Health equity in the Exchanges: Some good first steps

Last Monday, the U. S. Department of Health and Human Services (HHS) issued the final rules for the establishment of state Exchanges, a competitive marketplace for individuals and small businesses to purchase insurance. In addition to providing guidance to states as they develop these marketplaces, the rules may also help the Exchanges to better serve a diverse population.

HHS made some positive changes to specific provisions on nondiscrimination protections, language access, and Navigators’ linguistic and cultural competency.

• · Banning discrimination: All Exchange related activities including marketing practices, benefit designs of qualified health plans, and Navigator outreach and enrollment must comply with existing federal laws that prohibit discrimination on the basis of race, color, national origin, gender, sexual orientation and disability.
• · Access to language access services at no cost: Individuals and families with limited English proficiency will receive Exchange related information (i.e. notices, descriptions of health plan choices and grievance procedures) quickly and easily through oral interpretation, written translations and notices in non-English languages indicating the availability of language services. There is no charge for these services. HHS plans to develop guidance on best practices related to standards on language access services. This is a big win.
• · Navigator training on linguistic and cultural competency: Exchanges must establish training standards for Navigators to ensure that they serve the needs of a racially and ethnically diverse population. Further guidance on training model standards for Navigators is promised.

These are good first steps. However, a lot more still needs to be done. Advocates have more opportunities to push the federal government and state policymakers to develop robust policies that help the Exchanges be more responsive to the needs of people of color and immigrants and reduce health disparities. It is important to continue to raise the voices of consumers in support of accessible, equitable Exchanges.

• · At the federal level, we should urge HHS to quickly develop guidance on best practices related to standards on language access services and models for Navigator training on linguistic and cultural competency.
• · At the state level, while the final rules require at least one person on an Exchange Board to be a consumer representative, HHS leaves it up to states to decide on the diversity of the Exchange governing board. Therefore, we should advocate for state legislation that requires the Exchange board to mirror the gender, cultural, ethnic and geographical diversity of the states.

Community Catalyst is here to help move health equity forward in states. Based on our work on Exchanges over the past few years we’ve recently developed six principles to promote racial and ethnic health equity in Exchanges to help you shape your state Exchange. To make progress, we must be persistent and work with other stakeholders to increase the involvement and impact of members of the vulnerable communities that have the most to gain from full implementation of the ACA.

-- Quynh Chi Nguyen, Program and Policy Associate