All health plans are not created equal. Some go to great lengths and spend tremendous resources to personally provide you the highest quality and service possible. Others contract with the lowest bidder. Some get rated five stars and some only get one star. Some offer quick access to primary and specialty care and others don't. Some score high on health outcome measures and others score low.
How do you know the quality of your health plan? Under the Patient Protection and Affordable Care Act, or Obamacare, you will have easy access to that information by 2016. Californians were going to have easy access to this information less than 60 days from now. But a recent decision changed all that. Now you are going to have to wait. Please read on and let me explain.
The health insurance industry has long been cloudy and hard to understand. The plethora of plans, benefit schedules, prices and vendors make it very hard to gather enough similar information to comparison shop. The Affordable Care Act is supposed to change that beginning in 2014. By offering individuals an online marketplace with standardized benefit packages, Americans who purchase individual health plans should be able to shop for the level of benefits they want and make their purchase decision based on price and quality. This transparency should also spur vigorous price and quality competition. The act uses basic economic principles: knowledgeable consumers comparing like products will select the one that is the best value for themselves. Value is a function of price and quality, not price alone.
Our state has led the nation preparing for the changes coming in 2014. California elected to operate a state-run versus federally operated online market place and has been diligently preparing. Our marketplace is called Covered California and is almost ready to implement. Beginning in October, people who purchase their own health insurance will be able to compare and purchase health plans for 2014 coverage via Covered California. Many people who purchase insurance this way will be eligible for subsidies to help pay their premiums. The benefit packages of the plans will be the same. Although the act does not require quality measures to be in place until 2016, Covered California had previously said it would use available quality and service data. Unfortunately for consumers, Covered California recently announced it had reversed its decision. The announcement said a reason the data will not be included is that it is too old.
While everyone would like to have more timely data, we do have data. Something is better than nothing. Don't withhold it from the consumer because it is dated. Provide it and footnote it for the time period it covers. Let the consumer decide.
Another reason Covered California will not provide the data is that it was collected under different plan designs than will be offered in the marketplace. True, but it is the same companies providing the health plans and the care. Companies are designed to deliver quality or they aren't regardless of plan design. Again, it would be far better to provide the data with appropriate footnotes and let the consumer decide.
Covered California's decision reversal to not provide quality and service measures in the on-line marketplace significantly hampers an individual's ability to make a fully informed decision. You deserve to know the quality of care your health plan will provide to you and your family. This information is available today and Covered California should provide it to you.
David E. Womack
is the executive director of Kaiser Foundation Hospitals & Health Plan for Kern County. Kaiser Permanente serves more than 100,000 members in Kern County. Community Voices is an expanded commentary of 650 to 700 words.