State health insurance exchanges explained

NASW has urged the U.S. Supreme Court to uphold the individual health mandate and Medicaid provisions outlined in the Affordable Care Act in two amicus briefs, coordinated by the Legal Defense Fund, so that quality health care is available and affordable for all.

A new NASW Practice Perspective, “State Health Insurance Exchanges: What Social Workers Need to Know,” provides insight into the role social workers can play in shaping their states’ health insurance exchanges and what to anticipate from health care reform.

The U.S. Supreme Court is expected to rule on challenges to the ACA in June. In the meantime, states are required to follow the timetable set by the ACA and have health exchanges operating by Jan. 1, 2014.

A health exchange is a government-regulated marketplace of insurance plans, available at competitive rates to those without employer-sponsored health coverage and to small businesses. States are also required to develop a package of essential benefits that will be offered by health plans operating on the exchanges.

“It’s important to understand how health insurance exchanges will work, because every social worker will be touched by them in some way,” said Stacy Collins, an NASW senior practice associate who wrote the Practice Perspective.

She noted that regardless of what the U.S. Supreme Court rules, many states already see the value in establishing the exchanges.

“Some states are going full speed ahead,” Collins said. “This is an opportunity for social workers to get involved.”

Many clinical social workers will be part of provider networks in the exchange plans.

“While states are crafting the specifics of their essential health benefits packages, social workers will want to ensure that mental health and substance-abuse services offer adequate duration, scope and reimbursement levels,” Collins said.

“For macro social workers involved in state-level health and social welfare advocacy, ensuring that state exchanges are implemented appropriately is an important action on behalf of the vulnerable populations for whom the exchanges are meant to serve,” she said.

The good news is social workers need not start from scratch to get involved.

“Each state has some coalition effort already in place that social workers can join,” Collins said.

The Practice Perspective offers resources that can help social workers get started in learning more about the exchanges and coalition efforts.

Many NASW chapters have already taken the lead in working with coalitions. Joseph Robinson, from the NASW California Chapter, noted that he has been representing the chapter on the Coalition for Whole Health, which unites the mental health and substance use disorder fields advocating for the best care under the ACA.

Robinson, associate director with the California Association of Social Rehabilitation Agencies, said he got involved because he wants health care reform to have provisions for enrollment assistance and benefits education, and an avenue to voice grievances.

“Health care disparities based on race and socioeconomic status exist,” Robinson said. “Being involved is a way to work to lessen those disparities.”

He said the coalition is working to make sure the treatment of mental health and substance use disorders is part of health care reform planning and implementation.

“In addition, both the coalition and the chapter are focused on ensuring adequate enrollment policies and access issues, particularly for underserved communities,” Robinson said.

NASW Massachusetts Chapter Executive Director Carol Trust said the chapter formed a think-tank work group to advise staff on how to place and maintain social work in the new health care payment reform models.

“The group is made up of NASW members who are academicians, practitioners, policy folks and social work administrators,” Trust said. “They have guided us in drawing up ‘Principles for Health Care Reform’ that we have submitted to the legislature.”

The Practice Perspective, “State Health Insurance Exchanges: What Social Workers Need to Know,” also explains how the health care exchanges will likely affect social workers in helping their clients. For example, those who work in child welfare and human service agencies will have an opportunity to enroll clients — particularly those in low-income brackets — in health care plans.

“Social workers may be called upon to help their clients navigate this process,” Collins said.

Hospital and clinic social workers will need to know their state exchange systems, as they will often be called upon to help patients access needed benefits, she said.

“As social workers, we are specially trained to help be the voice for the most vulnerable people,” Collins said. “We can make sure they have a voice by getting involved.”

NASW members can download a PDF of the Practice Perspective — “State Health Insurance Exchanges: What Social Workers Need to Know.” {}