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Thursday, August 25, 2016

10 Tactics for Improving Health Insurance Provider Networks for Communities of Color

Communities of color, even once they have insurance, face barriers that can hinder access to high-quality, affordable health care providers. Of those barriers, one of the most notable is the often limited availability of health care providers and facilities in communities of color. However, the Affordable Care Act includes protections for network adequacy that can help address these long-standing barriers. 

Today’s post outlines 10 tactics advocates can use to work with state and federal officials to help address these issues. Our popular brief describes the specific barriers to provider access that communities of color face and the policies that can help address them in the private insurance market. Also see our slideshow: Network Adequacy 101.

The Affordable Care Act contains provisions to ensure health insurance provider networks are adequate

It’s important for advocates in communities of color to understand how the Affordable Care Act’s network adequacy protections can mitigate these barriers to provider access, by guaranteeing that consumers in marketplace health plans have access to:

  • a sufficient number of health care providers 
  • essential community providers (those that serve predominantly low-income, medically underserved individuals)
  • accurate information about which providers participate in a health plan’s network

These rights create a new floor of critical provider access protections for consumers in the marketplaces. But more work may be necessary to make these protections real, particularly in communities of color. 

6 tactics for effectively engaging state officials in improving network adequacy

To effectively advocate at the state level:

  1. Report provider access problems to your state’s insurance department. If people don’t report provider access problems to these regulators, they won’t know about them and will never take action to address them. 
  2. Urge state officials to enact more specific network adequacy protections (for some examples, see below). 
  3. Share examples of provider access problems that communities of color are facing in your state to build support for why these policies are necessary.
  4. Write to or meet with your insurance regulator (usually called the insurance commissioner), as he or she may have the authority to write regulations or introduce legislation to implement provider network standards to better protect communities of color in your state.
  5. Educate your state legislators about the provider access issues that diverse communities face and urge legislators to introduce bills to help address those issues. 
  6. If your state runs its own marketplace, reach out to the marketplace board, director, and staff. These individuals can implement policies to improve access to providers in marketplace plans.

4 tactics for effectively engaging federal officials in improving network adequacy

Talk to federal officials about enacting policies that apply to marketplace plans across the entire country, or that specifically apply to plans in federally facilitated marketplaces. 

To effectively advocate at the federal level:

  1. Report provider access problems that consumers are experiencing through the marketplace call center at 1-800-318-2596 and/or your regional HHS director.
  2. Share the specific policies that you would like the federal government to enact with your regional HHS director (for some examples, see below). Illustrate the need for these policies with examples of the barriers to providers that consumers in communities of color are facing.
  3. Contact HHS officials in Washington (such as the Secretary of Health and Human Services or other officials in leadership positions) if you spot egregious violations of consumer rights or if you are working in larger coalitions with clearly defined priorities that you would like the federal government to consider. 
  4. Reach out to Families USA to get advice on how to develop effective strategies for advocating with federal officials. 

Enacting more specific network adequacy protections: Two state examples

To ensure that health plans comply with the Affordable Care Act’s rules, states and the federal government can enact more specific network adequacy standards. These more specific standards could help better address the persistent provider access problems that communities of color face. For example:

  • Vermont has standards to ensure that consumers can reach providers within a reasonable travel time.
  • California has standards to ensure that consumers can get care from providers that are language-accessible to them. 

Be sure to read our related brief, Improving Private Health Insurance Networks for Communities of Color, which includes more examples of policies that can help improve network adequacy for communities of color and tips for how to urge officials to enact them.

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