NAIC Committee on Race & Insurance Considers Barriers to Preventive ‎Health Services

The health workstream of the NAIC’s Special (EX) Committee on Race & Insurance, co-chaired by Maryland and Minnesota, met yesterday. The overarching theme of the meeting was access to preventive services, particularly as it pertains to chronic diseases, emphasizing underserved populations, especially people of color. The regulators heard presentations from three academic and community advocacy experts (described in further detail below).

The opinions of the expert presenters were closely aligned though they approached the topic from different angles. Reading together the three presentations and the Q&A that followed, there are three primary takeaways. First, increasing access to preventive services increases costs in the short-term but decreases costs in the medium and long-term due to decreased costs arising from emergency clinic, ER, and hospital visits. Second, the biggest barrier to access for preventive care is out-of-pocket expenses such as co-pays and deductibles. Even modest co-pays can substantially reduce adherence to preventive care such as prescription medications. Third, underserved populations such as people of color and rural communities are disproportionately impacted.

Specifically, the three experts discussed:

• Ken Thorpe (Emory University): Dr. Thorpe presented on obstacles to adherence to prescriptions that manage chronic disease and the benefits that accrue when those obstacles are mitigated or removed.
• Colin Reusch (Community Catalyst): Mr. Reusch presented on the benefits of preventive services requirements under the ACA and continuing barriers to preventive care.
• Kara Hinkley (ALS Association): Ms. Hinkley spoke about health equity disparities pertaining to genetic disorders such as amyotrophic lateral sclerosis (“ALS”). She described the impact of diagnostic delays and disparate impact upon people of color, in particular African Americans.

The members of the health workstream and the external experts discussed significant gains arising out of the Affordable Care Act (“ACA”). In particular, Medicaid expansion has narrowed regional disparities in health outcomes and access to care, a concern in light of unwinding in some states. Workstream members raised state law reforms in Colorado ^[1] and Massachusetts ^[2] alongside proposed legislation in California.

The health workstream will continue its work over the summer and fall. Next month it will meet to discuss access to mental health services while in September it will continue the current topic emphasizing policy interventions such as capping the cost of insulin. The Special Committee (EX) on Race & Insurance has separate life and property & casualty workstreams that are working simultaneously on independent tracks.

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^{[1] In Colorado, medical debt cannot be included in credit score calculations.}

^{[2] Massachusetts prohibits cost-sharing for federally-defined preventive services.}