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Division of Insurance LaunchesConsumer Education Effort

Jo Donlin is the Director of External Affairs for the Division ofInsurance, one of nine divisions within Colorado’s Department ofRegulatory Agencies (DORA.) In addition to supporting DORA’slegislative initiatives, she is the Division’s lead on outreach andcommunications.

In an interview with Catherine Strode, Coordinator of the HealthCare Advocacy Program, she said there is currently a strongoutreach effort underway to educate the citizens of Colorado howhealth care reform will affect their coverage and how the Division ofInsurance can be a valuable resource for them. What do you see as the top issues facing consumers in thepurchase of health care insurance over the next two years? I think that there’s a lot of information out there, both good andbad, about health insurance and what consumers need to knowabout what’s changing and what’s not changing. Getting goodinformation out there is one of our goals. There’s a lot ofemphasis on the Exchange, which is a new marketplace forpurchasing insurance. We want it to be successful but we alsowant consumers to have choices outside of the Exchange if theydon’t feel their needs are met by the products inside of theExchange. There are some challenges right now in our role as aneducator to get people to engage about these choices, to betterunderstand their insurance options, the changes that will takeplace, and the role that we can play in assisting consumers. If forsome reason, their insurance carrier doesn’t meet theirexpectations, we can go to bat for them and try to figure out andresolve whatever is going on. We have a huge challenge in justhelping people know the role we play in regulating the insurancecompanies, making sure their rates are fair, that the companiesare solvent. That we are a resource for help.

What are the most difficult issues about health insurance policiesfor consumers to understand?

I think understanding that the more expensive policies are notalways the best polices and that the less expensive polices don’tnecessarily mean poor quality. I think that what I’ve seen a lot ofis that consumers need to be very careful to read their policies.Personal health is something that everyone knows verypersonally. Matching their needs up with what is offered in aninsurance policy is very important. Sometimes things need to bechanged, but so few of us really read our policies and understandexactly what is covered. Usually people don’t really read thedetails until it’s a moment of crisis. I think that is a big thing intruly understanding what is covered and what isn’t.

Please explain the Essential Health Benefits in the AffordableCare Act and the role of the Division of Insurance with the EHB.

The Essential Health Benefits is basically a combination ofbenefits in the ACA that the feds gave the states the authority to

Jo Donlin Director of External Affairs

DORA

Essential Health Benefits InformationHere

State Health Policy News

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create. The Essential Health Benefits will basically be a floor ofbenefits that plans must adhere to, inside and outside of theExchange. So it’s just the benefit structure. It’s not the costsharing; it’s not a particular carrier. What we had is certain plansthat we could choose from. We could not take a clean slate andjust create our own Essential Health Benefits. We had to pick thebenefit structure from 10 options: the two federal plans, threestate employee plans, (in Colorado we only have two), the largestHMO, and the three largest plans in the small group market (fiftyand fewer employees.) They did not say you could pick part ofthem, you can exclude part of them, they said you can pick abenchmark plan. They also gave ten categories and those tencategories are the basis for the benefits that are required. Wehad a very thorough stakeholder process. The Governor’s office,the Division of Insurance, DORA, and the Colorado Health BenefitExchange worked very closely together, with all the thoughts andfeedback from stakeholders, to select Colorado’s benchmarkplan. That benchmark was a Kaiser plan and it was one of thelargest small group plans. There were things we had to balance. We had to balance cost with coverage. We’ve sent that to HHSand now we will wait. HHS will review every state’s selection oftheir benchmark plan and if it meets the parameters that are setout in the ACA.

How do you think the Essential Health Benefits will improvecoverage for Colorado consumers?

It gives people some sense of being able to compare things whenthey start purchasing insurance. I think that is a benefit; certainthings are now required to be the baseline for any insurance plan.What’s really important to realize is, while we picked the KaiserDed/CO HMO 1200D, we didn’t pick Kaiser. We picked thebenefit structure in that plan, and it will be will be used by all thecarriers.

ProgramUpdates

Questions On Medicare-Medicaid EnrolleesDemonstration?

The Health Care Advocacy Program is in the process of developing the second, in aseries, of WEBINARS on the state’s Full Benefit Medicare-Medicaid EnrolleesDemonstration Contract. The WEBINAR will be conducted in coordination with TeriBolinger, Demonstration Liaison, from the Department of Health Care Policy andFinancing. We would like to address the questions of our clients and constituents inthe WEBINAR, scheduled to be held next month. For more information on theMedicare-Medicaid Demonstration Contract click here.

You can submit your questions to Catherine Strode, Coordinator of the Health CareAdvocacy Program, at cstrode@advocacydenver.org.

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EditorCatherine Strode, MPA, Health Care Advocacy Program and Outreach Coordinator

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