For minorities, those in lower-income brackets, and other populations who are underserved by the U.S. healthcare system, it's a double whammy: disproportionately affected by diseases like diabetes, these communities are often left to fend for themselves by a complex and not-easily-accessible healthcare system.
Changing our massive, complicated national healthcare system can be a bit like trying to turn an ocean liner around. Over the next few years, states will begin rolling out "insurance exchanges" -- groups of healthcare plans from which federally-subsidized health insurance can be purchased by individuals -- in order to make health coverage more accessible, a requirement of the federal Affordable Care Act (ACA).
As states begin to do this, federal authorities should keep two principles in mind: first, ensuring that the system -- including a national insurance exchange -- doesn't inadvertently discriminate against those who need it the most; and second, how to make Internet-based insurance exchanges part of the process both easy and uncomplicated.
As background, underserved populations tend to fall through the cracks of, and are not served by or eligible for, their state healthcare programs. To fill that gap, the ACA requires that a national insurance exchange be set up for those citizens -- a crucial means of covering the uninsured who live in states who do not (or will not) comply with the ACA's requirements. Although there are federal subsidies for those who cannot afford to pay for their own coverage, these are only guaranteed for users of state-based insurance exchanges, not necessarily the national one. Paradoxically, this potentially results in a policy of refusing help to those who need it the most, defeating the purpose of the ACA itself. Accordingly, premium support should be provided to federal insurance exchange users too, not only to state insurance exchange users.
Second, the U.S. Department of Health and Human Services (HHS) is currently considering regulatory policies relating to "Web-Based Entities" -- formal jargon for websites -- that provide information about, and the ability to participate in, insurance exchanges. WBEs already work for millions of individuals. Additional regulation regarding these websites can either make them harder and more cumbersome to use, or easier and more accessible. This is particularly important because underserved populations also may have reduced access to the Internet, ranging from no access, shared access or lower connection speeds. Consequently, HHS should ensure that these regulations make WBEs widely accessible and easy to use; citizens should be required to be provided clear, truthful and balanced information about the services they are getting without requiring a cumbersome process. In short, the government's structure for online health exchanges should be as user-friendly as popular e-Commerce sites.
Whatever your political leanings, it's hard to disagree with two central principles: first, if government-subsidized healthcare is to be provided in some form, it shouldn't discriminate against those who actually need it the most; and second, regulations should help, not hinder, online access to such programs. The minority and low income groups at the periphery of the health care system are those who stand to benefit the most from clearly-worded federal regulations that will make health insurance exchanges a relief -- or, to lose the most from poorly-conceived regulations.
And no matter what kind of subsidy they end up receiving, the uninsured should have a favorable chance to sign up for coverage through WBEs. No one should be frozen out because of socioeconomic status.
Online health exchanges are crucial to the goal of enrolling en masse the millions of people who have been squeezed out of the traditional insurance system. Through the exchanges, the states and the federal government are poised to meet this goal in a way that is cost effective and democratic. But the details must not be overlooked, and smart and clear HHS regulation is vital to making the exchanges, and the ACA, a success.