Addressing Health Insurance Literacy Gaps in an Urban African American Population: A Qualitative Study

Ali, Nida; Combs, Ryan; Muvuka, Baraka; Ayangeakaa, Suur D

doi:10.1007/s10900-018-0541-x

Cited by 19 publications

(18 citation statements)

References 17 publications

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“…On the other hand, some traditional health communication channels have received support in African-American samples of varying age groups (Ali, Combs, Muvuka, & Ayangeakaa, 2018;Lariscy, Reber, & Paek, 2010). For instance, along with the internet, television and radio were identified as preferred health communication channels in a sample of African-American youth (Lariscy et al, 2010).…”

Section: Health Literacy Strategiesmentioning

confidence: 99%

“…For instance, along with the internet, television and radio were identified as preferred health communication channels in a sample of African-American youth (Lariscy et al, 2010). Furthermore, a qualitative study by our research team examined health insurance literacy among 87 residents (young, middle-aged, and senior adults) of a predominantly African-American community and found that participants preferred in-person health insurance navigation delivered by culturally competent community health workers who are from or familiar with the community, trustworthy, nonjudgmental, and knowledgeable about health insurance (Ali et al, 2018).…”

Section: Health Literacy Strategiesmentioning

confidence: 99%

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Health Literacy in African-American Communities: Barriers and Strategies

Muvuka¹,

Combs²,

Ayangeakaa³

et al. 2020

HLRP: Health Literacy Research and Practice

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Section: Health Literacy Strategiesmentioning

confidence: 99%

Section: Health Literacy Strategiesmentioning

confidence: 99%

Health Literacy in African-American Communities: Barriers and Strategies

Muvuka¹,

Combs²,

Ayangeakaa³

et al. 2020

HLRP: Health Literacy Research and Practice

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“…Selecting health insurance is a complex task that requires significant cognitive capacity and knowledge of insurance terminology in order to compare plans comprehensively 22 . When faced with challenging decisions, consumers often rely on heuristics and biases that allow them to reduce the number of options they have to compare and to come to a decision more easily.…”

Section: Research Objectivesmentioning

confidence: 99%

When All That Glitters Is Gold: Dominated Plan Choice on Covered California for the 2018 Plan Year

Rasmussen

Anderson

2021

Milbank Quarterly

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Purchasing health insurance is a complex task with multiple potential points of failure. In 2018, following the silver‐loading price shock, 20.2% of households earning above 200% of the federal poverty level with coverage through the two Covered California insurers who sold dominated silver plans purchased the inferior, dominated silver plan. Individuals who were automatically reenrolled were more likely to purchase an inferior, dominated plan. Automatic reenrollment rules and marketplace choice architecture should be modified to avoid placing people into dominated health insurance policies and help consumers more easily select superior coverage for themselves. Context The Affordable Care Act (ACA) individual health insurance marketplaces rely on purchasers to make informed choices to impose price and quality discipline on a complex array of insurance products. A sudden and minimally expected policy shock in the fall of 2017—the termination of direct federal payment for cost‐sharing reduction (CSR) subsidies—led to a substantial change in the relative prices of silver and gold plans on the Covered California insurance marketplace. From 2014 to 2017, all gold plans in California were more expensive than comparable silver plans that were offered by the same insurer using the same network in the same county. For the 2018 plan year, however, some gold plans that had lower cost sharing also had lower premiums than did comparable silver plans, resulting in silver “dominated” plans being sold through Covered California. Methods We used the Covered California enrollment and product files from 2014 to 2018 in a retrospective data analysis of plan choice. We examined individuals earning above 200% of the federal poverty level who purchased plans from insurers who sold dominated silver plans in 2018. Findings We found that 3.9% of all Covered California enrollees in 2018 chose a strictly and transparently dominated plan. Among households with incomes above 200% of the federal poverty level that were enrolled in plans from the two insurers that offered dominated plans, 20.2% chose a dominated plan. Households that actively enrolled in 2018 and were enrolled in a silver plan in the previous year enrolled in a dominated plan at higher rates than did new enrollees and those who were enrolled in nonsilver plans in the previous year. More than 30% of households that had their coverage automatically renewed in 2018 enrolled in a dominated plan. On average, households enrolled in dominated plans in 2018 spent an additional $38.87 per month in premiums. Conclusions Households routinely chose dominated plans and were exposed to both higher monthly premiums and higher potential cost sharing. Health insurance marketplaces should improve decision supports and choice curation to eliminate the possibility of individuals choosing dominated plans.

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“…The aim of this qualitative study is to understand how HIL affects consumers' health care decision-making and access to care. It explores the health insurance experiences of the working-class population of South Louisville, Kentucky, and serves as a comparison to an HIL study conducted in the predominantly African American community of West Louisville, Kentucky ( Ali et al, 2018 ; Muvuka et al, 2020 ).…”

mentioning

confidence: 99%

Health Insurance Literacy Perceptions and the Needs of a Working-Class Community

Kakar¹,

Combs²,

Young³

et al. 2022

HLRP: Health Literacy Research and Practice

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Background: Despite increases in the number of insured Americans, consumers continue to face barriers in accessing care. Low levels of health insurance literacy (HIL) are associated with suboptimal use of health insurance coverage. There remains a need to further contextualize the relationship between HIL and access to care, especially among insured working-class people. Objective This study was conducted to understand the pathways through which HIL affects health care decision-making and access to care in an urban working-class population. Methods: Using a qualitative descriptive approach, we conducted five focus groups with 45 adult residents of South Louisville, Kentucky. The questions explored participants' experiences of insurance enrollment, use, and health care system navigation, as well as their perceptions and needs regarding accessing health insurance information. Using inductive thematic analysis, transcripts were open coded independently by team members, a focused coding framework was agreed upon, and emergent themes were identified through constant comparison techniques. Key Results: Most participants placed high value on their insurance, considering it the most important benefit employers offer. Despite having adequate HIL, most participants expressed frustration with the amount of time and effort they spent to determine the best insurance plan, obtain covered health services, and settle claims, often with ineffective results. Despite having insurance, cost considerations influenced many participants' decisions to accept certain tests or treatments, in some cases resulting in delayed or foregone care. Conclusions: The findings of this qualitative study indicate that obtaining health care is strongly influenced both by the individual context of HIL knowledge, experience, and life circumstances, and by the structural context of the complex, bureaucratic, and costly health care system. Interventions to improve HIL should include practical examples and real-life scenarios, because HIL gained from experiential narratives was the most useful in navigating the health care system. [ HLRP: Health Literacy Research and Practice . 2022;6(2):e61–e69.] Plain Language Summary: By conducting focus groups with a working-class population, this study contextualizes the pathways through which HIL affects consumers' health care decision-making and access to care. Findings demonstrate that obtaining health care is strongly influenced both by the individual context of HIL knowledge, experience, and life circumstances, and by the structural context of the complex, bureaucratic, and costly health care system.

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Addressing Health Insurance Literacy Gaps in an Urban African American Population: A Qualitative Study

Cited by 19 publications

References 17 publications

Health Literacy in African-American Communities: Barriers and Strategies

Health Literacy in African-American Communities: Barriers and Strategies

When All That Glitters Is Gold: Dominated Plan Choice on Covered California for the 2018 Plan Year

Health Insurance Literacy Perceptions and the Needs of a Working-Class Community

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