HHS Listening Session Promotes Transparency & Provides Rich Dialogue With Stakeholders – Say Ahhh! A Children’s Health Policy Blog

It used to be that late August in Washington, D.C. was
the perfect time to clean the junk out of your office, delete old emails, and
go to the dentist. Now, though, the high energy folks in the Obama
Administration charged with implementing health reform are bringing yet more
change to Washington, D.C.. 
Yesterday, they sponsored an all-day listening session with stakeholders
to gather thoughts and insights on the new Exchanges that are so central to
health reform.  They brought
together employers, labor leaders, consumer advocates, insurers, and a host of
other experts to cover exchange issues such as how to communicate with
consumers; small businesses and exchanges; governance issues; promoting
delivery system reform; and the role of exchanges in determining eligibility
for premium and cost-sharing subsidies and coordinating with Medicaid.

The discussion was incredibly rich, but one theme that
emerged over the course of the day – and that also was very much in keeping
with HHS’s vision for the meeting – is the importance of securing consumer
input into health reform implementation and using a transparent decision-making
process.  Glen Schor with the
Massachusetts’ Connector was particularly eloquent on this point, calling
transparency a “hallmark” of how Massachusetts has succeeded in implementing
health reform.  He and others noted
it can be time consuming and cumbersome to solicit consumer input and to share
all sorts of details about policymaking, but it is ultimately vital to helping
people feel comfortable with major changes.

From a consumer perspective, there also was a fascinating
discussion about the kinds of information that people will need to make
decisions about their health care coverage under reform.  Of particular note, I thought, were
comments by DeAnn Friedholm of Consumers Union about the importance of
recognizing that people make decisions in different ways.  Drawing on Consumers Union’s experience
with publishing Consumer Reports, she pointed out that not everyone is likely
to want a detailed chart comparing a health plan along a zillion different
dimensions.  Instead, some people
may want a much simpler set of information, such as three good health plan
options from which they can choose.  
While I personally am a huge fan of multi-dimensional charts and love a
good spreadsheet, I’m guessing that much of America will want dramatically
simplified information about how to secure coverage and enroll in subsidies.

I participated in a panel headed by Director of the Center for Medicaid and State Operations Cindy Mann on coordinating Medicaid and Exchange coverage.  Many of the ideas will be deeply familiar to long-time
Medicaid and CHIP experts and advocates, including the need for unified and
simplified application
and retention procedures for Medicaid and the Exchange; the
importance of building a strong information technology infrastructure for
eligibility determinations that allows linkages between the Exchanges, Medicaid
and CHIP and databases that can be used to verify eligibility; and the value of
providing people with multiple ways to apply for (renew) coverage, such as the
option to submit applications on-line and/or to secure help from a
community-based organization.  At
the same time, we discussed that the tax credits for premium assistance and cost-sharing
subsidies pose some unprecedented challenges, including that the tax system is
based on annualized income and is not designed to respond when incomes fluctuate over the course of a year. 

As intended, the day raised more questions than answers,
but, all-in-all, was much better than a trip to the dentist.  Seriously, it was impressive to the
extent to which people are beginning to roll up their sleeves and work on
turning the health reform law into a practical reality.

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