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Feds push for plain English, not jargon in health insurance

This article first appeared in the St. Louis Beacon, March 14, 2012 - Plain English rules to help consumers understand their health insurance aren't plain enough. That's the assessment of Dr. Karen Edison and Stanton Hudson of the Center for Health Policy at the University of Missouri at Columbia.

Both stressed that they are pleased by the Department of Health and Human Services' recent decision to require insurers to provide consumers with clear and understandable summaries of what's covered in their health plans. But both add that this federal effort should be regarded as a first step.

"This has been a dream of ours for a long time," Edison, a dermatologist and director of the center, says of the new rule. "We're coming from an environment where (even) most health-care professionals don't know (what's in) their own health policies because they're so complex. These recommendations are a vast improvement over what we had in the past."

Having said that, Edison adds that the health literacy runs much deeper than the fact that well-educated and ordinary people alike are not able to comprehend easily the fine print in their health-care policies.

Edison says the group needing the most help is the roughly 20 percent of the population that is functionally illiterate.

"A lot of them have some of the worst health outcomes. We can't ignore them. That is a basic literacy issue that we need to address."

Worse, she adds, one part of the plain English sample provided by the federal government is written at the 11th grade level even though Americans on average read at the 8th grade level.

Under the new regulations, insurers will be required to explain average amounts that consumers will pay for a plan, using several common illnesses. Fine print? It's supposed to vanish in favor of 12-point type.

"It's clear that the federal government is saying to the insurance industry that it's your responsibility to communicate clearly with patients," Edison says. "From where I sit, this is a big improvement. It recognizes that a lot of what has been done in the past really has not been easy to understand."

She says people tend to learn what their plans cover only after getting sick. Many consumers are shocked when they discover how little their insurance plans pay.

"That happens not infrequently, someone understanding that they really don't have the coverage they think they have. They've been paying these premiums for a long time. Then they get sick, and the insurance coverage is not there for them."

In announcing the rules last month, HHS Secretary Kathleen Sebelius said existing material from insurers made it difficult in some instances for consumers to understand what they were buying.

“All consumers, for the first time, will really be able to clearly comprehend the sometimes confusing language insurance plans often use in marketing,” she said in a statement. “This will give them a new edge in deciding which plan will best suit their needs and those of their families or employees.”

She added that the new rules would complement the federal push to set up state insurance exchanges to make it easier for consumers to compare health benefits offered by various companies.

The new guidelines have the potential to empower consumers, says Hudson, associate director of the center.

While consumers will have an easier way of making comparisons through the exchange system, Hudson says more might have to be done.

"You can't expect people to be competitively shopping around in a health exchange if the information is not usable," he says.

"We'll need some good evidence behind how well it's working or not working," he says. "This standardization is a first step, but there is still a long way to go."

Edison notes that when people talk about health insurance exchanges, they use the Expedia model for airline tickets as a comparison.

"You have a one-stop place to compare. But the need to have a real human to help people through it is something that the federal government learned years ago with their Medicare program."

She notes that consumers unable to understand Medicare can call a 1-800 number to "get a human to help them navigate the confusing world out there." She says this service is especially valuable to the most vulnerable people  because they tend to have the most trouble understanding what programs are available.

Hudson would like insurance reform to pay more attention to numeracy. 

"With these insurance tables you have to figure out percentages, co-insurance and things like that. These are other parts of the challenge of the health literacy picture that this first step" hasn't fully addressed.

Hudson and Edison say the goal is to make people active consumers in the health-care market.

"It needs to be just as easy to shop for a health-care plan as it is to shop for a car," Hudson says.

While broadly supported by consumer groups, the rules were disappointing to some because insurers won't be required to include their own premiums in the plain English summary of coverage. 

HHS officials rebuffed the industry on one count. Insurers wanted to prevent the rules from taking effect for 18 months. The agency decided to implement them in six months.

Robert Joiner Beacon staff

Robert Joiner has carved a niche in providing informed reporting about a range of medical issues. He won a Dennis A. Hunt Journalism Award for the Beacon’s "Worlds Apart" series on health-care disparities. His journalism experience includes working at the St. Louis American and the St. Louis Post-Dispatch, where he was a beat reporter, wire editor, editorial writer, columnist, and member of the Washington bureau.