NASW Advocates to Include Social Workers in New Insurance Exchanges

The National Association of Social Workers strongly urged the U.S. Department of Health and Human Services to include social workers in plans that will be offered in the new affordable health care insurance exchanges that will be available across the United States by Jan. 1, 2014.

NASW also made recommendations to ensure these insurance exchanges better serve consumers, especially underserved populations — those with low literacy or English skills or people who live in low-income neighborhoods with limited computer and Internet access.

“NASW is a strong supporter of the Affordable Care Act and we eagerly await the full implementation of the state-level insurance exchanges, which will facilitate expanded access to health insurance coverage for millions of individuals and employees of small businesses,” NASW Executive Director Elizabeth Clark said in a Sept. 27 letter to Donald Berwick, M.D., director of the Centers for Medicare and Medicaid Services at HHS.

In private health insurance markets, individuals and employers voluntarily participate as purchasers. However, people who want to buy coverage face hurdles, including affordability or being denied coverage based on pre-existing medical conditions.

The Affordable Care Act that President Obama signed into law in March 2010 calls for the development of a health insurance “exchange” in each state.

This new insurance marketplace is designed to allow individuals and businesses to shop for affordable coverage with clear, easy-to-understand information about plan options.

Low- and moderate-income individuals and families will receive federal subsidies to make purchasing health coverage through the exchanges more affordable.

HHS is seeking public comments before releasing the final rules regarding these exchanges.

In the letter, Clark said professional social workers should be included in all qualified health plans offered through exchanges, because clinical and medical social workers provide vital services in the U.S. health care system, including mental health care, case management and care coordination.

Social workers should be defined as “essential community providers” in the final rule because many members of the profession work for or are under contract to such organizations, which include critical access hospitals and children’s hospitals, HIV clinics, family planning clinics and federally qualified health centers, she said.

NASW also supports requirements that qualified health plans in the exchanges regularly update their electronic directory of participating providers, which includes social workers.

Clark said NASW recommends that the final rule require network adequacy standards to ensure consumers have access to professional social workers within a reasonable distance to their homes or workplace.

NASW also made several recommendations to make the health care insurance exchanges more consumer-friendly:

  • The majority of exchange governing board members should be consumer representatives and the final rule should clearly define what a consumer representative is. NASW recommends a consumer representative include exchange beneficiaries as well as organizations that represent medically underserved communities or people with certain diseases or conditions.
  • All consumer- assistance tools should be designed to meet the needs of a wide range of consumers, including those with cognitive and/or physical disabilities, families with mixed immigration status, or individuals with limited English skills. For instance, the proposed rules require exchanges to maintain up-to-date websites that consumers can use to compare plans. NASW recommended this information be available in written form for consumers who do not have Internet access.
  • Exchanges should offer a streamlined application process that creates no “wrong door” for applicants. For instance, the exchanges should be able to enroll qualified consumers in Medicaid or the Children’s Health Insurance Program instead of merely referring clients to these programs, NASW said. Requiring both paper and Web-based enrollment applications and permitting online, telephone, mail, or in-person applications will also make it easier for underserved populations to apply for insurance through exchanges.

The number of Americans without health insurance rose to 49.9 million in 2010, up from 49 million the previous year, according to the U.S. Census Bureau. With more people unemployed, many are losing employer-based health insurance and some businesses no longer offer health plans.

“NASW wants to work with HHS to ensure the exchanges encourage more Americans to get health coverage,” Clark said. “NASW looks forward to collaborating with (HHS) to make the new health insurance exchange successful in expanding coverage to more Americans.”