arbitrary guidelines and enrollment dates add additional challenges for those still uninsured, and those who have discovered just how terrible their new plans are presents challenges for most.

Help may be on the way now that State Commissioner for Health Insurance, Dave Jones is responding to complaints from California Consumers.  Jones is the head of the California Managed Care programs.





California State Health Commissioner, Dave Jones

On Monday, the California Department of Insurance issued an emergency regulation that aims to address narrow provider networks in the state and improve residents' access to care, Capital Public Radio's "KXJZ News" reports. 

According to the state Department of Managed Health Care, several insurers, including Anthem, have violated state law by misleading consumers about the size of their provider networks  State Insurance Commissioner Dave Jones (D) said DOI has "received complaints from consumers across the state about long waiting times, about inaccurate directories of providers, about being charged out-of-network costs when there isn't an in-network provider. The list goes on and on and on" 

Details of Emergency Regulation

The emergency regulation requires insurers to:

• Adhere to new standards for appointment wait times (DOI release, 1/5);
• Offer an adequate number of physicians, clinics and hospitals to patients who live in certain areas;
• Provide an accurate list of in-network providers ("KXJZ News," Capital Public Radio, 1/5);
• Provide out-of-network care options for the same price as in-network care when the number of in-network providers is insufficient; and
• Report to DOI information about their networks and any changes.

The emergency regulation will go into effect after it has been reviewed by the Office of Administrative Law. According to a release, emergency regulations often go into effect more quickly than standard regulations (DOI release, 1/5).

According to Jones, he can bar insurers that do not comply with the regulation from selling insurance in the state next year 

HealthCare.gov Online User Experiences

Similar to the roll out of Covered California, the nationwide Health.gov exchange was even more flawed and unreachable for more than one month.

Short Videos of Users on the HealthCare.gov Website

The brief videos below highlight some of the challenges faced by the study participants outside California as they used the federal HealthCare.gov website to enroll in health coverage under the Affordable Care Act.

• Positive Impressions: Participants had anxiety about applying for health insurance and were surprised and relieved by the ease-of-use and clean look and feel of HealthCare.gov. Watch Video
• Quitting Points: There were several points at which participants abandoned, or would have abandoned, the online process to seek phone or in-person help. Watch Video
• Areas of Uncertainty - General Context: Participants were unsure about some ACA concepts such as "deadlines" and "tax credits," and they didn't always find adequate explanations or help. Watch Video
• Areas of Uncertainty - Site Elements: Some participants had challenges providing income and household information, logging into the system and navigating through certain parts of the site. Watch Video

The Affordable Care Act expands coverage options and provides an opportunity to streamline the enrollment process in public and private coverage. CHCF funded an assessment of HealthCare.gov to identify actionable ways to improve consumer experience with online enrollment.

The assessment uses a methodology not common in the public sector — direct observation of consumers as they move through the website. This technique captures sources of consumer satisfaction, knowledge, confusion, and frustration. The most compelling findings relate to assisting consumers with plan shopping and selection, providing adequate help throughout the process, and ensuring accuracy in consumers' responses to application questions. The report concludes with researchers' recommendations for improvement.

Compare these findings with those of  Covered  California in our earlier blog post.

The California Health Care Foundation also published a study of Health.gov for comparison of states using the national Health.gov website.

Both reports illustrate the poor design and performance characteristics of sites not ready to 'go live'.

Were this a private enterprise it would have stood little chance of success. Supervision and implementation were poor from the bottom to the top of the chain of command.


Health.gov User Experience  download