Lawmakers, Advocates Call for New Consumer Health Office

The Assembly Committee on Health this week gets its first look at a bill to create a one-stop shop for consumers looking for health care help in California.

AB 922, by Assembly member Bill Monning (D-Carmel), would create the Office of Health Consumer Assistance to steer people in the right direction, answer questions and help resolve problems related to health care. Designed with an eye toward millions of newly insured Californians joining a fragmented, confusing system over the next few years, the new state agency is aimed primarily at consumers, but it also will help health care providers navigate new waters.

“Right now, Californians have 18 different phone numbers to call for health questions,” said Vanessa Cajina, legislative advocate for the Western Center on Law and Poverty, one of the bill’s co-sponsors. “Depending on what kind of insurance you have or what kind of health issue you want information on, you could end up in several different places looking for answers. We need one coordinated place for people to start,” Cajina said.

The bill, which seeks federal funds from the Affordable Care Act to establish the new office, would fold the current Office of the Patient Advocate into the new agency.

Will there be opposition to Monning’s plan?

“We’re not really sure,” said Anthony Wright, executive director of Health Access California, another bill co-sponsor.

“This seems like mom and apple pie to me. I can’t see why anyone would object. But we’re using federal funds and it’s part of health care reform, … so, we’ll see.”

Federal Money Already in Play

California already is using a federal grant made available by the health reform law. ACA provides funding for states to establish health insurance consumer assistance programs. To qualify for a grant, states must designate an independent office of health insurance consumer assistance.

The California Department of Managed Health Care and the state Office of the Patient Advocate were awarded $3.4 million to help pave the way for health care reform changes.

The current grant is to be used to:

  • Develop and promote a coordinated, consumer-friendly website and corresponding toll-free number that consumers can call with questions about health care coverage, and to receive assistance with the filing of complaints and appeals;
  • Conduct a statewide media campaign, in partnership with consumer organizations, to educate consumers about their rights and responsibilities and to provide assistance with enrollment in group health plans or health insurance coverage; and
  • Evaluate the effectiveness of the initiatives, and collect, track and quantify consumer problems and inquiries for reporting to state and federal policymakers.

AB 922 seeks more federal money to establish the new state agency, but exactly how much is up in the air.

“It’s been left open-ended,” Wright said. “We don’t want to limit our potential to draw down federal funds.”

California’s Complex System

California is not lacking in help for consumers, but finding the right place to ask a health care question can be a daunting prospect for many Californians.

California, the only state with two agencies overseeing health insurers, also has a dizzying array of consumer-oriented health care-related agencies — public and private. In addition to the Department of Managed Health Care and the Department of Insurance, which share oversight of the state’s health insurers, six other government agencies and several private, not-for-profit organizations provide information, assistance and counseling for individuals covered by public and private insurance.

These organizations and government agencies offer a wide array of assistance, ranging from directions on how to navigate particular systems, advice on coverage options, assistance with complaints and grievances.

“There are lots of answers out there and lots of people to help, but what we lack is one coordinated place to act as a hub for all this information,” Cajina said.

“It’s already confusing now, and this would be a good idea with or without health care reform,” Cajina said, “but we’re expecting to add more than four million people to the system because of reform. We need to simplify our system to get ready.”

California consumers will be dealing with two new facets of the state’s health care system — a new law that requires they have insurance and the new Health Benefits Exchange — that will surely give rise to many new questions and problems requiring official guidance.

Multiple Languages, New Problems

California’s uninsured population has different needs than those who are consistently covered, according to Western Center on Law and Poverty officials.

“This includes people who primarily speak a language other than English, those who have never navigated a health insurance plan, and those who have perhaps never consistently seen a health care provider,” Western Center on Law and Poverty said in letter supporting Monning’s bill.

“For all those reasons, Californians need a centralized hub to connect to when dealing with questions or problems with their coverage,” the letter said.

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