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Last month, the National Association of Insurance Commissioners (NAIC) held a special meeting with their Consumer Liaison Committee to hear presentations from consumer representatives about issues related to the COVID-19 pandemic. The consumer representatives covered a wide range of topics during this special session, but there was a unified theme: Insurance regulators have an important role to play in not only protecting consumers during this pandemic, but also in fighting the systemic racism leading to the virus’ disproportionate impact on Black, Latino and Native communities.
I had the opportunity to address the committee and talk about these disparities, and offer suggestions for how insurance regulators can evaluate the systems they work in and with to find opportunities to advance racial equity.
What is an Insurance Regulator’s Role in Advancing Equity?
Community Catalyst’s framework for achieving health justice offers a way for insurance regulators to start thinking about their work in three separate but related areas: health coverage and affordability, access and quality, and the social determinants of health. Addressing the root causes of inequity will require long-term dedication in each of these buckets, but I offered the committee several ways insurance regulators can start that work now.
1) Consumer Complaints and Community Engagement
For most insurance regulators, the most direct connection to consumers is through consumer complaints about insurance products. This is an important function of the office and this data can help identify trends related to access and quality of insurance coverage. However, data from complaints is unlikely to paint a full picture of the problems consumers face in a state or locality because most consumers are not aware that they have a right to file a complaint in the first place.
In order for this process to be an effective tool to address disparities, insurance regulators should invest in educating community members – specifically in communities of color – about their right to file a complaint. Additionally, as they work to improve awareness of complaints, they must also collect and publicly report complaints along with corresponding demographic information including race, ethnicity, sex, gender identity and sexual orientation, age, socioeconomic status and disability status. This will allow regulators and stakeholders to evaluate patterns and insurance practices that could be contributing to health disparities.
Insurance regulators should also find ways to engage with community members to hear about the issues they are facing firsthand. A good place to start is with consumer assistance programs or community-based enrollment assisters. Enrollment assisters are often deeply rooted in the communities they serve and can provide a window into the issues their communities face.
2) Robust Rate Review
As our country faces unprecedented unemployment rates and the financial uncertainty that comes with it, increasing health insurance premiums could force consumers to drop their coverage at a time when it is most critical. Right now, state and federal insurance regulators are engaging in a rate review process to determine whether proposed rates for 2021 coverage are based on accurate, verifiable data and realistic assumptions and projections. Robust rate review is a tool that insurance regulators can use to help control increases in health insurance premiums and to address the underlying cost of health care.
Consumer advocates play an important role in making sure regulators approach proposed rate increases with heightened scrutiny this year. In particular, consumer advocates can lift up affordability concerns from diverse communities so that insurance regulators understand the impact increasing premiums will have on individuals and families amidst the global pandemic. For more information about how states and advocates can push for a robust review of rates, check out our new resource:
An Advocate's Guide to Rate Review
3) Investing in Affordable Housing
The role of an insurance regulator might not be immediately apparent when you think about the social determinants of health, but they can play an important role in encouraging health plans to invest in affordable housing and community development. The housing crisis in our country is not new, but the pandemic is only making it worse. Plagued by decades of residential segregation, communities of color – specifically Black communities – lack affordable housing options free from environmental factors that are negatively affecting their health. UnitedHealth, among other carriers, recognizes the importance of affordable housing in health outcomes for underserved communities and has made investments in building affordable housing units.
The pandemic complicates the picture of whether or not insurance carriers will have the capital to invest in affordable housing in the immediate future, but that shouldn’t stop insurance regulators from examining their role in encouraging this type of investment through their regulation of capital reserve levels. For more information about these initiatives, visit our recent publication: Healthy Investments: Leveraging Health Plan Capital for Affordable Housing and Community Development.
The Work Ahead
These are just a few ways insurance regulators can work within their jurisdiction to protect consumers during the pandemic and uncover strategies to address some of the root causes of racial inequity. Consumer advocates should continue to think creatively about how their own insurance regulators can make a difference and hold them accountable as states continue to respond to the multiple public health crises at play today.